Welcome to Ask Joni, an advice column by Joni Kazantzis, the community guide for Bezzy Psoriasis. Joni has lived with psoriasis for over 25 years and is passionate about sharing what she has learned with others. In her column, Joni answers questions sourced directly from community members. To have your questions answered, join one of Joni’s nightly live discussions.
In my opinion, the scalp can be one of the most challenging places to treat psoriasis because it’s hard to get treatments to stay in contact with the affected area.
For example, shampoos can help and are a good treatment option, but typically, they don’t stay on your scalp long enough to be as effective as you’d like. Even if you take a longer than usual shower and apply the shampoo at the start and rinse at the end, it’s usually done before hitting the 20-minute mark. Another option is to use medications or oils that you can put on before bed and wash out in the morning.
Other challenges can be getting the treatment onto the scalp and not just onto the hair. The key is finding a product with an applicator tip and spending time massaging the product or treatment into the scalp. If your treatment doesn’t come with an applicator tip, you can buy one for a relatively low cost at a beauty store or online. You can also ask your dermatologist to prescribe you a topical treatment that is a foam or a spray to make application easier.
If you prefer to go the natural route, there are over-the-counter products that you can get pretty easily that are relatively inexpensive. You can also try products right from your kitchen cabinets, like coconut or olive oil.
To try it, use coconut or olive oil as a scalp mask. Massage the oil into affected areas and leave it on for as little as 20 minutes or as long as overnight. Then, rinse it out with a shampoo that includes either coal tar, sulfur, salicylic acid, ketoconazole, or zinc pyrinthione.
The salicylic acid and zinc pyrithione can also help soften scales, which makes it easier to remove them. You can also use a fine-tooth comb to help safely remove scales. Removing the scales will make it easier for treatments and products to work. If you try this, do so gently. Unless plaques are safely removed, there is an increased risk of infection.
There are various ways to treat scalp psoriasis, including prescription and natural options. Your doctor will often suggest starting with topical options, like shampoos or creams. If topicals don’t work, your dermatologist may prescribe biologics or systemic medications that work inside the body to reduce inflammation. These treatments are not just for the scalp but all the skin on your body.
Another distressing part of scalp psoriasis could be hair loss. It can happen in more severe cases for a variety of reasons, including that some plaques are too thick for hair to grow through. Other causes can include excessive scratching and picking at scaly spots, harsh treatments, or the stress related to psoriasis.
If this happens to you, try talking with your dermatologist about your options. And remember, it’s usually a temporary condition, and hair grows back once the skin clears.
In the meantime, while you’re waiting for those treatments to start showing results, there are various ways to manage the patches and flakes from scalp psoriasis.
What you choose to wear can help camouflage the flakes from psoriasis, cover affected areas, and make the experience more comfortable for you.
Here are a few tips for clothing:
Remember that some medications can be greasy and leave stains, so always keep that in mind when selecting clothing and accessories.
Your hairstyle can be another great way to help minimize the appearance of psoriasis. I used to scratch my scalp relentlessly, so I would bundle my hair into a ballerina bun so that any scratching would require me to redo it, which I didn’t want to do. But styles that are too tight could pull on the scalp and irritate spots, so there’s a delicate balance.
You can also wear it down or in a low ponytail to cover plaques on your neck. You can also change the part to find a spot on your scalp that doesn’t have flakes or plaques.
Be careful with heat tools, like hair dryers and straighteners, which can aggravate a flare and cause more dryness and itchiness. If you do blow-dry, always use the lowest setting.
If you can, skip using hair coloring when you have an active flare. Some dyes may include harsh chemicals that can irritate your plaques. Talk with your hairdresser about the ingredients in the products they use so you can do some research before moving forward.
Don’t skip the SPF! Yes, you need sunscreen on your scalp!
Sunburn can trigger a new psoriasis flare or can worsen a current flare. Apply sunscreen on the hairline and any parts of the scalp left exposed.
There are many options for treating your scalp psoriasis, but while you’re waiting for results, you can mask the visible spots and make lifestyle changes to make yourself more comfortable.
Medically reviewed on November 21, 2022
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