Scalp

Scalp psoriasis ranges from minor scaling with erythema to thick hyperkeratotic plaques that cover most of the scalp and extend beyond the hairline (ie pityriasis amiantacea). See here for photos of scalp psoriasis.

Initial therapy for scalp psoriasis is usually a topical corticosteroid in a lotion formulation, because it is not greasy and easier to use on hair-bearing areas. Tar preparations often work faster, maintain control longer, and are effective at reducing inflammation and scale; however, patients need to be motivated to tolerate the pungent odour and colour.

If starting therapy with a topical corticosteroid, use:

If response to treatment is inadequate after 2 weeks, use a more potent corticosteroid. Use:

Once symptoms are controlled, add a coal tar–based shampoo (available over-the-counter in pharmacies) to help withdrawal of the topical corticosteroid. Apply the shampoo to the scalp, but do not wash off immediately; massage into the hair and scalp before rinsing off. Use daily until the skin is clear, and then twice a week for maintenance. If the scalp starts to itch, resume the topical corticosteroid.

If symptoms are not controlled with a topical corticosteroid, add calcipotriol. Use:

If the scalp develops thickened psoriatic scale, apply a tar pomade. Use:

LPC can be started at a lower concentration, and increased according to response.

Alternatives for thickened psoriatic scale on the scalp include Ung Cocois Co (an extemporaneous product) or Coco Scalp ointment (a commercially available product).

If treatment for scalp psoriasis is not effective, refer for dermatologist advice.

For practical information on using topical corticosteroids, tars and calcipotriol in psoriasis, see Topical drug treatment for psoriasis in primary care.