Scalp psoriasis is a common form of psoriasis, affecting between 45 percent and 56 percent of those in the U.S. living with the disease. Aside from causing uncomfortable symptoms — including raised, scaly patches, flaking, and itching — scalp psoriasis can spread to other areas of the head, neck, and ears, causing it to be particularly noticeable.

“Psound Bytes,” the National Psoriasis Foundation’s podcast, recently invited Tirsa Quartullo to discuss scalp psoriasis. Quartullo, a board-certified family nurse practitioner with Arizona Dermatology and Cosmetic Surgery, weighed in on over-the-counter (OTC) treatments and tips for managing scalp psoriasis.

1. Choose the Right Over-the-Counter Medicated Shampoo

“There are a lot of products that are over the counter, specifically for psoriasis,” explained Quartullo. “A lot of these psoriasis shampoos can be very effective in reducing many symptoms, such as the flaking, the redness, and the itching.”

According to Quartullo, three of the most effective ingredients to look for in OTC shampoos for psoriasis are:

• Coal tar (or psoriasin) — “We have been using coal tar to treat psoriasis for over 100 years,” noted Quartullo, adding that this tried-and-true ingredient helps slow down the growth of skin cells, reducing scaling and the thickening of scalp lesions.
• Salicylic acid — This treatment is a keratolytic agent, meaning it causes the skin to shed or peel. Quartullo explained that salicylic acid works as a “scale softener,” helping to make plaques easier to gently remove from the scalp.
• Selenium sulfide — This ingredient helps to reduce the accumulation of yeast and bacteria on the scalp — both of which can contribute to inflammation and flake buildup.

Quartullo noted several of the many OTC shampoos containing the above ingredients, including:

• T/Gel Therapeutic Shampoo and DHS Tar Shampoo, which contain coal tar
• T/Sal Therapeutic Shampoo and DHS Sal shampoo, which contain salicylic acid
• Head & Shoulders and Selsun Blue, both of which contain selenium sulfide

“The type of shampoo that you can choose over the counter really depends on the specific issue that you’re trying to solve,” explained Quartullo.

Whether your concern is flaking, itchiness, or a combination of symptoms, you can work with your dermatologist to determine which ingredients will work best in managing your psoriasis.

Learn more about how to choose the right psoriasis shampoo.

2. Rotate Between Medicated and Nonmedicated Shampoo

Quartullo stressed that medicated psoriasis shampoos are specifically for the scalp. “They’re not necessarily the best for the hair strands,” she said. Certain ingredients, like salicylic acid, can actually dry the scalp when overused. “Don’t forget: A dry scalp is an itchy scalp,” she said.

For this reason, Quartullo suggested considering alternating between medicated and nonmedicated shampoos, depending on the severity of your psoriasis. Hair conditioner can also play an important role in preserving the softness and appearance of your hair while using medicated shampoos.

Note, however, that a lull in symptoms doesn’t necessarily mean being in the clear. As Quartullo explained, once you achieve your desired results, “it is recommended to not abruptly stop your treatments.” Instead, you may want to start using them less regularly — every seven or 10 days or so — for scalp maintenance and the prevention of further flares.

3. To Prevent Hair Loss, Don’t Pick or Scratch

Uncontrolled scalp psoriasis commonly results in hair loss, Quartullo said. In most cases, this is due to excessive scratching, picking, or trying to remove plaques.

“The good news with hair loss,” she added, “is that it’s temporary. So, once you find an effective treatment, the hair can actually grow back.”

Quartullo shared several ways of helping to prevent or minimize hair loss while living with active scalp psoriasis. Among them, she advised avoiding picking off the scales. “There are ways of removing the scales, but picking and aggressively removing them is certainly not one of them,” Quartullo cautioned.

Additionally, Quartulla recommended keeping your fingernails short. “If you do have an itch, at least if your nails are short, it won’t create such a severe trauma,” she said.

4. Treat Your Scalp With Care

As Quartullo noted, everyday grooming, scratching, and scrubbing can lead to the Koebner phenomenon, also known as Koebnerization. “What that refers to is the emergence of a new psoriatic lesion or plaque following an injury or a trauma” to the skin, she explained.

To avoid damaging the scalp and worsening psoriasis, Quartullo recommended treating the affected skin as gently as possible: “Vigorously brushing or washing too aggressively — or even habitually scratching or picking at the lesions — can actually produce or trigger new psoriatic lesions.”

The same goes for heat damage. Quartullo advised letting your hair air-dry and avoiding hot styling tools when possible, as a burn may result in Koebnerization. If necessary, keep heat styling tools set below 400 degrees Fahrenheit.

Quartullo also advised waiting until after flare-ups have subsided to undergo hair treatments like hair dye, bleaching, or chemical relaxers, as chemicals can worsen psoriasis.

Finally, she recommended using conditioner every day when you wash your hair. Doing so can help prevent some of the dryness associated with psoriasis shampoos

5. Be Open With Your Doctor

One of the most challenging aspects of living with scalp psoriasis, Quartullo stated, is the emotional impact it can have. “Living with scalp psoriasis has a stigma that can cause people with psoriasis to feel ashamed of their appearance — especially because it is in a very visible area, such as the face and the scalp.”

Mitigating the impacts of scalp psoriasis on your overall well-being starts with having open, honest conversations with your health care provider. Quartullo encouraged listeners to explain all the ways psoriasis affects their lives — including how it impacts their self-esteem or personal relationships or contributes to anxiety or depression.

“If it’s affecting your life that way,” Quartullo said, “your dermatologist should know.” How psoriasis impacts your day-to-day life can serve as a powerful tool for gauging the severity of your condition — and, subsequently, what treatments your dermatologist recommends.