Psoriasis on the scalp: what should you know?

Scalp psoriasis can affect a small area or much of the scalp. Look for clearly defined patches with scale, redness or a darker change in colour, including along the back of the neck and around the ears. Scale may cling to the hair, making ordinary dandruff care less effective. Some people have only scalp symptoms, while others also develop plaques on the elbows, knees or other sites. Hair itself is not the target of the condition, although inflammation, scratching and forceful scale removal can make the scalp tender and may contribute to temporary shedding. Similar-looking rashes can have different causes.

Part the hair in sections so treatment reaches the scalp rather than resting on the hair shaft. Wash with lukewarm water, massage with fingertips instead of nails, and loosen scale slowly after it has softened. Avoid picking, harsh brushing and fragranced products if they trigger stinging. Follow the exact directions for any prescribed lotion, foam, solution or shampoo; do not increase use because a plaque is visible. A dermatologist can adjust treatment for dense hair, sensitive skin or plaques at the hairline. Read more about psoriasis, dry skin and skin scaling.

Book an assessment when scalp scale is new, widespread, very itchy, painful or not improving with gentle care. Get prompt medical advice if the skin becomes hot, swollen, increasingly red, drains fluid, develops deep cracks, or is accompanied by fever. Seek review for sudden or patchy hair loss, tender pustules, or rash near the eyes. These features may point to infection, a different scalp disorder or a treatment reaction, and they should not be managed by adding products at random.

Ask how the diagnosis was made, which areas need treatment, and how to protect the hair while applying it. Ask whether nail changes or joint pain could be connected, how to recognise a flare, and when follow-up is appropriate if scale or shedding continues.