Psoriasis may cause thick, adherent scales that pile up on the scalp. This makes it difficult for topical medications to reach the scalp skin. The thick scales are difficult to remove. Scalp psoriasis may respond much more slowly than psoriasis in other areas, requiring special treatment. The following ideas are a good strategy for daily scalp treatment for psoriasis:
- In the morning, wash scalp with a commercial psoriasis shampoo followed by any conditioner. Your doctor may also recommend a medicated shampoo.
- While the hair is still wet, another great treatment option is to massage a prescription cortisone solution into the scalp skin. Often this is done nightly (as to not inconvenience hair styling during the day) or twice a day.
- At bedtime, massage in a scale-softener or removing solution such as coconut or mineral oil, or other. Your pharmacist may also mix 3% salicylic acid in mineral oil. Note: a combo option to use a cortisone (topical corticosteroid) a peanut oil mixture called Derma Smoothe (fluocinolone). Other great topical cortisones are fluocinonide, Clobetasol, or taclonex solution.
Note: The patient generally only has to use either Derma Smoothe oil or Fluocinonide. or Clobetasol or Taclonex (which is Betamethasone Dipropionate solution [a cortisone that is near equivalent to Fluocinonide] mixed with Calcipotriene [a vitamin D solution]) and not 2, 3 or all of these at a time. Derma Smoothe, a medium strength cortisone, is a great hydrating vehicle while Fluocinonide, Clobetasol and Taclonex are strong topical cortisones. Use one of the four solutions 1-6 x per week at night depending on the severity (or twice daily if desired).
Taclonex has a topical vitamin D solution to synergistically work with a strong cortisone. Both are very effective treatments though approximately 75% of “work” is being done by the cortisone. Taclonex is very costly but coupons and/or insurance may make it more reasonable. Often a prescription for Clobetesol or Fluocinonide is given along with a topical vitamin D (calcipotriene solution) which you can mix 1:1 (make a Taclonex equivalent). If the calcipotriene is not covered (expensive in the solution form) simply use the topical Clobetesol, Fluicinonide or Derma Smoothe oil l-2x a day l-6x a week as needed. Lastly as the Derma Smooothe is an oil and works in a different manner, some patients prefer this some days and then use the Clobetesol, Fluocinonide (with or without the calcipotriene mixed in) or the Taclonex on other days. You are welcome to modify the treatment as you see which things work.
After the scales have decreased, this strategy can be done l-3x a week. If you need to wash the hair in between treatment days, you may use a commercial shampoo followed by conditioner. Do not attempt to remove the scales by excessive brushing, scrubbing or combing. This may result in scalp irritation or injury.
* Shampoos or creams with tar help with redness and irritation. Shampoos or creams with salicylic acid help remove the scales. Products with tar include: T gel, DHS. You may also speak to your local pharmacist. As psoriasis can also cause inflammation inside to the body, please tell your provider if you have any new joint pain.
If you have any questions, please contact our office at: (801) 768-8800