Doctor’s Note: Your Essential Guide to Scalp Psoriasis

As dermatologists, we know scalp psoriasis can be tough to deal with. It causes red, scaly patches that often itch, flake, and spread beyond the hairline. Understanding what causes scalp psoriasis and how to manage it can help bring relief and keep your scalp healthier.

Watch the video summary to the right, or read on for more!

What is Scalp Psoriasis?

Scalp psoriasis is a type of psoriasis, an autoimmune condition. It occurs when the immune system sends faulty signals, causing skin cells to grow too quickly. Normally, skin cells renew over weeks, but in psoriasis, they do so in just days. This rapid turnover creates a buildup of skin cells, leading to the thick scales and red patches associated with the condition.

It causes red, raised patches covered with thick, silvery-white scales, primarily on the scalp but sometimes extending to the forehead, back of the neck, and behind the ears. This condition is common, with about half of those with psoriasis experiencing scalp involvement.

50% of people with psoriasis also have scalp psoriasis!

Causes of Scalp Psoriasis

The exact cause of scalp psoriasis is not fully understood, but we know it’s related to the immune system and genetics. Several factors contribute to scalp psoriasis, including:

Genetics: Many people with psoriasis have a family history of the disease. Certain genes make people more likely to develop psoriasis when triggered.
Immune System Response: Scalp psoriasis is considered an autoimmune condition, meaning the immune system mistakenly targets healthy skin cells. In this case, the immune system speeds up skin cell production, resulting in a buildup of cells on the scalp.
Triggers: People with psoriasis may experience flare-ups due to specific triggers. Common triggers include stress, infections, cold weather, certain medications, and even injuries to the skin (a response called the “Koebner phenomenon”).

Photos of Scalp Psoriasis

Photos of scalp psoriasis can help you spot this condition. It often appears as red patches on the scalp with white or silvery scales. These patches can be small or cover large areas, and sometimes they spread to the forehead, neck, or behind the ears. In severe cases, you might also notice hair loss in those areas. While photos can give you an idea of what it looks like, they aren’t enough for a diagnosis. If you think you have scalp psoriasis, it’s best to see a dermatologist for proper advice and treatment.

Symptoms of Scalp Psoriasis

Scalp psoriasis has distinct symptoms that set it apart from other scalp issues. Key symptoms include:

Red, Raised Patches: These patches are often inflamed and can be painful. They are typically covered with thick, silvery-white scales.
Itching and Burning: Many people experience itching, which can range from mild to severe. In some cases, it may feel like a burning sensation.
Flaking: The scales can flake off, especially when scratched, leading to noticeable flakes in the hair and on clothing.
Dryness: The affected areas of the scalp may feel dry and tight.
Bleeding: Scratching or picking at the scales can lead to small cuts and bleeding.
Temporary Hair Loss: Although scalp psoriasis doesn’t directly cause hair loss, repeated scratching and picking can lead to temporary hair loss. Once the condition is under control, hair usually grows back.

Scalp Psoriasis Tips

Proper Shampoo Usage: Always follow the directions for psoriasis treatments, including shampoos. Even effective products can cause side effects like irritation, itching, and redness if not used correctly. Sticking to the instructions can help prevent worsening symptoms.

Psoriasis Shampoos Are for the Scalp, Not the Hair: Medicated shampoos are designed to treat the scalp, not the hair. For best results, part your hair into sections and apply the shampoo directly to the roots. This allows the active ingredients to target the affected areas without overexposing your hair to the medication.

Moisturizing Hair: After using medicated shampoos, apply a moisturizing conditioner. This helps reduce dryness and irritation while nourishing both your scalp and hair. Balancing treatment with moisture can help manage psoriasis and keep your hair looking good.

Scalp Psoriasis Treatment

There isn’t a cure for scalp psoriasis, but treatments can help you manage symptoms and reduce flare-ups. The main goal of treating scalp psoriasis is to keep it under control by following two important steps: removing flakes and reducing inflammation:

Step 1: Remove Flakes

One of the most visible parts of scalp psoriasis is the thick, scaly flakes on the scalp. Removing these flakes can make your scalp feel better and help other treatments work more effectively. To remove flakes, try:

Medicated Shampoos: Look for shampoos with ingredients like salicylic acid or coal tar. These shampoos can be found at most drugstores and are often labeled for psoriasis or dandruff.
Scalp Oil: Applying an oil, like coconut oil or mineral oil, before shampooing can help loosen and soften scales. Gently massage the oil onto the scalp and let it sit for 10-15 minutes. This can make the flakes easier to remove. Be sure to wash thoroughly afterward to avoid leaving oil on the scalp.
Gentle Brushing or Combing: After applying a medicated shampoo, using a soft brush or comb can help loosen and remove scales. This can be especially helpful right after washing your hair, when the scales are softer and easier to remove. Be gentle to avoid irritating the scalp.

