Current Management of Scalp Psoriasis

Lyn Guenther, MD, FRCPC, FAAD


Skin Therapy Letter. 2015;20(3) 

In This Article

Abstract and Introduction


The scalp is involved in up to 80% of individuals with psoriasis. Eighty percent of those with scalp psoriasis experience a negative impact on quality of life. Topical treatment with corticosteroids with or without vitamin D3 analogues is the mainstay of treatment. Topical therapy most suitable for the scalp is formulated as a solution, lotion, gel, foam, spray, oil, or shampoo. Twice weekly maintenance in frequent relapsers may decrease the time to first relapse. Intralesional steroids, phototherapy and the excimer laser are occasionally used for resistant cases. In patients with moderate-to-severe psoriasis, apremilast, adalimumab and etanercept have been shown to significantly improve scalp psoriasis. They should be considered in patients who have failed topical therapy.


Up to 80% of individuals with psoriasis have scalp involvement, and 80% of those with scalp psoriasis experience a negative impact on quality of life.[1] Topical therapy is first-line treatment, with both the active ingredient(s) as well as the vehicle affecting efficacy, tolerability and treatment adherence.[2] In 2009, the US National Psoriasis Foundation recommended intralesional corticosteroids as second-line treatment, and phototherapy, conventional systemics and biologics as third-line treatments.[3]