DermatologyAdmin / January 01, 2025

Unravelling Scalp Psoriasis: Causes, Symptoms, Diagnosis and Treatment Options

Understanding Scalp Psoriasis: Causes, Symptoms, and Treatment

Scalp psoriasis is a chronic autoimmune condition that primarily affects the scalp, causing raised, reddish, and often scaly patches. It occurs when the immune system mistakenly attacks healthy skin cells, causing them to grow and build up rapidly on the skin's surface. This results in thick, silvery scales and red patches that can be itchy, sore, and sometimes lead to temporary hair loss. While scalp psoriasis can occur in isolation, it often occurs alongside psoriasis on other areas of the body, and its severity can vary significantly.

Who Does Scalp Psoriasis Affect?

Scalp psoriasis can affect individuals of any age, gender, or ethnicity, although it is more commonly diagnosed in adults. It can also affect children and adolescents. There is a genetic predisposition to the condition, meaning it tends to run in families. Those with a family history of psoriasis or other autoimmune diseases are at a higher risk. Individuals who already have psoriasis on other body parts are more likely to experience it on their scalp as well.

How Common is Scalp Psoriasis?

Scalp psoriasis is quite common, with approximately 2-3% of the global population affected by psoriasis. Among those with psoriasis, an estimated 50-80% will experience scalp involvement. Despite its prevalence, many individuals may not recognize the symptoms of scalp psoriasis, mistaking them for other scalp conditions like dandruff or seborrheic dermatitis. Proper diagnosis and awareness are key for effective management.

What Causes Scalp Psoriasis?

Scalp psoriasis, like other forms of psoriasis, results from a combination of genetic, environmental, and lifestyle factors. The primary causes include:

1. Immune System Dysfunction: Psoriasis is an autoimmune condition where the immune system attacks healthy skin cells, causing them to proliferate rapidly. This leads to thick, scaly patches on the skin.

2. Environmental Triggers: Certain environmental factors can trigger or exacerbate scalp psoriasis:

   • Stress: Psychological stress can worsen psoriasis by increasing inflammation.
   • Infections: Infections, especially streptococcal throat infections, can provoke flare-ups.
   • Weather: Cold, dry weather can exacerbate the symptoms of psoriasis.
   • Skin Injury: Any trauma to the scalp, such as cuts, burns, or even severe sunburn, can trigger flare-ups due to a phenomenon known as the Koebner response.

3. Lifestyle Factors:

   • Smoking: Smoking is linked to an increased risk of developing psoriasis and can worsen its severity.
   • Alcohol Consumption: Excessive alcohol intake can trigger or exacerbate psoriasis.

4. Certain Medications: Some medications can trigger or worsen psoriasis, including beta-blockers, lithium, antimalarials, and NSAIDs.

5. Genetics: A genetic component is evident, with certain genes associated with the immune system increasing the likelihood of developing psoriasis. A family history of psoriasis or autoimmune diseases can increase one’s risk.

6. Hormonal Changes: Fluctuations in hormones, particularly during puberty, pregnancy, and menopause, can trigger or worsen psoriasis flare-ups.

Symptoms of Scalp Psoriasis

Scalp psoriasis presents in various forms, ranging from mild to severe. The key symptoms include:

1. Red or Purple Bumpy Patches: These patches are raised and can vary in color depending on skin tone.
2. Silvery or Grey Scales: The patches are typically covered with thick scales, a result of rapid skin cell turnover.
3. Dandruff-like Flaking: Excessive flaking resembling dandruff is common, often more extensive than typical dandruff.
4. Dry Scalp: The affected areas can become very dry, leading to discomfort.
5. Itching: Intense itching is one of the most common symptoms and can lead to scratching, which exacerbates the condition.
6. Burning Sensation: Some individuals may experience a burning or stinging feeling on the scalp.
7. Soreness: The affected areas can be sore and tender, especially if scratched or if scales are removed forcefully.
8. Hair Loss: While scalp psoriasis itself does not cause permanent hair loss, excessive scratching and inflammation can lead to temporary hair loss.

