Julie Greenwood, who lives in Cary, NC, has had psoriasis for 30 years. Managing it on her scalp has been extra challenging, especially because of people’s reactions. “They seem to think it’s OK to brush the flakes off my shoulders or comment on all the white things in my hair,” she says.
Psoriasis may affect your scalp, hairline, and areas around your hair like your neck and ears. You may notice dandruff-like scales or thick, crusty plaques on your scalp.
With the right tips and tricks, you can manage it better.
Wash Your Hair Gently
Try limiting how often you wash your hair.
“Unless I get hot and sweaty, which I try not to do, I only wash my hair every 2-3 days,” Greenwood says. If she washes it more often, it dries out her scalp.
Be gentle when you shampoo. Avoid rubbing, scrubbing, and scratching. All these can make psoriasis worse.
Keep It Simple
“I’ve had psoriasis for 19 years and have gone through any and every product out there,” says Michele Ocana, a PhD student from Chicago. Ocana sticks to shampoos and conditioners with few ingredients. That has helped her.
“I use Alaffia unscented shampoo and conditioner. It’s only 4-5 ingredients and doesn’t dry out my patches,” Ocana says.
What works for you might be different. Keep in mind that “unscented” doesn’t mean that a product is totally free of chemicals. Like anything else that you put on your skin, you may need to experiment before you find your favorite products.
Try Medicated Shampoo
Over-the-counter medicated shampoos target your scalp to relieve mild symptoms and remove scales. They may also help your prescription topical medicine work better.
These shampoos are approved by the National Psoriasis Foundation:
- Dermarest Psoriasis Medicated Shampoo Plus Conditioner
- MG217 Medicated Conditioning Coal Tar Formula Shampoo
- Neutrogena T/Gel Therapeutic Shampoo-Stubborn Itch
“If you have a lot of redness and irritation, I like Neutrogena T/Gel Therapeutic Shampoo with coal tar. If you have a lot of thick, white scales, I prefer Neutrogena T/Sal Therapeutic Shampoo,” says Maryann Mikhail, MD, a South Florida dermatologist.
“Leave the medicated shampoo on your scalp for 2-3 minutes, at least twice a week,” Mikhail says.
David Chandler, who lives about 20 miles north of London, England, says it works for him. “I massage scaly areas with the shampoo and leave on to soak in. That appears to remove the loose pieces,” he says. After shampooing, he uses a fine-tooth comb to remove obvious flakes.
If medicated shampoo makes your skin feel too dry, alternate it with non-medicated shampoo
Be Smart With Styling
Take it easy with tools that use heat. They may dry your scalp even more.
“I mostly air-dry my hair,” Greenwood says. She says she only uses a blow dryer if she’s going out and wants a more styled look. Greenwood stopped using a curling iron years ago. She also stopped coloring her hair because it’s too harsh on her scalp.
The right haircut sometimes helps.
“I’ve had super short haircuts, hoping it would help my psoriasis, but now I like to keep it a little longer to hide any plaques that might show up through my short hair,” Greenwood says. Shoulder-length hair also helps her hide plaques just below her hairline, on her neck, and behind her ears.
Try Over-the-Counter Topical Treatments
If you have mild scalp psoriasis, over-the-counter products may help.
Look for products with salicylic acid. It helps soften thick patches and scales so you can remove them easily. It also helps your medicine penetrate better. Lift your hair out of the way, then apply it to your scalp.
Another effective ingredient is coal or wood tar. They can slow skin cell growth and help with inflammation, itching, and scales.
Greenwood has tried creams, lotions, foams, and oils. She says they often work, especially products with coal tar, but they can be messy.
Ocana agrees that topical treatments can be messy, but she says they’re worth the trouble.
After applying a topical treatment, Ocana wraps her head for about an hour, then rinses the treatment out with shampoo and conditioner. “It leaves my hair so moisturized and shiny that it’s worth it,�� Ocana says.
Consider a Topical Steroid
Talk to your doctor about topical steroids and prescription topicals.
“During an active flare, my go-to is a strong topical steroid solution like Clobetasol,” Mikhail says. “Use it twice daily for a week, then switch to weekends only for maintenance.”
Try Other Treatments
These treatments and remedies may ease symptoms.
Wet towels. “I’ve used a cold, wet towel on my scalp and a hot, wet towel,” Greenwood says. “I know that heat isn’t great for dry skin, but the hot towel feels so much better in the moment.”
Phototherapy. Phototherapy sends ultraviolet (UV) light to your scalp to slow skin cell growth and help with symptoms. You use a handheld unit with a built-in comb to make sure the rays get to your scalp.
Oral treatments and biologics. If you haven’t found a treatment that works well or if your psoriasis has spread beyond your scalp, your doctor may recommend prescription medication. One option might be methotrexate, a strong treatment that targets molecules inside immune cells all over your body. Another choice may be biologics, drugs that target specific immune cells.
Greenwood says biologics and methotrexate have helped her manage her scalp psoriasis better.
“One of the hardest things for me was learning to stop scratching my scalp every time it itched. Every time I scratched, I would lose clumps of hair,” Greenwood says. “There’s nothing that feels better than a good head scratch, but when my head is covered with psoriasis, I have to be as gentle as possible.”
Try to keep your hands off your scalp. It may help to keep your fingernails short.
Try to be flexible and patient. It may take time and trial and error to find the right mix of treatments and strategies that are right for you.