Julie Greenwood, who lives in Cary, NC, has had psoriasis for 30 years. It was especially challenging to treat it on her scalp, especially because of people’s reactions. “They seem to think it’s okay to brush the scales off my shoulders or comment on all the white things in my hair,” she says.
Psoriasis can affect your scalp, hairline, and areas around your hair such as your neck and ears. You may notice flaky flakes or thick, crusty plaques on your scalp.
You will do better with the right tips and tricks.
Wash your hair gently
Try to limit how often you wash your hair.
“Unless I get hot and sweaty, which I try not to do, I only wash my hair every 2-3 days,” says Greenwood. If she washes it more often, it will dry out her scalp.
Be gentle when shampooing. Avoid rubbing, scrubbing, and scratching. All of these can make psoriasis worse.
Keep it simple
“I’ve had psoriasis for 19 years and have tested every product on the market,” said Michele Ocana, a graduate student from Chicago. Ocana adheres to shampoos and conditioners with just a few ingredients. That helped her.
“I use Alaffia shampoo and conditioner without fragrance. It only consists of 4-5 ingredients and doesn’t dry out my stains, ”says Ocana.
What works for you may be different. Remember that “unscented” does not mean that a product is completely chemical-free. As with anything you apply to your skin, you may need to experiment before you find your favorite products.
Try medicated shampoo
Over-the-counter medicated shampoos target your scalp to relieve mild symptoms and remove dandruff. They can also help your prescription topical medicines work better.
These shampoos are approved by the National Psoriasis Foundation:
- Dermarest Psoriasis Medicated Shampoo Plus Conditioner
- MG217 Medicated Conditioning Coal Tar Formula Shampoo
- Neutrogena T / Gel Therapeutic shampoo against stubborn itching
“If you have severe redness and irritation, I like Neutrogena T / Gel Therapeutic Shampoo with Coal Tar. If you have a lot of thick, white dandruff, I prefer the Neutrogena T / Sal Therapeutic Shampoo, ”says Maryann Mikhail, MD, a South Florida dermatologist.
“Leave the medicated shampoo on your scalp for 2-3 minutes at least twice a week,” says Mikhail.
David Chandler, who lives about 20 miles north of London in England, says it works for him. “I massage flaky areas with the shampoo and let it take effect. That seems to remove the loose parts, ”he says. After shampooing, he removes any visible flakes with a fine-toothed comb.
If a medicated shampoo makes your skin feel too dry, alternate it with a non-medicated shampoo
Be smart with styling
Make it easy for yourself with tools that use heat. They can dry out your scalp even more.
“I mostly air dry my hair,” says Greenwood. She says she only uses a blow dryer when she’s going out and wants a more stylish look. Greenwood stopped using a curling iron years ago. She also stopped coloring her hair because it was too hard on her scalp.
The right haircut helps sometimes.
“I had super short haircuts in hopes it would help my psoriasis, but now I like to keep it a little longer to hide plaques that might be visible through my short hair,” says Greenwood. Shoulder-length hair also helps her hide plaques just below her hairline, on her neck, and behind her ears.
Try over-the-counter topical treatments
If you have mild scalp psoriasis, over-the-counter products can help.
Look for products with salicylic acid. It helps soften thick spots and flakes so you can easily remove them. It also helps your medication penetrate better. Lift your hair out of the way, then apply it to your scalp.
Another effective ingredient is coal or wood tar. They can slow skin cell growth and help with inflammation, itching, and flaking.
Greenwood has tried creams, lotions, foams, and oils. She says they often work, especially products made with coal tar, but they can be messy.
Ocana agrees that topical treatments can be messy, but she says they are worth the effort.
After applying a topical treatment, Ocana wraps your head for about an hour, then rinses the treatment out with shampoo and conditioner. “My hair gets so moisturized and shiny that it’s worth it,” says Ocana.
Consider a topical steroid
Talk to your doctor about topical steroids and prescription topicals.
“During an active flare, my first choice is a strong topical steroid solution like Clobetasol,” says Mikhail. “Use it twice a day for a week and then switch to the weekend just for maintenance.”
Try other treatments
These treatments and remedies can relieve symptoms.
Wet towels. “I used a cold, wet towel on my scalp and a hot, wet towel,” says Greenwood. “I know heat isn’t good for dry skin, but the hot towel feels so much better right now.”
Phototherapy. Phototherapy sends ultraviolet (UV) light to your scalp to slow skin cell growth and help with symptoms. You use a handheld device with a built-in comb to make sure the rays reach your scalp.
Oral treatments and biologics. If you haven’t found a treatment that works well, or if your psoriasis has spread beyond your scalp, your doctor may recommend prescription medications. One option could be methotrexate, a powerful treatment that targets molecules in immune cells throughout the body. Another choice could be biologics, drugs that target specific immune cells.
Greenwood says biologics and methotrexate helped her better manage her scalp psoriasis.
hands off
“One of the hardest things for me to learn was not to scratch my scalp every time it itched. Every time I scratched myself, I lost tufts of hair, ”says Greenwood. “Nothing feels better than scratching my head well, but when my head is covered with psoriasis, I have to be as gentle as possible.”
Try to keep your hands off your scalp. It can be helpful to keep your fingernails short.
Be patient
Try to be flexible and patient. It can take time and trial and error to find the right mix of treatments and strategies that are right for you.
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