Triggers for Scalp Psoriasis Flare-ups

Flare-ups of scalp psoriasis can be triggered by several factors:

1. Stress: Psychological stress can exacerbate psoriasis symptoms by provoking immune system responses.
2. Infections: Infections, particularly throat infections, can worsen the condition.
3. Weather: Both cold and dry weather and hot, humid weather can worsen symptoms.
4. Skin Injuries: Cuts, sunburns, or even tattoos can trigger flare-ups, due to the Koebner response.
5. Medications: Certain medications like beta-blockers, NSAIDs, and lithium can worsen psoriasis.
6. Alcohol and Smoking: Both alcohol consumption and smoking are associated with increased severity of psoriasis flare-ups.
7. Hormonal Changes: Hormonal fluctuations can influence the severity of symptoms.
8. Diet: Although not a direct cause, certain foods may exacerbate psoriasis symptoms in some individuals. These include spicy foods, dairy, and red meat.

Diagnosis of Scalp Psoriasis

The diagnosis of scalp psoriasis typically involves:

1. Medical History and Physical Examination: A thorough medical history and physical examination of the scalp and other affected areas help identify psoriasis-related signs such as red patches and scales.
2. Dermatoscopy: A handheld device that magnifies the skin for a closer examination, helping distinguish psoriasis from other conditions.
3. Biopsy: In some cases, a biopsy may be performed to confirm the diagnosis. This involves taking a small skin sample for microscopic examination.
4. Blood Tests: While not typically used for diagnosing scalp psoriasis, blood tests may help rule out other conditions and check for related health issues, such as psoriatic arthritis.

Treatment for Scalp Psoriasis

Treatment for scalp psoriasis depends on the severity of the condition and may involve:

1. Topical Treatments:

   • Corticosteroids: Anti-inflammatory creams or foams that reduce inflammation and relieve itching.
   • Vitamin D Analogues: These slow skin cell growth and are often used in combination with other treatments.
   • Coal Tar: A natural substance that reduces scaling and itching.
   • Salicylic Acid: Used to soften and remove scales.
   • Topical Retinoids: Vitamin A derivatives that help normalize skin cell production.

2. Prescription Treatments:

   • Calcineurin Inhibitors: These medications reduce inflammation and plaque buildup.
   • Anthralin: Helps normalize skin cell activity and has anti-inflammatory effects.

3. Phototherapy:

   • UVB Light Therapy: Exposure to ultraviolet B light helps slow skin cell growth.
   • PUVA Therapy: Involves taking a medication that increases sensitivity to light, followed by exposure to UVA light.
   • Excimer Laser: Targets small, localized areas of psoriasis with UVB light.

4. Systemic Treatments:

   • Oral Medications: Such as methotrexate, cyclosporine, and acitretin, reduce immune system activity.
   • Biologics: Advanced medications like adalimumab, etanercept, and ustekinumab are injected or infused to target specific immune system components.

Complications of Scalp Psoriasis

If left untreated, scalp psoriasis can lead to several complications:

1. Psoriatic Arthritis: Up to 30% of those with psoriasis develop joint pain and stiffness.
2. Crohn’s Disease: Psoriasis is linked to an increased risk of inflammatory bowel diseases.
3. Uveitis: Inflammation of the eye that can lead to vision problems if untreated.
4. Depression: The visible symptoms of psoriasis and its chronic nature can lead to emotional distress.
5. Cardiovascular Disease: Chronic inflammation in psoriasis increases the risk of heart disease.
6. Metabolic Syndrome: Conditions like obesity and insulin resistance are more common in individuals with psoriasis.

Dietary Recommendations for Managing Scalp Psoriasis

Diet can also play a role in managing psoriasis:

1. Fatty Fish: Rich in omega-3 fatty acids, fish like salmon, mackerel, and sardines can help reduce inflammation.
2. Leafy Greens: Vegetables like spinach and kale are high in antioxidants and anti-inflammatory compounds.
3. Olive Oil: Contains healthy fats and antioxidants beneficial for skin health.
4. Avoid Alcohol and Limit Dairy: Alcohol can trigger flare-ups, and some people find dairy exacerbates symptoms.
5. Monitor Citrus and Gluten: Some individuals report flare-ups with citrus fruits and gluten. Avoiding these can help improve symptoms for some people.

By understanding the causes, recognizing triggers, and adopting proper treatments and lifestyle adjustments, individuals with scalp psoriasis can better manage the condition and improve their quality of life.