When psoriasis affects the scalp, it causes thick, silvery-white or gray scales that may be inflamed and itchy. You may also feel burning or other discomfort. Psoriasis is an autoimmune skin disease in which the body’s immune system mistakenly attacks healthy skin cells, leading to the overproduction of skin cells.

In psoriasis, the scalp is the most commonly affected area. About 80% of psoriasis cases involve the scalp. Although it is rare for the scalp to be the only area affected by psoriasis, it is entirely possible. While there is no cure for psoriasis, it is treatable and manageable.

Symptoms

Scalp psoriasis causes scaly, inflamed skin patches on the scalp. Skin patches may also be found on the forehead, hairline, back of the head, and behind the ears.

Some people with scalp psoriasis may experience only mild, fine scaling. Others may have more severe symptoms.

Moderate and severe scalp psoriasis may cause the following symptoms:

• Red, purple, or brown skin patches
• Silvery white or gray scales 
• Dry scalp
• Itching 
• Burning
• Soreness 
• Bleeding
• Hair loss

What Scalp Psoriasis Looks and Feels Like

Scalp psoriasis causes a buildup of skin cells called skin plaques, which appear on the hairline, back of the head, forehead, neck, and ears.

Scalp psoriasis may present differently in different skin tones. For example, it will appear on light to medium skin as raised, red, or salmon-color patches with white scales. On darker skin, the patches may be purple or brown, and the scales may be gray.

Scaly patches may itch or feel sore. You may feel a burning sensation. The itch may be intense, affect sleep, and interrupt daily activities. 

Causes

Psoriasis occurs when the immune system malfunctions, causing skin cells to grow too quickly and pile up in patches. The underlying mechanisms are not yet fully understood. It is not a contagious condition.

Scalp psoriasis runs in families, so there may be a genetic predisposition. Psoriasis development is also linked to other factors called triggers that, in addition to genes, increase one’s risk for psoriasis. 

Possible triggers of psoriasis include:

• Infections 
• Physical or mental stress
• Air pollution 
• Medications  
• Smoking 
• Alcohol consumption
• Some health conditions, including metabolic syndrome, obesity, diabetes, and hypertension

Scalp Psoriasis vs. Dandruff

Dandruff is a common scalp problem in which dead skin cells are shed in large amounts. It causes flakes that fall off the scalp or cling to the hair.

Dandruff causes an itchy scalp and is sometimes considered a mild form of seborrheic dermatitis, a common skin condition mainly affecting the scalp.  Dandruff isn’t a serious condition and can be treated at home with over-the-counter (OTC) shampoos and ointments. 

While scalp psoriasis can cause similar symptoms to dandruff, it is a much more serious condition. It is a chronic condition you will have for the rest of your life, while dandruff can come and go. Scalp psoriasis outbreaks can be painful, while dandruff mainly causes itch. 

The most significant distinction between dandruff and scalp psoriasis is that psoriasis is an autoimmune disease.

Management and Treatment Options

Mild scalp psoriasis can be treated with OTC topical treatments (treatments that are applied directly to the skin). Moderate to severe scalp psoriasis needs more aggressive treatments, such as prescription topicals, systemic (whole-body) medicines, and ultraviolet (UV) light therapy.

Over-the-Counter and Home Remedy Options 

Topical treatments are first-line treatments for scalp psoriasis. Many are OTC and do not need a prescription.

OTC topicals for treating scalp psoriasis may include:

Some people also use home remedies. However, you must be cautious as some of these can irritate the scalp, produce an allergic reaction, or aggravate scalp psoriasis:

Prescription Treatment 

Psoriasis can sometimes be stubborn and resistant to OTC topicals. A dermatologist (a physician who diagnoses and treatments conditions of the skin, hair, and nails) can help you manage scalp psoriasis with prescription therapies. 

Prescription treatments for scalp psoriasis may include:

• Anthralin, an older topical treatment that can be applied directly to the scalp
• Antimicrobials to treat bacterial and yeast infections 
• Calcipotriene and betamethasone dipropionate, a combination medicine that contains a form of vitamin A (to slow down skin cell growth) and a corticosteroid (to reduce swelling, pain, itch, and other discomfort)
• Calcipotriene without a corticosteroid 
• Stronger topical steroids 
• Disease-modifying antirheumatic drugs (DMARDs) oral medicines, such as methotrexate, cyclosporine, and Otezla (apremilast)
• DMARD biologics, which are available as injections and infusions, to reduce skin cell growth
• Janus kinase (JAK) inhibitors that work to calm the immune system
• Ultraviolet (UV) light therapy to treat the entire scalp

Preventing Scalp Flares 

While psoriasis has no cure, you can reduce the number of scalp flare-ups you have by following your treatment plan. Research shows that people who follow their treatment plans have fewer flare-ups and are more likely to experience periods of remission.

You can also reduce flares by avoiding triggers that would lead to them. Some flare triggers are:

• Stress
• Infections and illnesses 
• Skin injuries 
• Cold, dry weather
• Smoking
• Alcohol consumption 
• Allergies 
• Medications 

When to See a Provider 

If you are experiencing scalp pain, itching, or soreness, make an appointment with a healthcare provider. They can examine your skin and run tests to determine if scalp psoriasis is the cause of symptoms or if it is something else.

If you were previously diagnosed with scalp psoriasis, you will want to reach out to your healthcare provider for:

• New symptoms, either related to the skin or systemic (fever, fatigue, etc.)
• Worsening symptoms
• If treatments are not helping 
• If psoriasis is affecting your mental health or self-confidence
• If you are curious about a new treatment 
• If your joints are starting to hurt

The National Psoriasis Foundation reports that up to 30% of people with psoriasis will develop psoriatic arthritis, a type of inflammatory arthritis that affects the joints and entheses (the areas in the body where tendons and ligaments connect to bone).

Summary 

Scalp psoriasis is an autoimmune skin condition that causes scaly, inflamed patches. The cause is unknown, but researchers think genetics and other risk factors might be involved. 

Treatment for psoriasis includes OTC topical medicines, prescription topicals, corticosteroids, biologics, and light therapy.

If you or a child have scalp pain, itching, soreness, or visible lesions, make an appointment with a healthcare provider. They can examine the scalp and run tests to diagnose psoriasis or another cause. Once you have a diagnosis, you can begin treatment, which may lead to clearer skin.