Psoriasis scales can usually be safely and gently removed from the scalp at home to help relieve uncomfortable — and often embarrassing — symptoms. Plaque psoriasis causes skin cells to quickly reproduce and form itchy, silvery scales as dead skin flakes off. With plaque psoriasis on the scalp, these flakes can look like dandruff, but the flakes are usually larger.
In general, itchy, painful, and flaking scales from psoriasis are reported to be one of the most stressful and frustrating symptoms of the condition, and scalp psoriasis is no exception. Scales on the scalp can be a physical and emotional burden. These scales can lead to changes in the clothing you wear (avoid clingy or tight clothing) and can affect work and your personal relationships. They can also lead to hair loss and have a significant impact on your quality of life.
Scalp psoriasis scales are a common topic of conversation among MyPsoriasisTeam members, who are often eager for tips on how to remove them:
By carefully removing scales on the scalp, you can help reduce itch and improve the effectiveness of topical treatments. Talk to your dermatologist before you start removing scales on your own to be sure it’s safe for you to do so.
Certain compounds used for the removal of psoriasis scales are called keratolytics, or keratolytic agents. Keratolytics help soften and separate the outer layer of skin and are used for the treatment of some inflammatory skin diseases, such as psoriasis, eczema, and seborrheic dermatitis. Keratolytics are also sometimes called scale lifters and can decrease the thickness of plaques and help peel away scales without causing damage to the scalp or skin.
Many over-the-counter (OTC) products and prescription treatments contain keratolytic agents that are appropriate for removing psoriasis scales on the scalp.
One of the most effective keratolytic scale lifters is salicylic acid, which can be found in a number of shampoos and other topical treatments for the scalp. Although high amounts of salicylic acid can be harmful to the skin, many products that can help remove scales on the scalp contain safe concentrations of salicylic acid.
Other keratolytic ingredients that can be beneficial for both the prevention and removal of scales on the scalp include:
The National Psoriasis Foundation (NPF) recommends three shampoos that can help safely remove psoriasis scales from the scalp:
The NPF has a directory of over-the-counter products with their Seal of Recognition that lists several other shampoos that may help soften and remove scales on the scalp. Other products, including oils, emollients, and ointments, that are not listed in the NPF directory may also be appropriate for removing scales at home. Many of these products will be described as being for seborrheic dermatitis, dandruff, or psoriasis.
Some people use natural oils such as coconut oil or olive oil to help soften and lift scales on the scalp. Talk to your dermatologist about products that may be helpful for your condition. It’s always a good idea to test a product on a small area of the scalp due to the risk of side effects, such as irritation, burning sensation, or stinging.
Removing psoriasis scales on the scalp should be done gently — allowing the appropriate shampoo, oil, or other product to work. Take your time when removing scales to ensure that you treat tender areas of the scalp carefully. If you are too rough in removing scales on the scalp, you could pull out hair or injure your skin.
Experts in dermatology recommend using an appropriate shampoo frequently to help exfoliate (loosen and remove dead skin cells) from the scalp. You may experience an increase in flaking when you first start using shampoo to lift scales, but that is usually a sign that the shampoo is working. Washing your hair daily will help wash away the scales and dead skin cells.
Medicated shampoos are intended to treat the scalp, rather than the hair, and should be applied only at the roots, unless you are instructed otherwise. Follow instructions for use and get medical advice from your health care providers to be sure you are using medicated shampoos properly. Oils, solutions, and foams may be more effective if they are left on the scalp as instructed, which may be anywhere from five minutes to an hour, or even overnight.
OTC and prescription oils, creams, or ointments that are appropriate for scalp psoriasis can be gently massaged into affected areas and left on the scalp for 30 to 60 minutes, or as long as instructed. You can wear a shower cap or wrap your head in a towel during this process to prevent the oil from dripping. Afterward, wash your hair with either a regular shampoo or a coal tar shampoo, washing away the scales.
While the scalp is still moist from washing, you can very gently comb out scales. Before combing, you can press a fine-toothed plastic comb flatly against the scalp and gently move it in a circular motion. You may want someone to help you with this process. Once scales are removed, hair should be washed again. A mild conditioner can be used to help moisturize the scalp.
In cases of severe psoriasis on your scalp or excessive scaling, discuss your treatment options with your doctor. Your psoriasis treatments may need to be adjusted to help reduce flare-ups and the severity of psoriasis on your scalp. In more severe cases, other prescription topical therapy or systemic therapy may be used.
Everyone’s experience with scalp psoriasis is unique, but MyPsoriasisTeam members’ tips for removing scales from the scalp may prove helpful for you.
One member had this advice for removing scales on the scalp: “Try using some scalp oil (available at the drugstore). Put it on wet hair, cover with shower cap, leave it on overnight, and wash hair the next morning. Do this every other night for about a week, then once a week.”
Another member wrote, “Clobetasol propionate topical solution for the scalp helps me a lot. Goes away almost overnight.”
“I started using Dermarest shampoo for my scalp. It surprisingly helped a lot!” said a member. Another member offered, “Years ago, when I had psoriasis on my scalp, I used Capex (fluocinolone acetonide topical shampoo). It worked great for me.”
“My skin and scalp are scaly, so I’m going to soak in a coconut oil bath for a while. It does help some,” a member shared.
Scratching and picking your scalp can result in bleeding, injury, or infection. Sometimes, you may pick without thinking, or have a hard time resisting scratching or picking at your scalp. Picking can make your condition worse.
People with psoriasis on their scalp are at risk of experiencing the Koebner phenomenon — even a minor injury to the scalp can cause new psoriasis lesions in areas of the scalp that had been clear before. Picking at scales on the scalp increases your risk of the Koebner phenomenon.
“Trying not to pick scales. They are covering most of my scalp. Using salicylic acid and tea tree oil shampoos,” a MyPsoriasisTeam member said. Another member wrote, “Battling scalp plaque buildup. I can’t take steroids and I’m prone to pick at it.”
Your treatment plan is designed to help manage symptoms of psoriasis and reduce scaling. Be sure to adhere to your treatment plan, which may include a combination of home skin care, topical treatments, systemic medication such as biologics or methotrexate, or phototherapy.
If you have questions about removing scales from your scalp, talk to your doctor. Your health care providers can help ensure that you are removing psoriasis scales safely.
MyPsoriasisTeam is the online social network for people with psoriasis and their loved ones. On MyPsoriasisTeam, more than 112,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis.
Are you living with scales on your scalp from plaque psoriasis? Have you tried removing scales at home? Share your experience in the comments below, or start a conversation by posting on your Activities page.