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Psoriasis & Scalp Psoriasis

Psoriasis can be a very painful, self-esteem-lowering skin disease.  It is a chronic, inflammatory disease affecting the skin, joints and nails. Psoriasis lesions commonly appear on the scalp, and hairline (known as scalp psoriasis), limbs and lower back, but they can occur anywhere on the body.

Disease overview

Description of Psoriasis & Scalp Psoriasis

["sor-eye-ah-sus"]

The causes of psoriasis are not fully understood and are the subject of ongoing research. In psoriasis, the immune system is mistakenly activated, which leads to overproduction of skin cells. Skin cells build up too rapidly on the surface of the skin, forming raised, red, scaly patches (called plaques). These plaques are often itchy and sometimes painful.

Some people are not very affected by their psoriasis symptoms, but for others, psoriasis is a disabling and embarrassing condition that affects their lifestyle and their interactions with others. There are many available treatments that may help to relieve symptoms and improve daily life.  In addition, psoriasis may occur in more than one part of the body. You should examine your elbows, knees, torso and fingers for symptoms of psoriasis. If you have scalp psoriasis these other areas may be similarly affected. If you’re not sure whether patches on your skin are psoriasis or not, talk to your healthcare professional.

Symptoms of Psoriasis & Scalp Psoriasis

These can vary from person to person and may include one or more of the following features:

  • Thick, red patches of skin (plaques) variable in size covered with silvery scales.  In scalp psoriasis these form on the scalp and around the hairline
  • Itching
  • Nail psoriasis and arthritis may also be present

What is the difference between scalp psoriasis and dandruff?

Dandruff and scalp psoriasis can be sometimes difficult to distinguish. Both are common conditions that affect the scalp and they may share similar symptoms (e.g. itch, redness and scaling). The following table may help you to distinguish between these two conditions by visually examining your and dandruff. However, telling the difference can be difficult. If you’re in doubt about whether your dandruff may indicate scalp psoriasis scaling, talk to your healthcare professional.

Scalp psoriasis dander

Dandruff dander

  • Larger
  • Thicker
  • Silvery
  • Many
  • Smaller
  • Finer
  • Yellowy or whitish
  • Powdery, like flour

Disease severity

The severity of psoriasis can range from a few spots of scaling in only certain parts of the body to major eruptions that cover large areas and are difficult to treat. Mild cases may be regarded as a nuisance, but more severe cases can be painful, disfiguring and disabling. Roughly 20% of psoriasis case are moderate to severe.The severity of scalp psoriasis can range from a few spots of dandruff-like scaling to major eruptions that cover large areas and are difficult to treat. Scalp psoriasis can also extend beyond the hairline onto the forehead, the back of the neck and around the ears. Persistent scalp lesions can eventually lead to thinning hair or even hair loss.  Regardless of the severity, psoriasis can impact a person’s quality of life.

KEY MESSAGES:

IMPORTANT FACTS ABOUT PSORIASIS

  • Psoriasis is not contagious.
  • Sufferers develop psoriasis between the ages of 15-20 years or later between 50-60 years. Around 75% of patients are affected before the age of 40.
  • Psoriasis varies from person to person in severity, in clinical presentation and how it responds to treatments.
  • The scalp and limbs are the most common places where psoriasis appears, but it can occur anywhere on the body, especially the knees, elbows and trunk.

Diagnosis

No special blood tests or diagnostic tools exist to diagnose psoriasis. A dermatologist or other healthcare professional diagnose psoriasis from the signs and symptoms by examining the entire skin surface. Sometimes a skin biopsy is taken and examined under the microscope to help differentiate between psoriasis and other disorders.

Quality of Life

Psoriasis has important consequences, both physical and emotional. Studies have shown that people with psoriasis have a lower quality of life and lower self-esteem than people who do not have the disorder. The physical impacts of psoriasis include irritation, pain or burning sensations. The emotional impacts include an increased chance of depression and impaired coping skills. People with psoriasis can feel stigmatised which may result in avoidance of social settings and increased isolation.

Causes, Triggers and Risk Factors

The causes of psoriasis are not fully understood today. The current consensus from healthcare professionals is that the immune system, genetics and the environment (e.g. stress, cold weather, etc.) all play major roles in the development of psoriasis. As a result there is skin inflammation accompanied by overproduction of skin cells.

Cells in the upper skin layer normally mature and are shed from the skin’s surface every 28 to 30 days. With psoriasis, the cells can mature in 3 to 6 days then move to the skin surface and pile up.

Research suggests that both genetic and environmental factors play a role in causing T cells (white blood cells) to malfunction.  In psoriasis it is thought that T cells attack healthy skin cells by mistake, as if to heal a wound or to fight an infection. 

  • Scientists believe that at least 10% of the general population inherits one or more of the genes that create a predisposition to psoriasis
  • However, only 2-3% of the population develops the disease

Researchers believe that for a person to develop psoriasis, the individual must have a combination of the genes that cause psoriasis and be exposed to specific external factors known as “triggers.”

