About half of the 8 million Americans (and 125 million people worldwide) affected with psoriasis have the condition on their scalp, aptly called scalp psoriasis. Scalp psoriasis formation has no relation to our hair types or textures, so pretty much anyone can develop the condition. Mild cases are characterized by fine, powdery flakes. Moderate cases involve scales, while more severe cases include plaques, which are raised, scaly patches of skin.
On lighter skin, these plaques appear red and silver; on darker skin, plaques appear purple, grey, or dark brown. The condition can cause itchiness, inflammation, and discomfort, and the temptation to scratch might lead to infection or hair loss. Managing scalp psoriasis involves some trial and error, as you find the over-the-counter shampoo or topical that works for you, without causing further irritation. A board-certified dermatologist can also prescribe medicated formulas, oral treatments, or administer a laser if you're not seeing an improvement from home remedies.
Ahead, dermatologists offer solutions for managing scalp psoriasis with home remedies, so you can get relief fast.
Meet the Expert
- Marisa Garshick, MD, FAAD, is a board-certified dermatologist at MDCS Dermatology: Medical Dermatology & Cosmetic Surgery, as well as an assistant clinical professor of dermatology at Cornell-New York Presbyterian Medical Center.
- Michele Green, MD, is a board-certified dermatologist who specializes in the treatment of cosmetic skin concerns.
What Is Scalp Psoriasis?
Scalp psoriasis is a type of psoriasis that affects the scalp and appears, according to Garshick, as flaking plaques. It can also "spread to your forehead, the back of your neck, or behind and inside your ears," says Green. Some people can experience itching, burning, soreness, or discomfort.
Soften Scales With a Salicylic Acid-Based Shampoo
In mild to moderate scalp psoriasis, silvery scales can develop on the scalp. Some people might also experience thicker plaque-like scales. To treat, Garshick recommends using salicylic acid. "Salicylic acid acts as a keratolytic to help soften the scales and decrease the thickness of the plaques. Salicylic acid-based products, also known as scale softeners, are generally best to help soften and eliminate the scales," she says. She adds that "daily washing of the hair can help to eliminate some of the dead skin."
You can also leave the salicylic based product on to let it penetrate deep in areas where thicker plaques persist. Let it sit for up to 10 minutes before rinsing. If this proves ineffective in breaking down the scales, a board-certified dermatologist can prescribe a stronger concentration of salicylic acid for relief.
Calm Inflammation With a Tar Based Shampoo
Another effective ingredient to treat itchiness and plaque-formation is tar. "Tar made from coal or wood works to slow skin cell growth and reduce inflammation, itching and scaling," says Green. "Apply the coal tar shampoo by massaging it into the scalp, and leave it on for 5-10 minutes before rinsing it out," she adds. "Staining and odor are the main drawbacks when using a tar shampoo, however a non-medicated conditioner can help against the odor of tar shampoo. Look for over-the-counter products that contain two to 10 percent coal tar." An indulgent clean beauty favorite is Sangre de Fruta's Botanical Hair Elixir, known for its purity of ingredients and luxe botanical properties.
Reduce Yeast With a Mild Anti-Dandruff Shampoo
In milder cases of scalp psoriasis, where thick plaques and scales are not as persistent, Garshick favors a dandruff shampoo such as Dove DermaCare Scalp Dryness and Itch Relief Anti Dandruff Shampoo or Head and Shoulders Classic Clean 2-in-1, as these contain zinc pyrithione, which she notes "can help with scalp psoriasis in addition to seborrheic dermatitis, as it helps to reduce yeast on the scalp."
Daily washing is crucial for people with scalp psoriasis, adds Garshick. "Finding a shampoo formula that you like is most important, as it is often recommended for those with psoriasis to wash their scalp daily or every other day. This helps eliminate excess build up of dead skin, which can worsen the flaking." When choosing a shampoo, consider that "in general, it is best to avoid any products that may be irritating or drying on the scalp, but the specific type of formulation that is preferred may vary based on hair type. So it generally is a personal preference."
Treat Scalp With Witch Hazel
One of the most effective over-the-counter herbal treatments is witch hazel. To use, Green says, "massage it directly onto scalp after washing. Continue to massage the area until the witch hazel is fully absorbed. From there, you can rinse you scalp and style your hair as you normally would."
Please note that Green cautions that home remedies and non-medicated treatments are best used on mild cases of scalp psoriasis to help ease discomfort and are not considered "proven cures."
