Scalp Psoriasis: How to Wash, Soothe and Care for Your Scalp

Quick answer: Scalp psoriasis causes red, thickened patches topped with silvery-white scale on the scalp, and it tends to flare and settle over time. You can calm it by shampooing gently, softening scale with a salicylic acid product instead of picking it, using an over-the-counter medicated shampoo as directed, and keeping heat and tight styles away from your scalp. If it doesn't clear, a dermatologist has many safe and effective treatments.

What is scalp psoriasis, and how is it different from dandruff?

Scalp psoriasis is psoriasis that shows up on your scalp. Instead of loose, light flakes, it forms raised, clearly outlined patches covered in silvery-white scale, and those scales can flake off and look like dandruff.

Psoriasis happens when faulty immune signals make skin cells form far faster than usual, within days rather than weeks, so the extra cells build up on the surface. Patches may stay inside the hairline, often at the back of the head, or spread onto the forehead, ears or neck, and they can be very itchy. On white skin the patches tend to look pink or red; on brown and Black skin they can look purple, dark brown or gray with gray or silver scale, and they can leave dark marks after they fade.

Psoriasis isn't contagious, it's more likely if someone in your family has it, and it usually runs in cycles of flare-ups and calmer stretches. Seborrheic dermatitis can look similar and can even happen alongside psoriasis. If your flakes are small and loose and your scalp isn't thickened, our guide to dry, flaky scalp in winter covers dry scalp and dandruff. A dermatologist can usually tell the difference by looking at your scalp, and occasionally takes a small skin sample to confirm.

What can make scalp psoriasis flare?

Common triggers include stress, injury to the skin (including scratching), infections, smoking, alcohol and some medicines. Knowing yours makes flares easier to manage.

• Stress, which can worsen psoriasis and also make hair shed.
• Skin injury. Psoriasis can appear where skin has been hurt, so scratching, picking and scraping your scalp can set off new patches.
• Infections, such as strep throat.
• Smoking and alcohol. Quitting smoking and limiting alcohol are among the lifestyle changes dermatologists suggest.
• Harsh products, including strong soaps and hair coloring, perms or relaxers.
• Hormonal changes around puberty, after giving birth and around menopause.
• Some medicines. If you suspect a prescription, talk with the doctor who prescribed it rather than stopping it on your own.

Sunlight usually helps psoriasis but occasionally makes it worse.

How should you wash your hair when you have scalp psoriasis?

Gently, and in a steady routine: soften thick scale first, get any medicated product onto the scalp itself, and condition every time. Here's a wash day that follows dermatologists' tips.

1. Soften thick scale first. Apply a scale softener that contains salicylic acid to thick, stubborn patches. Softening scale also helps the medicine you put on afterward work better. Some scale-softening products are designed to stay on for an hour or even overnight before you shampoo them out, so follow the label.
2. Part your hair and apply to the scalp. Lift your hair up and out of the way so treatment lands on your scalp, not just on your hair. A treatment can only help where it touches the patches.
3. Shampoo gently. It may feel right to scrub, but rubbing, scrubbing and scratching tend to make scalp psoriasis worse. Work the lather in lightly and follow the medicated shampoo's directions, including how long to leave it on.
4. Alternate shampoos. To avoid drying out your scalp and hair, try a medicated shampoo one wash and a gentle, non-medicated shampoo the next. Dry hair breaks more easily.
5. Condition after every shampoo. A non-medicated conditioner helps your scalp feel less dry and softens the scent of a medicated shampoo. If your lengths need extra slip, our guide to choosing a leave-in conditioner for your hair type can help.
6. Comb out loosened scale slowly. Gently comb or brush away scale once it has softened. Pulling it off forcefully can take hair with it, and picking can cause a flare.
7. Let your hair air dry. A scalp with psoriasis is already very dry, and blow drying can dry it further.

If you have coily, curly or textured hair that you wash less often, tell your dermatologist your wash schedule. A plan built around weekly washing and a leave-on treatment that suits your styling may fit better than a daily medicated shampoo.

How can you ease the itch without scratching?

Treat the psoriasis itself: when the patches clear, the itch fades. Meanwhile, protect your scalp from your nails.

Scratching can worsen scalp psoriasis, make your scalp bleed and loosen hair. Keep your nails short with smooth tips so you're less likely to break the skin; our weekly nail routine covers trimming and filing. Broken skin can let infection in, so if the itch feels unbearable or keeps you awake, tell your dermatologist.

How should you style your hair with scalp psoriasis?

Treat your scalp as easily irritated skin: brush gently, keep heat off it and skip tight styles, especially during a flare.

• Brushing and combing: go gently. Scraping your scalp with a brush or comb can trigger a flare.
• Hot tools: limit curling irons and hot rollers, and keep them from touching your scalp, since heat can irritate or burn it.
• Tight styles: avoid them. Pulling hard on hair irritates the scalp and, over time, can cause hair loss.
• Color, perms and relaxers: ask your dermatologist first, and avoid coloring, perming, relaxing and blowouts while you're flaring.
• Patch test every product: before using a new hair color, straightener or spray, dab a small amount on your scalp and leave it for a while. If your scalp feels irritated within a few hours, switch to something gentler.

