Treatment of Scalp Psoriasis

August 2022 | Volume 21 | Issue 8 | 833 | Copyright © August 2022


Published online July 28, 2022

Rabia Ghafoor MDa, Anant Patil MDb, Paul S. Yamauchi MDc,d, Jeffrey M. Weinberg MDe, Leon H. Kircik MDe,f,g,h,i, Stephan Grabbe MDj, Mohamad Goldust MDk

aJinnah Postgraduate Medical Centre, Karachi, Pakistan
bDepartment of Pharmacology, Dr. DY Patil Medical College, Navi Mumbai, India
cDermatology Institute and Skin Care Center, Santa Monica, CA
dDivision of Dermatology, David Geffen School of Medicine at University of California, Los Angeles, CA
eIcahn School of Medicine at Mount Sinai, New York, NY
fIndiana University Medical Center, Indianapolis, IN
gPhysicians Skin Care, PLLC Louisville, KY
hDermResearch, PLLC Louisville, KY
iSkin Sciences, PLLC Louisville, KY
jDepartment of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
kDepartment of Dermatology, University Medical Center Mainz, Mainz, Germany

Abstract
Scalp involvement is seen in a majority of individuals with psoriasis, a chronic autoimmune skin disease with variable phenotypes. Occasionally, isolated scalp involvement is observed; and this causes significant psychosocial morbidity. Management of scalp psoriasis is difficult, in part due to the difficulty of applying topical agents and its refractory nature. Various treatment options are available with variable efficacy. Topical agents include topical steroids, keratolytics, tar and anthralin compounds, vitamin D analogues, and vitamin A derivatives. The combination treatment of topical betamethasone and calcipotriene is the most effective topical therapy. Systemic agents include conventional agents such as methotrexate, cyclosporine, and oral retinoids. Biologics offer a greater efficacy, with near complete or complete clearance of the scalp. In this article we review the published literature on adult and scalp psoriasis to highlight its treatment. Articles published in peer-reviewed journals were included for qualitative analysis of the literature, including reviews, clinical trials, case series, case reports published in the electronic database (MEDLINE/PubMed) through June 2021, cross references of respective articles, and trials from clinicaltrials.gov.

J Drugs Dermatol. 2022;21(8):833-837. doi:10.36849/JDD.6498

INTRODUCTION

Psoriasis, a chronic autoimmune skin disease affecting individuals with geographical variations, has multifactorial pathogenesis. Worldwide prevalence is about 2%, but prevalence varies according to the region. The prevalence in Caucasian and Scandinavian populations is up to 11%.1 The pathogenesis of psoriasis is complex, resulting from the complex interplay of genetic, environmental, and immunological factors.2 It has a bimodal age of presentation. Chronic plaque psoriasis is the most common, with other presentations including guttate, pustular, unstable, and erythrodermic varieties. Psoriasis may involve any part of body, in particular the nails, scalp, and intertriginous areas. The most common phenotype is chronic plaque psoriasis, which affects about 85% to 90% of patients. Scalp involvement may be seen in any of the phenotypes of psoriasis.4

Diagnosis and assessment of scalp psoriasis
Scalp psoriasis affects about 80% of psoriatic patients.5 Clinically, it manifests as erythematous to salmon pink plaques covered by silvery scales, involving the scalp and sometimes extending to the nape of the neck, ears, or forehead. The patient usually complains of intense dandruff and itch. Seborrheic dermatitis is the most important differential diagnosis in patients with isolated scalp psoriasis.6 It may cause reversible non-scarring alopecia. Scarring alopecia has been rarely reported.7 Koebner phenomenon is seen in patients with scalp psoriasis as a result of injury including routine hair care. It adversely affects the patient's quality of life and has a significant psychosocial impact.8

Assessment of severity of scalp psoriasis
Decisions on how to manage scalp psoriasis depend upon
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