Dear Doctors: I recently developed very bad psoriasis, but only on my scalp. The itch is awful. I'm not interested in the medications advertised on TV because of the side effects. Can you recommend anything?
Dear Reader: Psoriasis is a chronic inflammatory condition in which a glitch in the immune system causes skin cells to multiply at an abnormally fast pace. This results in raised patches of scaly, reddened skin. Known as plaques, they are often itchy and can be painful.
On light-skinned people, a buildup of dead skin cells makes them appear silvery. In darker skin, plaques have a brown, gray or purplish hue. Although psoriasis can develop anywhere on the body, it occurs most often on the skin of the elbows, torso, knees and scalp. In some people, as in your case, symptoms are confined to the scalp. This results in powdery, scaling skin that often looks like dandruff.
When you say you're not interested in the newer psoriasis treatments, we suspect you're referring to a class of medications known as biologics. They work by calming the part of the immune system involved in the overgrowth of skin cells. Biologics are effective, and because they are targeted, there is a reduced risk of their causing problems to your kidneys, liver or other organs. However, as with any medication, they can cause side effects. These include headache, injection site reactions, upper respiratory infection and urinary tract infection. If you change your mind, your doctor can help you explore this option.
There is a range of other treatments for scalp psoriasis. Topical corticosteroids, such as clobetasol propionate, are effective at managing symptoms, including itching. For scalp psoriasis, they are available in medicated shampoos. These can be safely used regularly for several weeks to ease symptoms. After that, weekly or semi-weekly use is usually adequate for maintenance.
As with all corticosteroids, side effects are possible. These include redness and burning, thinning of the skin, skin dryness and acne. Corticosteroids can interact with certain medications, including aspirin. They should not be used when other medical conditions are present, including diabetes. Anyone using corticosteroids should follow directions carefully.
Additional treatments include salicylic acid, which can soften plaques. Retinoids, used to treat acne, can slow overgrowth and ease inflammation. A topical retinoid cream known as tazarotene is sometimes prescribed for psoriasis. Coal tar, a type of creosote, may also reduce inflammation and slow cell growth. It is available over the counter in many forms, including shampoo. Some people find relief with specialized laser and other light treatments. A dermatologist can explain the available options.
Lifestyle changes are also important. Psoriasis flares and ebbs, and you may find a connection to certain foods, climate or behavior. Don't try to manually reduce plaques or remove psoriasis “dandruff,” as this may increase inflammation. Because scalp psoriasis can occur in tandem with psoriatic arthritis, it would be wise to see a dermatologist for a definitive diagnosis. Depending on your symptoms and medical history, they may refer you to a rheumatologist.
(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)