Like many other skin conditions, psoriasis symptoms may come and go in cycles. Some people may not have symptoms for weeks, even months. You may notice that certain factors in your daily life may worsen (“trigger”) your psoriasis symptoms to flare-up. Trigger factors can be different from one person to another. It is important to be aware of the factors and avoid them.

Factors that may trigger psoriasis include:

Infection

  • Bacterial throat infection

Stress

  • Relaxation and stress reduction may help prevent stress from impacting psoriasis

Injury to skin

  • Cut or scraped skin, severe sunburn

Other suspected factors

  • Smoking
  • Heavy alcohol consumption

Anyone can develop psoriasis, but these factors can increase your risk of developing the disease:

Family history

The most significant risk factor for psoriasis is having a family history of the disease. 1 out of 3 patients with psoriasis may have a close relative who also suffers from the disease.

Other medical conditions

People with HIV are more likely to develop psoriasis than people with healthy immune systems.
Children and young adults with recurring infections – particularly streptococcal throat infection – may also be at increased risk.

Stress

Stress can impact your immune system and may increase your risk of developing or worsening your psoriasis.

Obesity

Excess weight increases your risk of psoriasis. In addition, plaques associated with all types of psoriasis often develop in skin creases and folds.

Smoking and alcohol

Smoking tobacco and alcohol consumption can increase your risk of developing or worsening psoriasis.

Treatments & Practical Tips

Psoriasis treatments can help control psoriasis and offer significant relief of its symptoms.  Treatment usually aims to:

  • Interrupt the cycle that causes an increased production of skin cells. This reduces inflammation and plaque formation
  • Remove scales and smooth the skin

Your healthcare professional will help you to decide which treatment is best for you. 

Treatments for psoriasis can be divided into 3 main types:

  • Topical treatments (creams, foams, lotions or ointments applied to the skin)
  • Light (photo) therapy
  • Systemic therapies (taken by pill or injection)

For mild to moderate psoriasis, topical treatments can in many cases be used effectively on their own. But when the disease is more severe, your healthcare professional may prescribe a regimen of different therapies to manage symptoms over time. The typical uses and side effects of various treatments used in the United Kingdom are discussed below. Most of the products discussed below are indicated for use primarily in adults, so speak to your healthcare professional about the suitability of a particular therapy in children or adolescents younger than 18 years of age.

Topical Treatments

How it works on psoriasis

Corticosteroids

 

Main characteristics;

  • Reduces inflammation, scaling, redness and itch.
  • Most commonly used for mild-moderate psoriasis and can be used in combination with other treatments for moderate-to-severe psoriasis.

Formulations include;

  • Cream, ointment, gel, foam, spray, lotion, shampoo, etc.
    Strengths range from very potent to mild

Potential side effects include;

  • Always follow the advice of your healthcare professional, but generally avoid long-term use;
  • May cause skin thinning, changes in pigmentation, stretch marks and redness.
  • Use of very potent medications can affect adrenal function.
  • Avoid contact with eyes and with skin around the eyes.

Vitamin D3 

Main characteristics;

  • Reduces scaling, inflammation and itch. Often combined with corticosteroids for more effectiveness and less irritation and is generally suited to longer term use.

Formulations include;

  • Ointment
  • Cream
  • Foam
  • Lotion
  • Scalp solution

Potential side effects include;

  • Some preparations can be irritating, so contact with sensitive skin (face, eyes and lips) should be avoided.
  • Less common effects are dry skin, peeling and rash. 
  • May also affect how your body metabolises calcium, so tell your healthcare professional if you have kidney disease or renal insufficiency.

Retinoids

Main characteristics;

  • Vitamin A derivative
  • Slows skin cell growth and may reduce inflammation..

Formulations include;

  • Cream or gel (gel absorbs more rapidly, while cream may be less irritating if skin is dry or sensitive).

Potential side effects include;

  • Irritated, dry skin
  • Avoid contact with eyes
  • Sun sensitivity.

Coal Tar

 Main characteristics;
  • One of the oldest treatments
  • Reduces scale, itch and inflammation. 
  • Effectiveness varies from person to person.

Formulations include;

  • Many formulations available e.g cream, gel, oil, ointment, shampoo.
  • The higher the tar concentration the stronger the product.

Potential side effects include;

  • May irritate, dry and redden the skin
  • Messy: Stains clothing, bedding and light colored hair
  • Strong odour.
  • 'Unpleasant' smell.

Salicylic acid

 Main characteristics;
  • Softens scales making them easier to remove. 
  • In some circumstances, healthcare professionals may recommend use with other medications to allow more effective drug delivery.

Formulations include;

  • Various formulations depending on if for use on skin or scalp.

Potential side effects include;

  • May irritate the skin if left on too long.

Light (photo) therapies

These treatments use artificial ultraviolet (UV) light to treat psoriasis.

