Psoriasis of the scalp

[SameToo]

My daughter has just seen a dermatologist who has diagnosed this. He’s said it can be managed. Does this mean it’s incurable? Will it always be there and are there any foods etc that are likely to trigger it? Is it painful at all? I don’t really know anything about it. Thank you.

It can be managed means that treatment can get it under control, hopefully to the point that it won't be there at times. Sometimes it might flare due to stress or ill health.

It isn't painful but it can feel tight and itchy. What treatments has the dermatologist prescribed?

Yea it’ll always be there but can be managed and go into ‘remission’ where it could be not there at all to see for years. I have it and I’ve just noticed patches on my sons scalp but there’s much more treatment than when I was younger. I don’t have any at all at the minute.

Mine was very well controlled with Betnovate scalp lotion for flare ups, and some milder treatments and shampoos for other times. It remember it feeling tight and dry.

(I'm on a biologic now because other issues, which takes care of my scalp psoriasis too.)

It'll probably always be there to some extent. Stress doesn't help, neither does getting too hot or the hair getting too dirty/sweaty. Over-cleaning can be drying to the scalp so there's a balance to be struck. For spspecial ccasions- bridesmaid, prom, that kind of thing you can get steroid cream from the gp but they aren't recommended for long term or frequent use.
As for foods, you'll have to keep a track of that because it's very personal.
Try and find a shampoo that helps. Some of the medicated ones can hurt when you're applying them but they can help to clear the scales. So really my best advice us to try different things and see what helps. I know that's a bit obvious but it really is very personal to the individual. I find a cream that helps itching can reduce scratching, which is a real positive but obviously can be difficult to apply to the scalp.
No easy answers but don't panic, it's an annoyance, nothing more.

Thank you all, this is really helpful. The dr has recommended using neutrogena shampoo twice a week and combing with a nit comb to remove loose scales. My husband also mentioned a cream the dr said to use but I’m not sure of the name.

@SpindelWhorl

Mine was very well controlled with Betnovate scalp lotion for flare ups, and some milder treatments and shampoos for other times. It remember it feeling tight and dry.

(I'm on a biologic now because other issues, which takes care of my scalp psoriasis too.)

What is a biologic please?

Biologics are systemic drugs, usually injected, for people with very severe psoriasis and other autoimmune conditions like inflammatory arthritis. I'm on Imraldi, better known by its US name, Humira.

They lower your immune system so are not given out by GPs. Only a consultant can prescribe them after all other avenues have been tried, usually.

I have this -have done since I was little! I’d also recommend using a gentle sulphate free shampoo on the days you don’t use the specialist shampoo as it makes a big difference (for me) as to how tight/sore/dry my scalp feels. Now I don’t use the specialist shampoo at all but my psoriasis is much less bad than it used to be. It’s an autoimmune issue so no cure as such but I can have long periods of remission. Stress is a trigger for flares (for me anyway). I watched a documentary once in the bbc that suggested omega three supplements would help….

I have had this condition for many years. I have been in so much pain when it has been bad, particularly in my head but everywhere else on my body too.
I have been prescribed lots of different medications and even tried stuff from the pet shop in an effort to alleviate the amount of scaling and bleeding and the discomfort that this 'thing' causes.
I have had light treatment at the hospital which was wonderful and kept the 'beast' at bay for a good eighteen months at a time, but it always returned.

These days I am in remission mostly and only have very small patches of psoriasis on my elbows, under my breasts and at the base of my spine, which I treat with Betnovate cream, but if my scalp shows any sign of anything I instantly apply my Betnovate scalp application. It is cooling and stops the rash from breaking out.

I co-wash my hair. Shampoo has a drying effect and even the coal tar shampoos which I used when it was bad do not really help.

The main thing you have to try to avoid doing and it is almost impossible not to - is scratch the itch. Scratching causes bleeding and makes the rash worse, and in your head the flaking and dandruff effect is embarrassing especially for a young person.

Betnovate scalp application and cream is my saviour. I hardly ever use it but I always have some - just in case.

My husbands given me the info from the doctor which says it’s Pityriasis amiantacea which is as a result of psoriasis I think? I’m more confused now as i can’t work out if this one causes alopecia and baldness as the information seems contradictory. Does anyone have any experience of this condition? Or is it something that commonly occurs alongside psoriasis?

