Psoriasis that affects the scalp is also called seborrheic psoriasis. The scalp may be the first site to be affected by psoriasis. The condition may resemble severe dandruff. Patches of thick, flaky skin may extend to the forehead below the hairline. Scales may build up in the outer ear. Other than the forehead and the ears, the face is usually spared. However, some people may have patches of inflamed skin that resemble seborrheic dermatitis a type of dandruff eczema that affects the scalp and face.
Psoriasis on the scalp is common and, in many cases, it is the only area affected. It usually consists of red, scaly patches that are sometimes lumpy. The edge of the patch tends to be well defined. This type of psoriasis can extend beyond the hairline, onto the forehead. Psoriasis of the scalp does not damage the hair follicle and is not associated with alopecia (hair loss), but if the scale is thick and forms hard lumps, it can lead to temporary hair thinning. However, this is not permanent and will grow back again after the psoriasis clears.
This form of psoriasis can be extremely uncomfortable. It is often very itchy, and the psoriatic patches that are inflamed and sore can start to bleed if they are scratched or picked. The condition is not caused by poor hygiene or hair care. Scalp psoriasis can be demoralizing, as the look of dead skin cells on clothing can be embarrassing, and it is not always easy to brush them off inconspicuously. Itchiness is another big problem, not only because of the social implication but also because it inflames the condition and makes it worse. Forehead along the hairline is a common site as is the temples, nape of the neck, around the ears, as well as the hair parting. Massaging a little warm baby/olive/coconut oil gently into the scalp, preferably before going to bed to allow plenty of time to soak (bind up the head in an old towel) will help. Wash out with cream shampoo (i.e. Dry Hair Products), add a little lemon juice to the final rinse to get rid of excess grease. Only shampoo three times a week, more than this and the natural oils may be washed out. Always treat the head as gently as possible, do not comb or brush harshly. Perms and colorants can be used as long as the skin is not broken. Shampoo the hair and scalp with a tar-based shampoo that can be purchased over-the-counter or by prescription. Shampoos, scalp steroid lotions, vitamin D analogues and some tar preparations such as tar pomade may be used on the scalp.
