If you've been dealing with dry, itchy, flaky scalp, your first thought might be that it's dandruff—but there could be another culprit at play: scalp psoriasis. But before we dive into the condition as it relates to your scalp (and ways to relieve it), it's important to understand what psoriasis is.
Psoriasis is characterized as an immune-mediated disease, which means that it's not an auto-immune disorder, but inflammation that's caused by a problem in your immune system . Vanessa Coppola, a nurse practitioner, explains further: "Psoriasis is a very common skin disorder that can occur anywhere on the body including the scalp. It is estimated that between seven and eight million Americans have psoriasis. We don't currently know exactly what causes psoriasis however we do believe it is an autoimmune disease that causes an over-proliferation of skin cells."
If you've been diagnosed with scalp psoriasis, one of the main ways to treat it is with specialized shampoos. If you're wondering what to look for in a shampoo for the condition, you've definitely come to the right place. Read on for more information from our experts, below.
Meet the Expert
Scalp Psoriasis Symptoms
Scalp psoriasis is more than just flaky skin and dandruff. "Scalp psoriasis is characterized by thick, inflamed, itchy patches known as plaques," says board-certified dermatologist Geeta Yadav, M.D. "They can occur on the entire head or in just some areas. The scaly flakes that shed from these plaques can be larger than what you'd see with dandruff and the amount of shedding can be more prolific. It can spread beyond the perimeters of the scalp to the forehead, back of the neck, and behind the ears."
"You may notice a silvery scale, a scalp that feels very dry to the touch and sometimes can even crack and bleed, itching, bleeding, a burning sensation, soreness and temporary hair loss," adds Coppola. She explains that it's important to note that it is not the scalp psoriasis itself that causes hair loss, but rather the itching and scratching. "Itching and a dry sensitive scalp are often the most common early signs and symptoms of scalp psoriasis."
Shampoo Ingredients to Look For
Yadav recommends that when you're looking for a shampoo to use to help soothe scalp psoriasis, you first want to look out for kerolytic ingredients or ingredients that help dissolve the scaly skin and help it shed. These types of kerolyic ingredients include salicylic acid, lactic acid, glycolic acid, urea, and trichloroacetic acid. According to Coppola, salicylic acid is a key ingredient that's designed to help soften psoriasis plaques and remove them.
"Psoriatic shampoos that are formulated to treat scalp psoriasis typically have three common ingredients that help to both sooth and treat scalp psoriasis, while also allowing any topical medications to penetrate better," adds Coppola. "These ingredients include hydrocortisone, which will help to reduce inflammation as well as alleviate itching, coal tar which helps to decrease cellular proliferation, and also helps the scalp to turn over dead skin cells and shed them."
However, if you have severe scalp psoriasis, Yadav recommends you should see a dermatologist to get a prescription-strength treatment to see real results.
When to Expect Results
In a world where we want to see instant results (Amazon Prime, anyone?), it's important to know that treating scalp psoriasis can be a particularly lengthy endeavor. How long, you ask? You're looking at about eight to 12 weeks, according to both Yadav and Coppola. And after that, you'll need to continue to use medicated products to keep the psoriasis at bay.
"It's important to recognize that treating scalp psoriasis is often a long-term approach that requires maintenance," says Coppola. "Even after you have reached a therapeutic stage where the condition has been well controlled it is often necessary to enter a maintenance period where you continue to use the over-the-counter medicated shampoo or topical agent once or twice weekly to maintain your results."
Even though it might take a long time for you to see results from using scalp psoriasis shampoo, you can rest assured that most shouldn't cause adverse effects. Coppola says that this is especially true for products that have earned a seal of recognition from the National Psoriasis Foundation.
However, this doesn't mean that these shampoos can't have side effects. "Some common side effects that you may encounter are increased redness or irritation, as well as photo sensitivity which can make the scalp more sensitive to sunburn," says Coppola.
"Some used useful tips if you are experiencing an irritated and sensitive scalp are to avoid direct sun exposure to the affected area between the hours of 10 A.M. and 4 P.M., wear a hat when outdoors, and to use a sunscreen that contains zinc oxide or titanium oxide of at least SPF 30," Coppola says. "However, you never want to apply sunscreen to broken skin."
And as always, if you're starting a new product, Coppola recommends to do a spot test to determine if you'll have any adverse effects. "If any side effects occur that are intolerable or not easily treated by reducing or stopping usage of the product, it is important to seek the care of a board-certified dermatologist or dermatological nurse practitioner," she says.
Recommended Scalp Psoriasis Shampoos
Yadav's #1 recommendation is this option from Nizoral. It's formulated with three percent salicylic acid to help fight psoriasis plaques, as well as tea tree oil to help soothe.
Coppola recommends this option from Neutrogena, as it bares the National Psoriasis Foundation seal of recognition. (The seal is designed to highlight over-the-counter products created to be non-irritating and safe for those living with psoriasis.)
Studies have shown that coal tar can help treat and relieve symptoms of psoriasis . This shampoo, formulated with coal tar and salicylic acid, is another one on Coppola's list of products recognized by the National Psoriasis Foundation.
The Final Takeaway
If you're looking for scalp psoriasis shampoos, you can rest assured that you'll find relief—but it might take a couple of weeks longer than you were expecting. If you're finding that you're not seeing results, it might be time to see a dermatologist for a prescription-strength option.
Singh JA, Guyatt G, Ogdie A, et al. 2018 american college of rheumatology/national psoriasis foundation guideline for the treatment of psoriatic arthritis. Journal of Psoriasis and Psoriatic Arthritis. 2019;4(1):31-58.
Slutsky JB, Clark RAF, Remedios AA, Klein PA. An evidence-based review of the efficacy of coal tar preparations in the treatment of psoriasis and atopic dermatitis. J Drugs Dermatol. 2010;9(10):1258-1264.