Psoriasis is a common, chronic inflammatory skin condition. It affects an estimated 2-3 percent of the global population, about 125 million people worldwide.
Psoriasis is a common, chronic inflammatory skin condition. It affects an estimated 2-3 percent of the global population, about 125 million people worldwide. In the United States, over 7.5 million adults live with psoriasis.
The condition typically appears as red, scaly patches.
Symptoms also often include:
Skin irritation
Itchiness
Skin flaking
Symptoms can show up anywhere on the body, including on the scalp (AKA scalp psoriasis).
Studies suggest that anywhere from 50-80 percent of people with psoriasis experience scalp symptoms at some point.
Psoriasis of the scalp is a chronic immune-mediated skin condition that causes red, scaly patches to develop on the scalp.
Scalp psoriasis can range in severity, from light scaling to thick, crusted plaques (raised, inflamed areas of skin covered with silvery-white scales). In severe cases, these plaques can cover the entire scalp and may extend beyond the hairline to the forehead, neck, and ears.
Psoriasis of the scalp can occur on its own or alongside psoriasis affecting other areas of the body, such as the knees, elbows, hands, feet, and lower back
Scalp psoriasis isn’t contagious but it can significantly impact your quality of life.
It can be uncomfortable, it can mess with your confidence, and can even cause significant emotional distress.
Symptoms often come and go, with periods of flare-ups and periods of improvement or remission.
Common signs of scalp psoriasis include:
Red or discolored patches. Inflamed plaques that may appear red on lighter skin and purple or brown on darker toned skin. These may be covered by thick, silvery-white scales.
Flaking. The scales on the psoriatic plaques can flake off and may look like dandruff.
Itching. You might also experience mild to severe itching. Scratching may worsen the irritation and inflammation.
Dry scalp. Your scalp may feel tight and dry.
Bleeding. Scratching or picking at plaques can lead to bleeding and increased irritation.
Burning or pain. Psoriasis often causes discomfort including some areas that might feel sore or like they’re burning.
Temporary hair loss. Scalp psoriasis itself doesn’t cause permanent hair loss, but excessive scratching, inflammation, and plaque build up can lead to temporary shedding.
Scalp psoriasis can be tough to deal with, especially since it’s so visible. It’s not uncommon for it to also cause anxiety or self-consciousness, sometimes even leading to depression.
Mild cases of scalp psoriasis can look like dandruff, but the flakes and scalp condition differ:
Flake texture. Dandruff flakes are usually loose, white, or yellowish, while psoriasis flakes tend to be dry, silvery, and may stick to the scalp.
Scalp condition. With dandruff, you’re more likely to experience an oily, scalp and greasy hair. Dry scalp is more likely with psoriasis.
Psoriasis happens when an overactive immune system speeds up skin cell production. This causes a buildup of scales and inflammation.
A mix of genetic factors, immune system dysfunction, and certain environmental influences can trigger an immune response that leads to inflammation, rapid skin cell production, and scaling.
Genetics. Psoriasis often runs in families. Researchers have identified multiple genes that may play a role in psoriasis.
Immune system dysfunction. An overactive immune system mistakenly attacks healthy skin triggering inflammation that results in redness, irritation, and discomfort. This immune response also causes skin cells to multiply much faster than typical, but instead of shedding at the usual rate, the excess cells accumulate on the surface. This buildup leads to scaling and plaque formation.
Environmental influences. While genetics and immune dysfunction are the main drivers of psoriasis, including scalp psoriasis, certain risk factors can make you more likely to develop psoriasis.
Scalp psoriasis can appear on its own or alongside psoriasis elsewhere on the body. While it can affect anyone, it’s most common in adults.
Several factors can increase your risk of developing scalp psoriasis, including:
Family history. Psoriasis often runs in families. If a close relative has it, your risk is higher.
Age. Psoriasis can develop at any age, but it most commonly starts in early adulthood (between ages 20 and 30) or later in life (between ages 50 and 60)
Stress. High stress levels can disrupt the immune system and potentially trigger symptoms.
Infections. Illnesses like strep throat or HIV can trigger psoriasis, especially if you’re genetically predisposed.
Skin injuries and friction. Scratching, sunburn, cuts, or prolonged friction from hats and helmets can trigger or worsen psoriasis.
Medications. Certain drugs, like beta-blockers, lithium, and anti-malarials may trigger psoriasis or worsen symptoms.
Smoking and alcohol consumption. There’s a link between smoking and alcohol consumption and an increased risk of psoriasis.
Obesity. The inflammation associated with excess body weight may worsen psoriasis symptoms.
