Scalp Psoriasis: A Literature Review of Effective Therapies and Updated Recommendations for Practical Management

Abstract

The scalp is one of the most commonly affected regions in psoriasis. However, scalp psoriasis can be difficult to treat because of challenges in the delivery of therapy. Effective therapeutic regimens for scalp psoriasis are essential to improving the quality of life of patients. Recent data on topical therapies, phototherapy, systemic agents, and complementary therapy have demonstrated that it is possible to achieve and maintain significant improvement in scalp psoriasis. In this review, efficacy data for these modalities and an algorithm for the practical management of scalp psoriasis are presented.

Narrative Review of the Emerging Therapeutic Role of Brodalumab in Difficult-to-Treat Psoriasis

“…The scalp is one of the most commonly affected body regions in psoriasis, with 45–90% of patients with psoriasis having scalp psoriasis. In adolescents with psoriasis, the scalp is often the only affected area [ 3 , 48 , 49 ]. Scalp psoriasis generally presents as erythematous plaques and flaky silvery white scales associated with dry skin, cracking, bleeding, and itch.…”

“…Topical corticosteroids are typically the first-line treatment of scalp psoriasis and are generally used in various formulations, including foam, gel, solutions, shampoo, and spray; they can also be used in combination with vitamin D analogues [ 48 ]. Scalp psoriasis is, however, difficult to treat with topical agents because of the presence of hair, poor accessibility to lesions, unappealing cosmetic effects (e.g., greasiness, unpleasant odors), difficulties in application, and increased frequency of applications required, thus leading to poor patient adherence and dissatisfaction with treatments.…”

“…Scalp psoriasis is, however, difficult to treat with topical agents because of the presence of hair, poor accessibility to lesions, unappealing cosmetic effects (e.g., greasiness, unpleasant odors), difficulties in application, and increased frequency of applications required, thus leading to poor patient adherence and dissatisfaction with treatments. Use of systemic or biologic therapies in such cases may therefore be warranted [ 3 , 8 , 48 ].…”

“…Systemic therapies (e.g., methotrexate, cyclosporine) may be used as second-line therapy when topicals or phototherapy have failed [ 48 ]. The efficacy of conventional systemic agents for psoriasis is well documented [ 51 , 52 ].…”

Non-Pharmacological Treatments of Psoriasis in Persian Medicine a Narrative Review

“…Available treatments can be classified as topical treatment, systemic treatment, and phototherapy [ 8 ]. For patients with mild psoriasis, topical medications such as topical corticosteroids, vitamin D analogues, calcineurin inhibitors, keratolytics, and coal tar have been used [ 9 ]. Patients with moderate-to-severe disease can be treated with biologics (such as etanercept, adalimumab, certolizumab, infliximab, ustekinumab, secukinumab and ixekizumab) and small molecules (apremilast) [ 10 ].…”