Treatment of Scalp Psoriasis
Topical therapy includes corticosteroids, calcipotriol/calcipotriene, tazarotene, tars, and anthralin. Tars and anthralin are discussed above. If the psoriasis lesions are thick, measures must be taken to thin down the plaques. Since creams and ointments are difficult to apply to the scalp and wash out of the hair, they are rarely used to treat scalp psoriasis. Lotions, solutions, and gels are more commonly used since they are easier to apply, do not leave a greasy appearance to the hair, and are easier to wash out.
Topical corticosteroid gels, lotions, solutions, oils, foams, sprays and shampoos may be used to treat scalp psoriasis. They work quite quickly, often within 1-2 weeks. However, with long-term use, steroids often lose their effectiveness.
Examples of topical steroid preparations
Corticosteroid - oil combination
- Valisone® lotion
- Cyclocort® lotion
- Clobex® lotion, spray, shampoo
- Betamethasone and clobetasole mousse
Calcipotriol/calcipotriene is a derivative of vitamin D. The scalp solution may be easily applied to the scalp, the onset of action is usually slower (could take up to 2 months) than with topical steroids, but it is usually effective and safe for long term use. Since it may cause irritation, you should take care to limit application to your scalp and avoid use on your face.
Example of topical calcipotriol/calcipotriene scalp solution:
Example of combination vitamin D + corticosteroid topical suspension:
- Calcipitriol scalp solution (Dovonex®)
- Calcipotriol/calcipotriene + betamethasone dipropionate (Xamiol®, Taclonex Scalp®)
Tazarotene is a selective retinoid with properties that are similar to vitamin A. The gel formulation is generally applied once daily overnight to the scalp patches, it can be easily worked into your scalp. Scalp irritation may occur with this product, but less commonly than elsewhere. To minimize irritation, apply a thin layer of the medication only to the patches and avoid the uninvolved surrounding skin. You should not use this medication if you are pregnant.
Most of the time oral medications are not required to treat scalp psoraisis, but if you have a very resistant case or if the itching is uncontrollable, they may be used.
Methotrexate is usually given once a week orally (pills) or occasionally by injection (with a needle). It helps control psoriasis affecting your skin, nails, and joints. Potential side-effects include upset stomach, mouth ulcers, suppression of the bone marrow with low blood counts, and liver damage. Careful monitoring by your physician is essential while you are taking this medication. Liver biopsies may be required.
Acitretin is a retinoid with properties similar to vitamin A. For most patients, it does not appear to be as effective as methotrexate or cyclosporine in the treatment of plaque psoriasis. However, it works quite well for pustular psoriasis. Side-effects include dryness of the skin, lips, eyes, and nose, elevation of your cholesterol and triglyceride levels, liver toxicity, and bone changes. Since it may cause birth defects, it is used mainly in men, and women who are post-menopausal or have had a hysterectomy. Monitoring by your doctor and regular blood tests are required while taking this medication.
Cyclosporine is an immunosuppressant medication that is commonly used in organ transplantation. It is very effective for psoriasis, but because of its cost and side-effects (kidney toxicity, high blood pressure, numbness and tingling, hair growth, skin cancer, and lymphomas), cyclosporine is usually reserved for people with severe, disabling, resistant disease. Careful monitoring by your doctor is required while taking this medication.