Step 2: Reduce Inflammation

Reducing inflammation is important to relieve the itchiness, redness, and swelling that often come with scalp psoriasis. Controlling inflammation can help keep flare-ups from getting worse. To reduce inflammation, try:

Hydrocortisone Creams: Hydrocortisone is a mild corticosteroid available over the counter. It can be applied to the scalp to reduce redness and swelling. However, be careful not to overuse it. Hydrocortisone should be used only as directed on the label or by a healthcare provider.
Anti-Dandruff Shampoos: Shampoos containing zinc pyrithione, ketoconazole, or selenium sulfide can help with both flakes and inflammation. Zinc pyrithione has anti-fungal and anti-inflammatory properties that help reduce itching, redness, and irritation on the scalp. These shampoos are often available in regular and stronger formulas.
Prescription Treatments: If over-the-counter treatments aren’t helping, a dermatologist can prescribe stronger medications, such as topical corticosteroids or vitamin D analogs, which work directly on the immune system to reduce inflammation. Light therapy (UVB) may also be recommended for more stubborn cases.

First, let’s look at shampoos that remove flakes:

Salicylic Acid Shampoo

Salicylic acid shampoo is a popular choice for treating scalp psoriasis because it helps soften and remove thick flakes. Salicylic acid works by breaking down the dead skin cells on the scalp, making it easier to wash away the scales that come with psoriasis. This shampoo can reduce flaking and itching, making your scalp feel more comfortable. To use it, apply the shampoo to wet hair, gently massage it into your scalp, and let it sit for about 5 minutes before rinsing. Regular use can help keep flakes under control and make other scalp treatments work better.

Nizoral Psoriasis Shampoo

Active Ingredient: 3% salicylic acid
Usage: Use twice a week. Leave on for several minutes.
Note: Highest % salicylic acid.

MG217 Psoriasis 3% Salicylic Acid Shampoo

MG217 Psoriasis Shampoo

Active Ingredient: 3% salicylic acid
Usage: Use twice a week. Leave on for several minutes.
Note: Highest % salicylic acid.

Neutrogena T/Sal

Active Ingredient: 3% salicylic acid
Usage: Use twice a week. Leave on for several minutes.
Note: Neutrogena has two popular shampoos: T-Sal (with salicylic acid) and T-Gel (with coal tar).

Dermarest Psoriasis Medicated Shampoo and Conditioner

Dermarest Psoriasis Shampoo

Active Ingredient: 3% salicylic acid
Usage: Use twice a week. Leave on for several minutes.
Note: Highest % salicylic acid.

Next, let’s look at shampoos that reduce itching and inflammation:

Best Shampoo for Itchy Scalp

Shampoos with zinc, selenium, or ketoconazole are great for treating an itchy scalp. These ingredients help reduce itching, flaking, and irritation by targeting yeast and reducing inflammation on the scalp. Zinc pyrithione helps calm the skin and reduces itching and redness, making it ideal for milder cases. Selenium sulfide also fights yeast and slows skin cell turnover, which can reduce flakiness. Ketoconazole is a strong antifungal ingredient that works well for more stubborn scalp issues. To use, apply the shampoo, gently massage it into the scalp, and let it sit for about 5 minutes before rinsing. Regular use can help keep your scalp itch-free and healthy.

