Scalp Psoriasis: How to Treat this Tricky Area

by Heather Durocher Patient Expert

When my scalp psoriasis has been at its worse, I know this for sure: avoiding wearing black, or any dark-colored clothing for that matter, is wise. White flakes covering my shoulders and back, after all, isn't a look I'll ever be going for.

If you're like me and have scalp psoriasis, you probably can relate. You also know how itchy and downright uncomfortable it can be. In addition to struggling with scalp psoriasis since my teen years, I've also battled dry, flaking skin along my hairline and on the inside and outside of my ears.

I've found that treating these areas, as opposed to what we use for psoriasis on other parts of our bodies, comes with its own challenges. As a woman with long, thick hair, my scalp psoriasis has been especially burdensome at times. Having dark brown hair only seems to magnify any flaking I do experience.

At one time I figured switching to your over-the-counter dandruff shampoo would tame my angry scalp. Not so much. I instead have had to experiment over the years with various brands of medicated shampoos and conditioners.

Thankfully, many of these products no longer necessarily smell as bad as they once did. Manufacturers have gotten smarter and realized that we want something that treats our scalp psoriasis and smells clean and fresh. It's embarrassing enough to have scalp psoriasis - must we also endure terribly-smelling shampoos?

Here's what I've learned about treating my scalp psoriasis (including those tricky areas of the hairline and ears):

• I can't think of a time when I haven't had some flaking on my scalp. But this doesn't mean I'm always using medicated shampoos and conditioners. I love delicious-smelling hair product as much as the next woman, so I indulge in these as much as I can. But I also keep on hand bottles of therapeutic shampoos (and occasionally conditioners) when I notice more scalp build-up than usual. Neutrogena's T-Gel and T-Sal both have worked well for me, though I find that the T-Gel - containing 2.5 percent solubilized coal tar extract - is most effective when my scalp psoriasis isn't too widespread and built-up.

If it is especially thick - this typically happens during a pretty bad flare on my entire body - I'll turn to the maximum strength T-Sal, which contains 3 percent salicyclic acid. This ingredient fights the crusty, flaky build-up more effectively for me. I've also used shampoos and conditioners such as Selsun Blue and Walgreen's. It's true what my dermatologist once told me: you have to experiment, try different products, see what works best for you. And you should also try mixing things up every now and again since our scalp, like our skin on our bodies, can get accustomed to a particular product and no longer work as effectively.

• Sometimes you've got to go with something stronger than an over-the-counter product. I've used a slew of foams, liquids, solutions and prescription shampoos to combat my scalp psoriasis. Talk with your dermatologist about any prescription options. You can also target the scalp through ultra-violet light therapy. Check with your doctor for more information - some physicians have in-office UVB "comb-like wands" that can be used on the scalp. Biologic drugs, such as Enbrel, also can prove effective in battling scalp psoriasis; when I was using this medication for several months last year, I did notice that my scalp psoriasis diminished significantly. Again, talk with your dermatologist about whether this would be a good option for you.

Heather Durocher
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Heather Durocher

Heather wrote for HealthCentral as a patient expert for Psoriasis.