Psoriasis and the scalp: what to know

Scalp psoriasis is an inflammatory skin condition affecting the scalp, and it may reach the forehead, behind the ears, or the back of the neck. Affected skin may look red or darker than nearby skin, with dry scale that can be silvery, white, or closely adherent. Itching, tenderness, flaking, and cracking can occur. Scratching can irritate the skin and may loosen hairs temporarily, but flakes are not caused by poor hygiene. Dandruff and seborrhoeic dermatitis can look similar, so an examination helps distinguish them.

Use a fragrance-free cleanser and massage with fingertips rather than nails. Do not pick plaques or pull off scale; softening it first with a clinician-recommended emollient can reduce trauma. Follow the prescribed contact time and amount for any scalp lotion, solution, foam, or shampoo. Keep products away from the eyes and wash hands after application. Tell your clinician about hair dye, straightening, braids, or extensions, because friction and chemical irritation can aggravate active patches. Take photos during flares so changes are easier to discuss.

Arrange a dermatology review if scale is thick, the area is spreading, symptoms disturb sleep, or self-care has not helped. Seek prompt assessment for pus, increasing warmth, marked swelling, fever, or sudden painful hair loss, which can suggest infection or another scalp problem. Eye symptoms need separate medical attention. Psoriasis can also affect nails and joints, so mention nail pits, persistent joint stiffness, or swollen fingers during the visit.

Could this be scalp psoriasis or another scaling condition? Which treatment is suitable for the scalp, and how should it be applied around hair? How long should I try it before review? Could my nail or joint symptoms be related?