What to look for in scalp psoriasis products

Look for an active ingredient that matches your scalp's needs and a texture that's easy to use on hair. Product types worth knowing:

• Salicylic acid shampoo or scale softener. Softens and lifts scale and can help other treatments, including corticosteroids, get through. Urea is another scale-softening ingredient.
• Coal tar shampoo. Weaker strengths are sold without a prescription and may be suggested when your scalp itches. It can stain the scalp and hair.
• Light textures. Lotions, solutions, gels, foams and sprays are usually easier to use on the scalp than heavy ointments.
• A gentle, non-medicated shampoo and conditioner for the washes between medicated ones.
• Scalp oils or moisturizers. Regular use of emollients can ease dryness. Skip undiluted essential oils, which can lead to a skin allergy.
• Antifungal shampoos (such as ketoconazole or zinc pyrithione) work well for dandruff and seborrheic dermatitis but have a more variable effect on psoriasis, so ask your dermatologist whether one suits your scalp.

If you're pregnant, trying to get pregnant or breastfeeding, check with your doctor or pharmacist before starting any medicated scalp product, including salicylic acid and coal tar, because some psoriasis treatments can be harmful in pregnancy.

How do dermatologists treat scalp psoriasis?

If over-the-counter care isn't enough, a dermatologist builds a plan for you, often combining more than one treatment and sometimes using different ones morning and night.

• Corticosteroids applied to the scalp are the most prescribed treatment and work quickly on redness, swelling, itch and scale. Because long-term use can cause side effects, they're often paired with another treatment, such as calcipotriene, a man-made form of vitamin D usually applied at bedtime.
• In-office treatments for thick or stubborn patches include corticosteroid injections into a patch (limited to a few times) and an excimer laser, which treats only the affected areas. Laser care usually means two or three visits a week of about 10 minutes each for several weeks; possible side effects include redness and sunburn-like pain.
• Medicines that work throughout the body, including pills and biologics that act on the immune system, are options for stubborn psoriasis.

Use any plan exactly as prescribed and for as long as recommended; stopping early is a common reason people don't see clearing.

What to expect from scalp psoriasis care

Be patient with any new routine. Most scalp treatments need regular use for several weeks before you see a benefit, though prescription corticosteroids tend to work faster, and you may need to keep using a treatment to keep your scalp clear.

• After clearing: using a medicated shampoo may help keep scalp psoriasis from returning.
• Hair: any shedding from scalp psoriasis is usually temporary, and hair tends to regrow once the scalp clears. Rarely, long-running psoriasis can cause permanent hair loss.
• Long term: psoriasis is a lasting condition that comes and goes, so plan on maintenance rather than a one-time fix. With a dermatologist's help and a plan you follow, it's rare to struggle with scalp psoriasis for long.

When to see a dermatologist

See a board-certified dermatologist or your doctor if you think you have psoriasis, if over-the-counter products aren't clearing your scalp, or if your treatment seems too harsh or causes side effects. Also book a visit if:

• you have thick patches, bleeding, hair loss or itch that keeps you up at night
• your hair keeps falling out despite treatment, since hair loss can have other causes
• you have pain, stiffness or swelling in your joints that keeps coming back, which can be a sign of psoriatic arthritis
• you're pregnant or planning a pregnancy and use any psoriasis treatment
• it's affecting your mood or confidence, which is common

Call 911 or go to the nearest emergency room right away if your skin quickly turns red and you develop pus-filled bumps that join together (redness can be harder to see on brown and Black skin), especially if you also have a fever, chills or a fast heartbeat. These can be signs of a more serious condition or an infection, so don't drive yourself.

FAQ

Is scalp psoriasis contagious?

No. Psoriasis isn't contagious, so you can't catch it from someone or pass it on. It's linked to the immune system and is more likely if someone in your family has psoriasis.

Can scalp psoriasis cause hair loss?

It can, often from scratching, picking or pulling off scale forcefully. Hair loss from scalp psoriasis is usually temporary, and hair tends to regrow once the scalp clears. If hair keeps falling out despite treatment, see a dermatologist, because hair loss can have other causes.

How often should I use a medicated shampoo for scalp psoriasis?

Follow the label or your dermatologist's plan. Dermatologists suggest alternating a medicated shampoo with a gentle, non-medicated one to avoid drying out the scalp and hair. If you wash your hair less often because of its texture, tell your dermatologist so the plan fits your routine.

Will scalp psoriasis go away?

Scalp psoriasis is a long-term condition that tends to flare and settle. Treatment can clear the patches, and ongoing care, such as a medicated shampoo after clearing, may help keep them away. With a dermatologist's plan that you follow, it's rare to struggle with it for long.

Sources

1. Scalp psoriasis: Tips for managing (American Academy of Dermatology)
2. Scalp psoriasis: Shampoos, scale softeners, and other treatments (American Academy of Dermatology)
3. Scalp psoriasis: 10 ways to reduce hair loss (American Academy of Dermatology)
4. Hair styling tips that can reduce flares of scalp psoriasis (American Academy of Dermatology)
5. Scalp psoriasis (DermNet)
6. Psoriasis (NHS)