Apply Aloe Vera to Scalp
Green finds that the soothing properties of aloe vera cream can have some healing properties for people with mild to moderate scalp psoriasis. "Aloe vera creams that contain 0.5 percent aloe can help reduce itching, inflammation, flaking, and redness on the scalp," she says. "This cream should be applied up to three times per day to keep skin moist. It may take up to a month to start feeling and seeing positive effects." Also note, it's a good idea to run your home remedy by your dermatologist before proceeding.
Try an Apple Cider Vinegar Rinse
A home remedy to combat itchiness involves applying an apple cider vinegar rinse. Green says, "Apple cider vinegar may help reduce itchiness associated with scalp psoriasis. Dilute the apple cider vinegar with water, apply to the scalp, and rinse the skin thoroughly to prevent irritation. You will be able to see results in several weeks." Use up to a few times per week. Please take the aforementioned precautions when using this home remedy, and also note that people experiencing cracked or bleeding skin should not use apple cider vinegar at all.
Mix Tea Tree Oil Into Your Shampoo
Green says that tea tree oil, due to its antioxidant properties, can be soothing to scalp psoriasis. "You can try mixing psoriasis-friendly ingredients, such as apple cider vinegar or tea tree oil with your usual shampoo," she says. "This can serve as a gentle, homemade psoriasis remedy. However, this is usually only an effective measure in very mild presentations of scalp psoriasis." She underscores the importance of using a shampoo with active ingredients. In addition to those listed above, look for ketoconazole to help remove plaques and reduce the chance of fungal infection or selenium sulfide to treat scales and flaking.
Massage Coconut Oil Into Scalp
A coconut oil hair treatment might be one of the more indulgent ways of managing scalp psoriasis; plus, the healthy fats are known to boost skin health. "Massage a few drops onto your scalp and put on a shower cap," says Green. "Once the oil is on your scalp, set your timer for 20 minutes. After your time is up you may remove the cap and wash your hair as usual."
Another favorite soothing hair treatment is the ultra healthy Mighty Majesty Fortifying Hair Serum by Ravanat. This scalp-nourishing serum includes a high concentration of oleic acid, vitamin C, plus vitamin E, jasmine oil, and sunflower oil.
Scalp treatments are important for people with scalp psoriasis to help eliminate some of the dead skin. Some salons offer special treatments like the Biologique Recherche Lotion P50 Capillaire Purifying Hair and Scalp Treatment at the Paul Labrecque Salon, which may be helpful. For an at-home scalp treatment, try the Scalp Detox in conjunction with the Scalp Renew from Act + Acre, a brand that helps restore the microbiome of the scalp.
Do note that any attempt to manually remove plaques is not recommended. Garshick cautions against picking off the scales, since it could actually trigger increased scaling and flaking. "Patients with psoriasis can experience the koebner phenomenon, which describes a new plaque of psoriasis that can develop anytime the skin is injured or traumatized in some way. As much as possible, avoid scratching the scalp as not only can it make psoriasis worse, it can also lead to bleeding and possible hair loss," she says.
Limit Your Use of Styling Tools
Be gentle when styling your hair, in order to avoid irritating the scalp. "It is best to avoid tight hair styles, as pulling too tight on the scalp can lead to irritation," says Garshick. "Additionally, curling irons, rollers, coloring, perming or relaxing your hair should be limited–especially if there is an active flare–as these can be irritating on the scalp."
If you're concerned about concealing plaques, Green suggests "a low pony with added texture to hide irritation at the nape of your neck. You can add volume to down-dos by gently teasing strands at the root to conceal any scaliness behind the ears. If the hairline is typically your trouble zone, full or side-swept bangs can help hide redness."
Consult a Dermatologist
If you don't see improvement with over-the-counter remedies, it's time to see a board-certified dermatologist. Dermatologists can prescribe prescription shampoos, topical steroids, and non-steroidal anti-inflammatories in the form of solutions, foams, gels, sprays, or oils. Garshick notes that another course of treatment includes "intralesional steroid injections into the plaques themselves, oral medications such as Otezla, or biologics."
Another option might be a type of laser treatment known as the excimer laser which, according to Garshick, "delivers ultraviolet light at 308 nm to the psoriatic plaques on the scalp." Both Garshick and Green advise you keep an open dialogue with your dermatologist about lifestyle and treatment, as consistency is key for effectiveness.