Scalp Psoriasis: Causes, Symptoms, Treatment Options, and Flare Management

Unless you’re living with scalp psoriasis, it’s hard to understand just how tough the condition can be when it’s out of control or what a relief it is when it’s well-managed. 

Fortunately, today we know more about the best scalp psoriasis treatment options than ever before—from medications that provide rapid relief, to holistic strategies that improve your skin health from the inside out. 

Whether you’re newly diagnosed or have been living with scalp psoriasis for years, empowering yourself with more knowledge about your condition is a huge step towards better skin health. 

So if you’ve got questions about your scalp psoriasis—like what the most common triggers are, or how to treat scalp psoriasis naturally—then we’ve got expert answers. 

Here, we’ll take you through all the scalp psoriasis basics, from what causes it to the most effective treatments for scalp psoriasis. 

What Is Scalp Psoriasis?

People often think of psoriasis as just a skin problem, but the condition starts below the surface. “Psoriasis is a systemic inflammatory condition,” explains Rachel Day, M.D., Chief Medical Officer of Zest. 

That means that your immune system is overactive, which causes chronic inflammation throughout your body—including the skin, where it causes rashes. (Some people with psoriasis will also have psoriatic arthritis, where the inflammation affects the joints, causing joint damage.)  In psoriasis, the inflammation is primarily affecting the skin. (When the inflammation also affects the joints, it causes psoriatic arthritis.) 

This inflammation interferes with your skin’s natural regeneration cycle. It’s normal to shed around 40,000 skin cells every single day.  Meanwhile, new skin cells form every 30 days or so to replace the lost ones. But in psoriasis, inflammation causes new skin cells to form too quickly—every few days instead of every few weeks. “Your skin is developing faster than your body can keep up with shedding it,” Dr. Day explains. 

The buildup of skin cells creates the patches of thick, scaly skin (called plaques) that you see in psoriasis. The scalp is often the first place that psoriasis shows up, and research published in the American Journal of Clinical Dermatology found that about 80% of cases involve the scalp at some point. 

Causes of scalp psoriasis

So, why does this happen? What makes one person develop scalp psoriasis and not another? According to the Mayo Clinic, scientists are still unraveling the precise causes. But generally speaking, the formula is “genes plus environment,” Dr. Day says. 

Genes

Scientists have discovered over 80 different genes that can make you more vulnerable to developing the condition, according to research.

That’s why psoriasis tends to run in families. “If your parents have psoriasis, you're more likely to have psoriasis,” Dr. Day says. But it’s not guaranteed. And studies show that only about 20% to 40% of people with psoriasis have a family history.

Environment

The second variable in the equation is certain environmental triggers that can actually “turn on” the genes that make you more susceptible to psoriasis.

Climate is one pivotal factor. “Globally, we see less psoriasis as we get closer to the equator,” Dr. Day says. That’s because sunlight and humidity are anti-inflammatory (meaning they help fight the underlying inflammation). 

In fact, somebody with a genetic predisposition could grow up psoriasis-free in sunny, steamy Florida—and then develop the condition when they move north to a darker, drier climate, Dr. Day explains. Another example of an environmental trigger is long-term exposure to air pollution, a recent study found. 

Scalp Psoriasis Symptoms and Diagnosis

The signature sign of scalp psoriasis is thick, scaling plaques on the scalp, hairline, and behind the ears, Dr. Day says. 

On lighter skin, psoriasis plaques are red around the base, with a silvery or white scale on top, Dr. Day says. On darker skin, plaques may look more salmon, purple, or dark brown with a gray scale, according to the National Psoriasis Foundation (NPF). 

These plaques can cause scalp flaking that looks like dandruff. You’ll probably also experience symptoms like serious itching, irritation, soreness, and stinging, Dr. Day says. “It can be very painful.” 

You might even notice bleeding or temporary hair loss from excessive scratching or picking at plaques, the American Academy of Dermatology (AAD) says. (As itchy as you may be, scratching will only make your psoriasis worse. This is called the Koebner phenomenon, where trauma to the skin actually triggers more inflammation, Dr. Day explains.) 

To diagnose you, a dermatologist will take a good look at your scalp, as well as ask about your symptoms and family history. Sometimes they’ll want to confirm the diagnosis (and rule out other conditions) by taking a small skin sample to look at under a microscope. 

