Thick, discolored scales. Excessive flaking. Hair loss. Scalp psoriasis is a common but serious health challenge for many people with psoriasis. Besides the maddening itch, scratching and picking can create raw, bleeding lesions on the scalp that impact physical appearance, self-esteem, and overall quality of life.

At least 50 percent of people with plaque psoriasis (the most common type of psoriasis) will experience a scalp psoriasis flare at some point in their lives. Excessive scaling on the scalp can leave dark clothing covered with white flakes. Embarrassment about visible plaques on the head, ears, neck, and hairline can impact a person’s quality of life.

Researchers have found that more than 70 percent of people with scalp psoriasis report that it interferes with daily activities. Many people with the condition wear hats and wigs to hide their symptoms — or stay at home.

“The plaques get so thick, they feel like super glue in my hair and are hard to get out.”

— A MyPsoriasisTeam member

If you have persistent scalp psoriasis, there may be treatments you haven’t tried yet. “First and foremost, I think it’s really important to let your doctor know how much it’s affecting you,” Dr. Raja Sivamani, a board-certified dermatologist at the University of California, Davis, told MyPsoriasisTeam.

What Does Scalp Psoriasis Feel Like?

Scalp psoriasis appears as raised, red or purple, itchy patches with silvery white scales that often start in one spot — behind the ear, for example — and spread through the hair. Symptoms include mild to severe itching, burning, cracking, or bleeding skin. Members of MyPsoriasisTeam have described how it feels:

• “Feels like chickenpox on my scalp during a flare-up.”
• “Looks like it’s constantly snowing from my head.”
• “My scalp is so itchy; I feel like pulling out my hair.”
• “The plaques get so thick, they feel like super glue in my hair and are hard to get out.”
• “My scalp gets so bad it bleeds and is sometimes painful, especially behind the ears.”

What Causes Scalp Psoriasis?

Although the cause isn’t fully understood, researchers believe scalp psoriasis — similar to psoriasis on other parts of the body — occurs when the immune system mistakenly signals skin cells to grow quickly. Instead of shedding the excess cells, the body accumulates them on the skin’s surface, forming psoriasis plaques.

Scalp psoriasis can affect people at any age. Stress, smoking, obesity, and genetic predisposition are thought to be risk factors for developing the skin condition. “I’ve had scalp psoriasis since age 7, but in my adult years, stress always makes it worse,” said one member.

“I’ve had scalp psoriasis since age 7, but in my adult years, stress always makes it worse.”

— A MyPsoriasisTeam member

Scalp psoriasis can be mistaken for seborrheic dermatitis (dandruff). Psoriasis has thicker, drier silvery scales and often extends beyond the hairline. Seborrheic dermatitis scales are greasy-looking and white or yellowish, and they attach to the hair shaft.

The presence of psoriasis on other areas of the body usually helps dermatologists make a diagnosis, although a skin biopsy for a lab test can confirm it.

How Is Scalp Psoriasis Treated?

Scalp psoriasis is treatable. Treatment options include medications applied to the skin, medicated shampoos, scale softeners, injections, light treatments, and oral medications.

Watch dermatologist Dr. Raja Sivamani talk about treatments for scalp psoriasis.

Scalp psoriasis is often challenging to treat because plaques can become thicker under hair than on an arm or a knee. Hair also makes it harder to apply creams and ointments to affected areas. Finding the right treatment — or combination of treatments — can take time, because each person responds differently. Treatments must also be rotated, because they can have side effects or become ineffective when used for long periods.

Treatment options include:

• Medicated shampoos — Over-the-counter medicated shampoos, foams, or creams can be helpful for mild scalp psoriasis. These products may contain coal tar or salicylic acid. Prescription shampoos are also available.
• Topical corticosteroids — These creams, lotions, ointments, or shampoos are often the first-line prescription treatment for moderate to severe scalp psoriasis. Dr. Sivamani recommends fluocinolone topical oil: “It’s a great option that you can get and treat the entire scalp with.”
• Nonsteroidal topicals — These include vitamin D analogs, retinoids, and psoriasis treatments approved in the last five years, like AhR agonists and PDE4 inhibitors.
• Systemic medications — Your doctor may recommend systemic drugs like immunosuppressants or biologics.
• Other treatment options — In some situations, corticosteroid injections into the scalp and phototherapy with hand-held excimer laser devices may be appropriate.

Natural and Home Remedies

The National Psoriasis Foundation recommends several natural remedies, in conjunction with medical treatments, to soothe the pain, itch, and plaque of scalp psoriasis:

• Aloe vera juice, gels, or creams
• An apple cider vinegar rinse (1 part vinegar to 1 part water)
• Tea tree oil shampoos
• Dead Sea salts
• Capsaicin pepper in creams or ointments

The National Psoriasis Foundation recommends finding a hairdresser who’s familiar with scalp psoriasis. Not only will this remove potential anxiety about visiting a new salon, but it will also give you a chance to discuss the risks and benefits of certain styling services.

Talk to your doctor before using any alternative or complementary therapies.

Gentle Hair Care

Dermatologists advise extreme care when washing or styling your hair. Avoid rollers and curling irons that can burn the scalp or tight hairstyles that may irritate skin and cause a flare.

Coloring, perming, or relaxing your hair may make you feel better but can also worsen symptoms. One member who stopped coloring said, “It was suffocating my hair and adding to the problem!” Another asked their hairdresser to use foils during hair coloring so the dye didn’t touch their scalp.

The National Psoriasis Foundation’s safe styling recommendations include finding a hairdresser who’s familiar with scalp psoriasis. Not only will this remove potential anxiety about visiting a new salon, but it also gives you a chance to discuss the risks and benefits of certain styling services. Always check with your dermatologist if you still have questions or concerns.

MyPsoriasisTeam Members’ Tips for Managing Scalp Psoriasis

Members of MyPsoriasisTeam frequently talk about their go-to remedies. Here are some of their tips:

• Coat your scalp with coconut oil and wrap your hair: “After a few hours, I take it off and wash my hair with tar shampoo.”
• Coat your scalp with extra-virgin olive oil and go to bed with a shower cap. “It does wonders. No more bleeding or cracking. It removed the heavy plaque, and my hair is growing back.”
• Mix neem oil into hair products. “Adding it to my conditioner really helps with redness and flakiness.”

Be sure to check in with your dermatologist before updating your scalp and hair care regimen.

Talk With Others Who Understand

MyPsoriasisTeam is the social network for people with psoriasis and their loved ones. On MyPsoriasisTeam, members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis.

How does scalp psoriasis affect your life? Has your doctor prescribed treatments to manage your symptoms? Share your experience in the comments below or start a conversation by posting on your Activities page.