A healthcare professional, like a dermatologist can usually diagnose psoriasis by looking at your scalp, skin, and nails. If the diagnosis is unclear, they may also perform additional tests to rule out other conditions.
Getting an accurate diagnosis is the first step toward effective treatment. Here’s how dermatologists typically diagnose scalp psoriasis:
Medical history. Your doctor may ask about your personal or family history of psoriasis or other autoimmune conditions. They will also want to know when your symptoms started, how they’ve changed over time, and whether anything seems to trigger or worsen them (such as stress or illness).
Physical examination. Your doctor will examine your scalp, skin, and nails for signs of psoriasis.
Scalp biopsy (if needed). If the diagnosis is unclear, they may take a small skin sample and examine it under a microscope to rule out skin conditions like seborrheic dermatitis or fungal infections (tinea capitis).
Unfortunately, there’s no known cure for psoriasis. But effective treatments can help control symptoms and reduce flare-ups.
Several treatments can help you manage scalp psoriasis symptoms, reduce inflammation, and prevent flare-ups.
These directly target the scalp and are usually the first choice for mild to moderate scalp psoriasis:
Topical corticosteroids are often an effective short-term option for scalp psoriasis. These anti-inflammatory medications can help reduce redness and scaling.
They’re available in lotions, foams, gels, shampoos, and solutions designed for use on the scalp.
Long-term use can cause skin thinning, irritation, and withdrawal effects, so you should always use them as directed by a doctor.
Vitamin D analogs like calcipotriene and calcitriol help slow rapid skin cell production.
Your provider might recommend combining vitamin D analogs with corticosteroids for greater effectiveness.
Your provider may recommend using keratolytics, like salicylic acid and coal tar, alongside corticosteroids or vitamin D analogs.
Salicylic acid softens and removes thick scales, making other topical treatments more effective. Coal tar shampoos and creams help reduce scaling, redness, and itching. Both are available over the counter. Higher potency coal tar products are available with a prescription.
Combination therapy, which involves using two or more treatments together, is often the most effective approach for treating scalp psoriasis Common combinations include:
Corticosteroids + Vitamin D Analogs (proven to work better together)
Keratolytics + Other Topicals (helps improve absorption and effectiveness)
If topical treatments aren’t effective, your doctor may recommend corticosteroid injections directly into the thick psoriasis plaques.
If scalp psoriasis is severe or part of widespread psoriasis, your doctor may prescribe systemic medications (treatments that work throughout the body rather than just on the skin). These target the underlying immune system dysfunction that drives psoriasis.
These include:
Biologic therapies (injectible treatments targeting the immune system):
Adalimumab (Humira)
Secukinumab (Cosentyx)
Etanercept (Enbrel).
Oral medications (for severe, treatment-resistant cases):
Methotrexate, which suppresses the immune system
Cyclosporine, a fast-acting immunosuppressant used short-term due to potential kidney side effects.
Apremilast, a non-immunosuppressive drug that reduces inflammation with fewer risks than traditional systemic treatments
For mild scalp psoriasis, certain OTC shampoos, lotions, and creams can help manage symptoms:
Medicated shampoos containing coal tar or salicylic acid
Moisturizers and scalp oils to help soothe dryness and irritation.
Anti-itch treatments like hydrocortisone creams or ointments
While OTC treatments can help with mild cases, moderate-to-severe scalp psoriasis usually requires prescription medications.
You can’t completely prevent scalp psoriasis, but avoiding triggers and maintaining a healthy lifestyle may help reduce flare-ups and minimize symptom severity.
Ways you can help prevent flare-ups include:
Protect your scalp from irritation. Use gentle, fragrance-free shampoos designed for sensitive scalps. Avoid harsh hair products, excessive heat styling, and tight hairstyles that can cause friction. And be gentle when brushing or combing to avoid scalp injuries.
Avoid skin injuries. Psoriasis can develop or worsen in areas of skin trauma. Protect your scalp from scratching, cuts, sunburns, and friction from hats or helmets.
Manage stress. Stress is a known trigger for psoriasis flare-ups. Try practicing stress-reducing techniques like mindfulness, yoga, or deep breathing exercises.
Maintain a healthy diet. Eat a balanced diet high in nutrient-dense foods like fruits and vegetables. And minimize your intake of ultra-processed foods.
Quit smoking and limit alcohol. If you smoke, quitting may help reduce symptoms. And try to minimize your alcohol consumption.
Monitor and treat symptoms early. Address early signs of scalp psoriasis before they worsen. Talk with a healthcare provider for guidance on treatment options if symptoms persist.
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