Head & Shoulders Classic Clean Dandruff Shampoo.jpg

Head and Shoulders Dandruff Shampoo

Main Ingredient: Zinc Pyrithione
Reduces: Flakes, irritation
Notes: Suitable for sensitive scalps; gentle for regular use

Nizoral Anti-Dandruff Shampoo

Main Ingredient: 1% Ketoconazole
Reduces: Severe flakes, fungal growth
Use: 1-2 times weekly
Notes: Stronger prescription option available (2% ketoconazole)

Selsun Blue Medicated Anti-dandruff Shampoo

Selsun Blue Dandruff Shampoo

Main Ingredient: 1% Selenium Sulfide
Reduces: Flakes, scalp oil
Use: 2-3 times weekly
Notes: Effective for oily dandruff

Head & Shoulders Clinical Dandruff Shampoo

Head and Shoulders Dandruff Shampoo

Main Ingredient: 1% Selenium Sulfide
Reduces: Flakes, scalp oil
Use: 2-3 times weekly
Notes: Effective for oily dandruff

Dove Dandruff Shampoo

Main Ingredient: Zinc Pyrithione
Reduces: Flakes, irritation
Notes: Suitable for sensitive scalps; gentle for regular use

Scalpicin Max Strength Scalp Itch Treatment

Scalpicin Itch Treatment

Main Ingredient: 1% Hydrocortisone
Note: Topical steroid. Do not overuse. Much stronger steroids are available by prescription (clobetasol, betamethasone, fluocinonide, etc.)

Nizoral Scalp Itch Relief

Main Ingredient: 1% Hydrocortisone
Note: Topical steroid. Do not overuse. Much stronger steroids are available by prescription (clobetasol, betamethasone, fluocinonide, etc.)

Biolage Dandruff Shampoo

Main Ingredient: Zinc Pyrithione
Reduces: Flakes, irritation
Notes: Suitable for sensitive scalps; gentle for regular use

Next, let’s look at shampoos that do both:

Coal Tar Shampoo

Coal tar shampoo is a common treatment for scalp conditions like psoriasis and seborrheic dermatitis. Coal tar helps slow down the rapid growth of skin cells, which can reduce the thick, scaly patches and flakes on the scalp. It also helps relieve itching and redness, making the scalp feel more comfortable. To use coal tar shampoo, apply it to your wet scalp, gently massage it in, and leave it on for about 5 minutes before rinsing. This shampoo may have a strong smell, but regular use can make a big difference in keeping scalp symptoms under control.

Neutrogena T/Gel Therapeutic Shampoo

Main Ingredient: 0.5% Coal Tar
Reduces: Flakes, skin cell growth
Notes: Strong smell; can be messy

Denorex Therapeutic Dandruff Shampoo

Main Ingredient: 0.5% Coal Tar
Reduces: Flakes, skin cell growth
Notes: Strong smell; can be messy

Tarsum Extra Strength Psoriasis Shampoo

Main Ingredient: 2% Coal Tar
Reduces: Flakes, skin cell growth
Notes: Strong smell; can be messy

DHS Coal Tar Shampoo

Main Ingredient: 0.5% Coal Tar
Reduces: Flakes, skin cell growth
Notes: Strong smell; can be messy

Best Prescriptions for Scalp Psoriasis

Sometimes, over-the-counter creams and lotions aren't enough to manage psoriasis. When this happens, doctors may prescribe stronger medicines that require a prescription. These prescription topicals are more powerful and can help control symptoms more effectively. If over-the-counter treatments aren't working, it's important to talk to your doctor about other options. Common prescription treatments for psoriasis include:

Topical steroids help reduce inflammation and itching and come in different strengths. However, using them for a long time can thin the skin, so they are typically used for shorter periods. Examples include clobetasol, betamethasone, fluocinonide, and Bettamousse.

Vitamin D treatments help slow down skin cell growth and are often combined with topical steroids for better results. They have few side effects. Common examples include calcipotriene and Sorilux.

Sotyktu is a daily pill used when topical treatments aren't an option. It has few side effects but does require regular monitoring.

Prednisone, an oral steroid, is sometimes used for severe flares of psoriasis. It’s meant for short-term use only, as symptoms can worsen once you stop taking it. Because of this risk, it’s not the preferred treatment option.

Biologics are injections that you can give yourself at home to reduce skin inflammation. While they’re convenient, they do require regular monitoring and can have side effects that affect the whole body. Common examples include Humira, Stelara, Cosentyx, and Skyrizi.

Otezla is a pill taken twice a day to reduce inflammation. A common side effect is diarrhea. In general, Otezla isn’t as effective as biologics for treating psoriasis.