@SameToo

My husbands given me the info from the doctor which says it’s Pityriasis amiantacea which is as a result of psoriasis I think? I’m more confused now as i can’t work out if this one causes alopecia and baldness as the information seems contradictory. Does anyone have any experience of this condition? Or is it something that commonly occurs alongside psoriasis?

OP, pityriasis amiantacea is quite rare and can be associated with psoriasis vulgaris (i.e. 'regular' psoriasis), but needs specialist treatment, which you have rightly sought by having an appointment with a dermatologist.

There's quite a lot online about this, but you tend to see photos of the worst cases, so don't despair.

Just to add - I found having scalp psoriasis incredibly stressful and humiliating as a girl. This stress fed back into my triggers for psoriasis and it got worse. My parents were very unhelpful in that they didn't take it in their stride; they made it all about their stresses and strains with lots of dramatic sighing and eye-rolling and arguments about whose fault it was. (Sounds mad, but that's how it was.) I'd have loved them to have let me take the lead on treating it and given me a lot more privacy to do so (as age appropriate).

Your DD may also need someone to talk to about this, such as a counsellor, at some point, maybe through school perhaps.

@SpindelWhorl thank you so much for this. It is definitely an area I am worried about as there is enough pressure on girls as it is. She’s currently 3, so I am hoping that the management of it is just something that she does as she gets older because it will be what she’s used too? I was going to explain to her about using a special shampoo for her head but do you think that would be worse?

I think telling her she has a special shampoo to help to make it better is absolutely fine.

Thank you @SpindelWhorl I really appreciate it.

I’ve had this on and off since I was 21 (I’m 44 now). The best treatment I’ve had has been Dovobet scalp gel (on prescription) and washed out with Capasal shampoo (cheaper over the counter than on prescription).

It cleared it up very well for a few years, but stress has triggered it again and this combination is keeping it just about under control (but I still know it’s there).

Good luck!

Thank you @StrongTeaDropOfMilkNoSugar. Can I ask if it affected your confidence at all or if it’s something you don’t really notice?

@SameToo I must admit it did when I was in my early 20s and it was really bad (before I used this treatment). I avoided wearing dark colours because of the flakes showing up on my back and shoulders, and didn’t put my hair up in a pony tail because of how the back of my neck looked near my hairline. I also subconsciously scratched my head and picked at scales (sorry, grim I know!) which drew attention to it.

Mostly gone now and I can keep it in check. If the neutrogena shampoo doesn’t work then ask the GP or dermatologist what options there are on prescription for children.

Thank you @StrongTeaDropOfMilkNoSugar I appreciate the info.

@StrongTeaDropOfMilkNoSugar sorry to ask another question, but did any of your hair fall out and did it grow back? Some of DDs has come out and looks to be growing back but I’m worried it won’t or that it’ll be really brittle.

@SameToo No, it didn’t. It might be where’s she’s scratched her scalp rather than the psoriasis itself.

Why don't you do some googling? Try www.psoriasis-association.org.uk

It's not curable but it can be kept under control, via diet, reducing stress, etc. But you might have to try lots of things before you find one that works.

Both my son and I get bad psoriasis on our scalps. We use Alphosyl 2 in 1 medicated shampoo when we have a flare up and use Body Shop ginger shampoo the rest of the time. I've used all sorts of shampoos and found that the body shop one is the best one throughout.

I had this as a teenager, I did lose hair and have a couple of permanent tiny bald patches on the tip of my head. They're only noticeable when I part my hair a certain way. HOWEVER this was because my parents didn't seek treatment and wouldn't take me to the GP Eventually I took myself and got steroid lotion and it improved massively. I think it was the delay in getting treatment that led to the hair loss, and if I'd got it sooner it wouldn't have happened.

My dad had this from being about 17 to late fifties. He cut out all sugar from his diet (including refined carbs, bread etc) for 6 months.

It went and never came back.

Thank you @StrongTeaDropOfMilkNoSugar and everyone.

@RavenAtTheWindow that’s what worries me. We sought treatment but it was wrongly diagnosed as ringworm for a year so she has some patches where the hair has come out or is broken but seems to be growing back just thinner. I feel awful. We pushed for samples to be taken to check it was ring worm but because of Covid etc it took until last month for the dr to do it to then find out it wasn’t that. Her diagnosis came from going private and I’m so angry with myself we didn’t do it sooner. Definitely have failed her on this.