Systemic Medications

Oral medications and biologics may help to clear psoriasis, but are only appropriate for moderate to severe cases. These drugs are potent and can have side effects that must be considered before taking.  Your healthcare professional will help you assess which form of treatment is appropriate for you.

You may want to consider the following factors when selecting a treatment that is right for you:

  • First, the treatment should never be worse than the psoriasis itself.
  • When choosing the treatment with your healthcare professional your lifestyle, available time and your budget have to be taken into account to help decide among the options
  • The treatment should be used until the condition is under control or as directed by your healthcare professional. Remember that some products should only be used for a limited time because of risks or side effects, so speak to your healthcare professional about how long you can use the product safely.
  • Keep in mind: treatment compliance strongly influences treatment effectiveness (If you don’t use it, it won’t work!)
  • Apply topical treatments only to psoriasis lesions if possible. This will help to avoid irritating unaffected skin.
  • A thin layer of medication is generally sufficient.
  • Wash your hands thoroughly after applying topical treatments, unless treating the hands.
  • Do not apply topical treatments in areas of the skin not discussed with your healthcare professional, especially near the eyes, genitals or other sensitive areas.
  • When prescribed a regimen of topical treatments, apply them exactly as your healthcare professional instructed.
  • Cleanse or prepare the lesions for treatment as directed by your healthcare professional.  Do not cover or ‘occlude’ your topical medication with other products like moisturisers or other medications unless specifically directed to do so by your healthcare professional. 

HELPFUL HINT

  • Protect healthy skin with a thin layer of petroleum jelly before applying medications to the psoriatic lesions.
  • Stain protection Here is a list of some easy and accessible household items you can use to protect from staining while treatments are active:
  • Towels
  • Plastic wrap*
  • Plastic produce bags*
  • Cotton socks
*Be sure not to obstruct airways if using plastic to protect untreated areas of the body

Although these suggestions won’t cure psoriasis, they may help reduce the discomfort of affected skin.

Daily baths

  • Helps to remove scales and calm inflammation
  • Avoid harsh soaps

Moisturise

  • Moisturise frequently, especially after bathing, while skin is still moist
  • Oil may be preferred for very dry skin

Avoid drinking alcohol and smoking

  • Alcohol consumption and smoking worsen psoriasis

Avoid psoriasis triggers

  • Try to keep track of the types of things that worsen your psoriasis 
    (e.g. stress, smoking, etc);
  • You may want to keep a psoriasis diary to help determine what your triggers may be.  See below for an example.

The goal of keeping a psoriasis diary is to help you and your healthcare professional better manage your psoriasis symptoms and treatments.

A psoriasis diary can be useful for identifying triggers and determining the treatments that work well for you in relieving your psoriasis symptoms. The example diary here can help you to follow improvements in a psoriasis flare-up. Noting the factors that play a role in your psoriasis flare-ups is a small task, but it may go a long way in deciding on an effective treatment plan that works for you.

It is a good idea to take your psoriasis diary with you when visiting your healthcare professional. Make sure it is clear and legible. If you arrive prepared, many of the questions your healthcare professional may ask can be answered quickly and more thoroughly.

What to include in your psoriasis diary

1. When does your psoriasis seem to worsen?

  • This will help you to identify what factors trigger your psoriasis flare ups
  • When looking back at your diary, you may see that your psoriasis often occurs after certain types of events (e.g. environmental factors, emotional stress, with certain medications, after drinking alcohol, etc)

2. On a calendar, keep track of any treatments used for your psoriasis and the effect it had on your lesions

  • Make sure to record which symptoms, if any, improved after each treatment (e.g. itchiness, redness, scaling, etc)
  • Record changes in symptoms on a scale of 1 to 10, where 10 is the worse and 1 is better

Before beginning treatment for a flare-up, select and record your most distressing psoriasis symptom and note its severity. 
Use the below headings the psoriasis medications you are using and how this symptom improves or worsens with each application of your psoriasis therapy. This will help you to follow the effectiveness of your psoriasis treatment.

  • Took medication for the following symptom (e.g. redness, scaling, itchiness):

  • Severity at start of treatment: (Normal)   1   2   3   4   5   6   7   8   9   10   (Severe)

  • Medication Name (formulation, dose)

  • Date used

  • Left on for how long? (if applicable)

  • Severity at end of treatment period: (Normal)   1   2   3   4   5   6   7   8   9   10   (Severe)

  • Notes

galderma.co.uk is focused on educating the public and patients about skin conditions and the different types of treatments that are available to treat and manage these diseases. This site is not intended as a substitute for medical advice from your doctor, dermatologist, or other healthcare professional and may include discussions about therapies or treatment options that are not suitable for your individual needs. We encourage you to use the information contained in this site to educate yourself about your disease and allow better communication between you and your healthcare professional.  Always consult a dermatologist or a healthcare professional for more information about your condition and the appropriate treatment / product that is right for your individual needs.

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