Psoriasis on the head: what to know

Scalp psoriasis may form thick, dry or greasy-looking scale on the scalp, behind the ears, at the neck or along the hairline. Itching can be distracting, and scratching may cause soreness or small areas of bleeding. Scale can loosen and fall onto clothing, but this does not mean the condition is infectious. Hair usually grows through affected skin, although forceful scratching or picking can injure the scalp. Seborrhoeic dermatitis, eczema and fungal infection can resemble it, so a clinician may examine the scalp and hairline before choosing treatment.

Use the prescribed scalp treatment exactly as directed, allowing it to reach the skin rather than coating only the hair. Loosen scale gradually with a suitable emollient if your clinician recommends it; do not scrape with a comb or fingernails. Wash gently, rinse products thoroughly and avoid very hot water. Choose fragrance-free products when the scalp is irritated, and pause harsh chemical treatments if they cause burning. Keep nails short to reduce injury from scratching. Mention hair loss, tenderness or discharge during review so the cause can be checked.

Seek a dermatology assessment if scalp scale is persistent, extends beyond the hairline, bleeds with minor contact or is affecting sleep. Prompt care is appropriate for spreading warmth, pus, severe tenderness or fever. Report new joint pain or stiffness as well. Sudden patchy hair loss, broken hairs or painful scalp areas need examination because they may point to another condition or a complication of scratching.

Does the scalp pattern fit psoriasis or another rash? How should I soften and remove scale? Which treatment is safe around my hairline and ears? What should I do if itching causes bleeding or hair changes?