Psoriasis hair symptoms: scalp signs and next steps

Scalp psoriasis may appear as well-defined areas with thick scale, including at the hairline, behind the ears or on the neck. It can itch, feel sore and leave flakes on clothing. Hair may look dry because scale and treatments build up around it. Scratching, picking and forceful scale removal can break hairs or increase shedding; this does not necessarily mean the follicles are permanently damaged. Dandruff, eczema, fungal infection and contact reactions can have similar features, so diagnosis may require examination.

Use the cleanser or medicated scalp treatment recommended for you, allowing it to remain in place for the advised time before rinsing. Loosen scale gradually rather than pulling it off. Comb gently, avoid tight braids and minimise heat or chemical treatments when the scalp is sore. Keep nails short to reduce damage from scratching. Photographing the hairline and noting periods of shedding can help your clinician judge whether treatment is working and whether another cause needs attention.

Arrange care when scalp symptoms are new, spreading, or not settling with the plan you were given. Seek prompt advice for sudden heavy shedding, bald patches, pus, bleeding, painful swelling, marked crusting or fever. A clinician can check the scalp, hair shafts and skin beyond the hairline, then choose treatment that fits your symptoms. Mention joint stiffness or nail changes because these can provide useful clues about psoriasis activity.

Is my shedding from inflammation, scratching, breakage or another condition? How should I remove scale safely? Which shampoo or scalp treatment fits my hair type? When should I return if the hairline changes?