Effective scalp psoriasis treatment options

You certainly don’t have to suffer just because you’re living with scalp psoriasis. There are a variety of highly effective treatments for scalp psoriasis available, from drugstore shampoos and scalp psoriasis home remedies to prescription pills. 

Keep in mind that scalp psoriasis treatment is not one-size-fits-all. The cornerstone of successful treatment is partnering with a specialist who is not only well-versed in the many scalp psoriasis treatment options out there, but who will tailor their treatment approach to your individual needs and goals. 

At-home scalp care

If you’re interested in gentle but effective scalp psoriasis home remedies, start with the products you use every day. “Having the right over-the-counter scalp-care routine makes a big difference,” Dr. Day says. These are the key ingredients to look for in shampoos and scalp serums: 

• Salicylic acid: Salicylic acid, commonly found in psoriasis shampoos, breaks down built-up dead skin cells and gently exfoliates scales. “That then allows moisturizers and topical prescription medications to penetrate the skin better,” Dr. Day says. 
• Coal tar: This shampoo ingredient soothes inflammation and provides scalp psoriasis itching relief, Dr. Day says. 
• Ketoconazole: Shampoos containing this antifungal are particularly good for preventing yeast and flake buildup in people who don’t wash their hair as frequently, Dr. Day says (like individuals with Afro-textured hair, whose hair is dried out and damaged by frequent washing). 
• Emollients: These hydrate a dry scalp and “keep the skin barrier healthy,” Dr. Day says. She recommends applying argan oil or coconut oil once or twice a week in the evening, after your scalp treatment. 

Equally important is what’s not in your products: Avoid irritating ingredients like fragrances and dyes. 

The best shampoo for scalp psoriasis is a gentle, fragrance-free formula containing a beneficial ingredient, Dr. Day says. She recommends Vanicream products. You can also look for the NPF seal of recognition on products from brands like Neutrogena, MG217, and Act+Acre. They sell special scalp psoriasis shampoos and scalp treatments.

Topical prescription medications

The next least invasive but still effective treatments for scalp psoriasis are various prescription topicals. “Topicals work really well for many people,” Dr. Day says. They usually come as a foam, gel, solution, or medicated shampoo. (For most people, scalp psoriasis creams aren’t convenient to apply—though they can work well if you’re bald, Dr. Day notes.)

• Topical steroids
  • Often the first choice, they’re the most prescribed psoriasis medication in the U.S. Topical steroids provide rapid scalp psoriasis itching relief, reduce inflammation, and slow down skin cell growth. Your doctor might prescribe you a solution or shampoo containing clobetasol propionate, for example. 
• Vitamin D analogs
  • If topical steroids aren’t providing full relief—or your dermatologist is worried about side effects from overuse—they may prescribe another kind of topical, like a solution containing a vitamin D analog (a lab-made version of vitamin D). This puts the brakes on skin cell production, the National Library of Medicine explains.
• Newer topicals
  • More recently developed topicals specifically for psoriasis (like Vtama and Zoryve) have “unique mechanisms of action” that can reduce inflammation and lead to a remission period, similar to some systemic medications, Dr. Day explains. 

Systemic treatments

Finally, systemic treatments (meaning they work throughout the entire body) may be needed if you have a severe case of scalp psoriasis that doesn’t respond well to other treatments, Dr. Day says. 

One option is phototherapy, where doctors use a specific kind of light (narrowband UVB light) that, provides scalp psoriasis itching relief and tamps down on:

• Rapid skin cell growth
• Overactivity in the immune system
• Inflammation

Then there are biologics (given by IV or injection) and immunomodulators (usually taken in pill form). These treatments “address the underlying immune system overactivation” causing psoriasis, Dr. Day explains. While these more aggressive scalp psoriasis treatment options can be “very effective” for more severe psoriasis, Dr. Day says, they also carry risks— like an increased risk of infection with biologics. 

Managing and preventing flares 

Using the right scalp-care products and medication is essential. But if you’re curious about how to treat scalp psoriasis naturally, you’ll be glad to learn that taking a holistic approach to skin health is also key for minimizing flares. 

Bathing and hair care routines

Maintaining a healthy “micro-environment” on your scalp prevents local inflammation that can trigger or worsen flares, Dr. Day says.

Number one: Regular washing to prevent inflammatory yeast and flakes from building up. Most individuals should wash their hair every day or every other day, Dr. Day says. For individuals with Afro-textured hair, whose hair can be damaged by frequent washing, she recommends washing once a week with two different shampoos (like one with ketoconazole and one with salicylic acid). Always be sure to wash with warm instead of scalding hot water and cap your showers at about 15 minutes, the Cleveland Clinic says.

