In fact, between 45 and 56 percent of all people with plaque psoriasis develop it on the scalp, according to the National Psoriasis Foundation (NPF). Interestingly, “there are also people who only have scalp psoriasis,” says Jerry Bagel, MD, a dermatologist in East Windsor, New Jersey, and a member of the National Psoriasis Foundation board. Scalp psoriasis can run the gamut from mild — with thin scales or plaques that are hardly discernible — to severe, with plaques and scales that cover the scalp, forehead, back of the neck, and the skin around the ears. Besides eliciting stares, scalp psoriasis can be extremely itchy, as well as challenging to treat, since hair is apt to get in the way, according to Dr. Bagel. Chances are that your doctor will have you try topical treatments for scalp psoriasis first, like salicylic acid. You can also find scalp psoriasis shampoos, gels, oils, lotions, creams, and foams at your local drugstore, including over-the-counter and prescription-strength brands. The tips below will help you get the most out of whatever treatment you are using and clue you in to a few strategies you may not have tried yet.
2. Try a Parting of the Ways
When applying a product, part your hair to expose your scalp so you can target plaques directly, says Fran Klapow, a hairstylist from Long Island, New York, who has scalp psoriasis. Repeat this sectioning piece by piece so you can treat your scalp without getting the gooey stuff all over your hair. RELATED: 9 Things You Only Understand if You Have Psoriasis
3. Follow the 5-Minute Rule for Shampooing
Before you rinse, let the lather sit for five. “If you carefully lather your hair without touching your scalp, it won’t end up smelling like medicine,” Klapow says. As far as topical treatments, these are meant to stay on longer — for 12 hours or more before shampooing. (Check the label and ask your doctor for specifics.) RELATED: What to Do if Topical Treatments Aren’t Enough for Your Psoriasis
4. Don’t Scratch That Itch
Refrain from rubbing or scrubbing your scalp when shampooing, as tempting as it may be to dig into those itchy spots. “Scratching induces trauma which in turn induces psoriasis, a process known as Koebnerization,” Bagel explains. If you’re finding it hard not to scratch, try applying a dab of hydrocortisone, a mild corticosteroid, to itchy spots, to help decrease itching and inflammation, the NPF says. Start with the least powerful topical steroid that works for you, and use it just three to four times a week. (If you overuse steroids, your scalp psoriasis could get worse instead of better.)
5. Avoid Products With Mint
“Minty shampoos and conditioners can irritate plaques,” Bagel says. A good rule of thumb for shampooing when you have scalp psoriasis? The fewer ingredients on the label, the better.
6. Look for Coal Tar
Coal tar is often listed as the active ingredient in shampoos for people with scalp psoriasis. It works by slowing the growth of new skin cells and helping shed dead skin cells, the NPF says.
7. Try the Mediterranean Diet — for Your Hair
Like the beneficial Mediterranean diet, this tip relies on olive oil. Apply it to your scalp and keep your head under wraps overnight, Bagel advises. In the morning, apply Neutrogena T/Sal shampoo to any plaques, wait 10 minutes, then wash out. (You may want to follow up with another round of shampooing.)
8. Avoid Alcohol
Wine, beer, and spirits may exacerbate psoriasis, Bagel says. Psoriasis is an inflammatory disease, and according to a study published online in August 2019 in Psoriasis, alcohol seems to cause and aggravate inflammation.
9. Cover Your Ears
To avoid irritating your ears with chemicals, apply petroleum jelly to two cotton balls and gently place one in each ear before using a medicated shampoo or other treatments.
10. Taper Off Gradually
It can take eight weeks or more for scalp treatments to have an effect, Bagel says, so don’t bail out too soon. No matter what, it’s important to not stop a treatment abruptly, even if your scalp psoriasis clears up. Continue to use a tar or medicated shampoo once or twice a week to maintain the results.
11. Get Yourself Conditioned
If you have scalp psoriasis, itching can be a real problem, and itching is caused by a dry scalp. To keep things lubricated, look for over-the-counter products designed to ease that itch. Klapow recommends using conditioner every time you shampoo to keep your scalp moisturized (and your hair looking glossy).
12. Don’t Blow It
Hot air from a blow dryer can worsen dryness and itching, so let your hair air dry, Klapow recommends. If you must use a blow dryer, keep it on the lowest setting.
13. Talk With Your Doc
If you still need relief, ask your dermatologist about new treatment options, including biological agents, says Bagel. A study published in June 2020 in the Journal of Dermatological Treatment found that patients with moderate to severe scalp psoriasis saw improvement within two weeks when given biologics and small-molecule drugs. RELATED: 10 Signs It’s Time to Call Your Dermatologist About Psoriasis
