Caring for your scalp psoriasis

How do I know if I have scalp psoriasis?
If you already have psoriasis on other parts of your body, chances are you'll recognize the scaling if it appears on your scalp. Lesions from scalp psoriasis can appear from your forehead to the back of your neck, often including the area behind your ears. The plaques may be fairly mild in nature (silvery, fine scales similar to dandruff) or they may become severe (i.e., thick and crusted scaling). You may also experience nail pitting and arthritis in some cases.

What are some medications I can use?
Many treatment options exist for scalp psoriasis and your doctor will recommend which ones best suit your condition. These may include coal tar products (such as shampoos, creams, and soaps), topical (skin-applied) steroids, or a vitamin D3 derivative in the form of an ointment, gel or foam that your skin absorbs overnight. Some products may contain more than one of these ingredients for a stronger effect. You may need to vary treatments over time, as your body may grow tolerant to a particular treatment and the medication may become less effective.

What are "keratolytics"?
When psoriasis medications are applied to psoriasis plaques, medications can have trouble penetrating the scales. If some of the scales can be softened and then removed ahead of time, then the medication can be absorbed more easily and have a greater effect. Products that help soften psoriasis scales for removal are called keratolytics. Keratolytics include ingredients such as salicylic acid and urea.

What is "occlusion" and what does it do?
Occlusion involves covering certain topical treatments with a dressing or covering (such as a cap, in the case of scalp treatments) that does not breathe so that the medication can work properly. (In the case of sometimes messy scalp psoriasis creams and ointments, occlusion can also help protect your pillows and sheets!) Check with your doctor before occluding any treatments, as this procedure is not appropriate for all treatments.

What about my hair?
In terms of practicality, hair can hamper medications being applied to your scalp and can sometimes make your treatment process more difficult. Hair can become entwined with psoriasis scales, and as you attempt to remove these scales, your hair may come out as well. Or some treatments may cause your hair to weaken and break (e.g., salicylic acid) or stain your hair colour (e.g., coal tar).

The good news is that scalp psoriasis itself does not cause hair loss, and hair does grow back. Dry hair can break more easily so avoid using harsh shampoos or other hair care products. Air drying your hair, as opposed to blow drying, is also less drying on the scalp. But if you have scalp psoriasis, and you are treating it, you may want to consider keeping your hair short to keep things simple. (This could be a good reason for that bold cut you've always considered!)

For further information on treatment for scalp psoriasis, or for resources to help manage the impact of this condition, speak to your doctor or pharmacist.

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