Be careful when it comes to hairstyling. The AAD recommends the following to avoid triggering or exacerbating flares:

• Gently brush and comb your hair, and avoid scratching the scalp.
• Don’t wear your hair in tight styles. (“That traction on the hair follicles can exacerbate psoriasis, so wearing looser hairstyles supports a better scalp health environment,” Dr. Day explains.)
• Avoid using heat-styling tools (curling irons, straighteners, and blow-dryers) too often.
• Never let hot styling tools touch your scalp.
• Talk to your dermatologist before coloring, perming, or chemically relaxing your hair. Color can be “really tough on the scalp,” Dr. Day says.

The Cleveland Clinic also recommends not wearing hats too often to allow your scalp to breathe. 

Lifestyle habits

You’ll also want to focus on anti-inflammatory habits that can reduce the inflammation in your whole body, and therefore your risk of flares.

“If you're working to decrease systemic inflammation, your scalp psoriasis will get better,” Dr. Day says. Many of the best things you can do for your overall health—like quitting smoking, cutting down on drinking, and losing excess weight if you’re overweight—are good for your scalp psoriasis, too. Why? Smoking, alcohol, and fat cells can all promote inflammation.  

Diet

What you eat can impact your scalp psoriasis. “If you're eating a lot of fast food and heavily processed foods, it’s not good for your body, it's not good for your inflammation, and it's certainly not good for your [scalp] psoriasis,” Dr. Day says.

Excess fat and sugar can harm your gut microbiome and gut lining, causing inflammation. But fresh whole foods and anti-inflammatory diets “have a positive impact on psoriasis,” Dr. Day says.

A 2022 review of 34 studies on psoriasis and diet found that the Mediterranean diet showed “promising results.” And if you have celiac disease (which people with psoriasis are at higher risk of), eating gluten-free to avoid inflammation has a “significant impact on your skin,” Dr. Day says.

Identifying triggers

If you feel like you’re doing all the right things and you’re still experiencing frequent flares, then psoriasis triggers might be to blame, Dr. Day says.

What are the triggers for scalp psoriasis? It depends on the person, but common triggers include stress, illness, alcohol, sunburn, cold and dry weather, and certain medications. Tracking your unique triggers—with the assistance of a symptoms log and a supportive doctor—can help you prevent flares, or at least be proactive when you know one’s coming.

If you’re interested in a more integrated approach, seek out a psoriasis specialist who appreciates the link between lifestyle, psoriasis, and general health and can discuss those nuances with you. “Finding somebody who dedicates the majority of their time to treating people with psoriasis will allow you to get that holistic, well-rounded approach,” Dr. Day says. 

Impact on quality of life

Living with scalp psoriasis can take its toll not only physically, but emotionally and mentally, too. “It can have a tremendous impact on your day-to-day life,” Dr. Day says. For example, “If you're really itchy, it's hard to focus and it's hard to sleep.”

So your performance at work, ability to be present with loved ones, and energy levels can all suffer. Not to mention, a flare can dampen your mood and cause you stress. Psoriasis is even inked with depression and anxiety.

It’s not unusual to feel insecure about your appearance, either, due to scaling, flaking, or hair loss. “A lot of patients report feeling self-conscious or embarrassed,” Dr. Day says.

Researchers have found that psoriasis affects people’s body image and self-esteem. Living with scalp psoriasis can feel isolating, too, since it isn’t as normalized as something like acne. “Almost every single person has had a pimple, so most people get it. But that’s not true with psoriasis,” Dr. Day says.

While poorly managed scalp psoriasis is a big burden, the upshot is that good psoriasis care can be life-changing.

Getting your psoriasis under control can drastically improve not only your skin health—but your focus, sleep, mood, and confidence. “It’s really important to talk about quality of life and how treatment can positively impact that,” Dr. Day says.

Partnering with a team of psoriasis experts at Zest who deeply understand the scalp psoriasis journey, the role of inflammation, and the various treatments is empowering. 

An experienced specialist can provide you with effective treatments for scalp psoriasis that align with your needs—from routine scalp care, to prescription medications, to healthy lifestyle choices that can help prevent flares. With the right team behind you, you can find scalp psoriasis relief that lasts.