Best Procedures for Scalp Psoriasis

Sometimes, even prescription treatments aren’t enough to control psoriasis. In these cases, doctors might suggest phototherapy, a more advanced option. Phototherapy uses controlled amounts of ultraviolet (UV) light to reduce inflammation and slow down skin cell growth. It’s usually done in a clinic but can also be done at home with special devices. If creams or pills aren’t working, talking to your doctor about phototherapy could help. Common types of phototherapy for psoriasis include:

You can buy over-the-counter phototherapy devices online. They're usually used a few times a week on problem areas and can help treat mild to moderate psoriasis.

Office phototherapy uses UVB light to reduce inflammation and itching. It works well for moderate to severe psoriasis and can be done in a clinic or at home with a special unit.

Home phototherapy is a prescription treatment that lets you use a device like the one in a clinic, but at home. Check your insurance coverage under "Durable Medical Equipment (DME)." The most popular companies providing these devices are National Biologic + SolRx.

If these products aren’t helping your scalp, it might not be scalp psoriasis. Here are some other common scalp issues to consider:

Scalp Psoriasis vs Dandruff

Scalp psoriasis and dandruff can look alike, but they have key differences. Dandruff causes loose, white or yellow flakes and mild itching, but it doesn’t usually cause redness or thick patches. Scalp psoriasis, on the other hand, creates red, inflamed patches covered with thick, silvery-white scales that can be larger and tougher to remove. Psoriasis patches may also spread beyond the scalp to areas like the forehead, back of the neck, or behind the ears. While dandruff can often be managed with regular anti-dandruff shampoo, scalp psoriasis typically requires medicated treatments to reduce scaling and inflammation.

Dandruff

Cause: Yeast
Itch: Mild to moderate
Flakes: Large, white to yellow, with “hair holes”
Context Clues: Look for flakes with “hair holes,” which dry scalp flakes don’t have.
Treatment: Antifungal shampoo.

Scalp Psoriasis

Cause: Overactive immune system in scalp.
Itch: Moderate to severe +/- burning or soreness
Flakes: Thick, silvery-white scales + red, raised skin
Context Clues: Often extends beyond the hairline onto the forehead, back of the neck, or behind the ears.
Treatment: Medicated shampoos, topical steroids, and other prescription treatments.

Scalp Psoriasis vs Dry Scalp

Scalp psoriasis and dry scalp can look similar, but they’re different conditions. Dry scalp is usually caused by a lack of moisture, which leads to small, white flakes and mild itching. Scalp psoriasis, however, is an autoimmune condition that causes thick, red patches with silvery-white scales. These scales are often larger and can spread beyond the scalp to areas like the forehead and behind the ears. While dry scalp can often be treated with a good moisturizer or gentle shampoo, scalp psoriasis usually needs special medicated treatments.

Dry Scalp

Cause: Lack of moisture
Itch: Mild
Flakes: Small, white
Context Clues: Cold weather, dry air, harsh shampoos, eczema
Treatment: Scalp moisturizers, gentle shampoo, avoid harsh chemicals.

Scalp Psoriasis

Cause: Overactive immune system in scalp.
Itch: Moderate to severe +/- burning or soreness.
Flakes: Thick, silvery-white scales + red, raised skin
Context Clues: Often extends beyond the hairline onto the forehead, back of the neck, or behind the ears.
Treatment: Medicated shampoos, topical steroids, and other prescription treatments.

Scalp Psoriasis FAQs

Is olive oil good for psoriasis on the scalp?
Yes, olive oil can be beneficial for scalp psoriasis. Its moisturizing properties help soften scales and reduce dryness. Applying warm olive oil directly to the affected area can loosen scales, making it easier to remove them. It can also help soothe itching and inflammation.

Can scalp psoriasis cause headaches?
While scalp psoriasis itself doesn’t directly cause headaches, the associated discomfort, tightness, or inflammation can sometimes lead to tension or stress-related headaches. Additionally, severe itching or the presence of thick plaques may contribute to scalp tenderness, which could be perceived as headache-like pain.

Does castor oil help scalp psoriasis?
Castor oil may help with scalp psoriasis due to its thick, emollient nature. It can moisturize the skin and potentially reduce scaling and dryness. Some people find it soothing, but results can vary. Combining castor oil with other treatments may enhance its effectiveness.

Is short hair better for scalp psoriasis?
Short hair can be more manageable for those with scalp psoriasis. It makes it easier to apply treatments and reduces the risk of buildup from products. Additionally, short hair allows the scalp to breathe and may minimize irritation caused by long hair rubbing against affected areas.

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