Scalp psoriasis is a chronic condition where skin cells build up too quickly, forming silvery-red patches that can flake, bleed, and itch. Simply put, it’s plaque psoriasis of the scalp.
Over 8 million people in the United States have psoriasis, and it’s estimated that close to half have scalp psoriasis.
Not much is known about the cause of psoriasis apart from it being an autoimmune disease. Psoriasis is generally believed to be caused by a combination of genetic factors and environmental triggers.
Psoriasis scales on the scalp can be a setback to feeling confident and moving comfortably throughout your day. You may feel eager to scrape off your scales quickly. But approach this with caution. Removing these scales incorrectly can result in additional pain and infection.
When done properly, mitigating the scales and flakiness of scalp psoriasis can provide cosmetic benefits, pain relief, and help your medications work better.
The short answer is: yes. It’s safe to remove psoriasis scales if you’re doing it the right way.
Before you start picking at them, however, speak with a primary care doctor or dermatologist.
The biggest concern regarding flake removal is ripping healthy skin away. This can lead to additional pain, discomfort, and scarring. By picking your scales, you risk enlarging the affected area.
The scalp is a tricky place to treat psoriasis, since many people want to balance maintaining their hair health with treatment.
It’s important to be patient and gentle throughout this process to ensure you’re protecting your hair and healthy skin.
The following steps will help to remove scales and aid in the overall treatment of your psoriasis. But you should see a doctor before getting started.
1. Use gentle chemical exfoliants
The American Academy of Dermatology stresses the importance of using active ingredients to remove scales from your skin. This is important because they soften the attachment of the scale to the skin, making the scales easier to remove.
Locate the scales that you want to remove
Your approach will be different if the scales are hidden under hair, sitting right at your hairline, or behind your ears.
Choose a spot treatment or shampoo
If your scales are surrounded by hair, it’s best to use a medicated shampoo to soften them. Although shampoos have milder ingredients than topical spot treatments, they provide the added benefit of gentle physical exfoliation.
A spot treatment might have stronger ingredients and should be applied directly onto hairless skin.
For expert recommended shampoos, check out this list from the National Psoriasis Foundation.
Choose your ingredients
Look for the following ingredients, either in shampoos or topical creams:
- Salicylic acid is a powerful exfoliating ingredient that can be found in shampoos and creams. It helps lift and soften scaling and is best as a spot treatment. Shampoos with salicylic acid should be used sparingly, as they can dry your scalp and may lead to more flaking.
- Coal tar is one of the most common ingredients in psoriasis shampoos. It helps soften any scaling on the scalp.
- Lactic acid and urea work similarly to salicylic acid. They’re scale lifters that soften and break down the thickness of your flakes. They can be found in shampoos or spot treatments.
2. Physical Removal
Once the scales on your scalp have been softened, it’s safe to work toward physically removing the scales from your head.
Start by shampooing your hair with a psoriasis shampoo. Slowly work the shampoo into your head and use your fingertips to gently massage the scalp.
This light exfoliation technique detaches the softened flakes from the bed of your scalp. You shouldn’t feel unusual pain or resistance.
Consider a scalp mask before you rinse out your shampoo. Lock in the active ingredients with some warm (not hot) water by wrapping the affected skin in a towel or plastic wrap for 15 minutes.
This can accelerate the softening of your scales.
Remove the flakes with a gentle fine-toothed comb. In the process of exfoliating your scalp, some flakes might get stuck in the strands of your hair. A fine-tooth comb will be able to pick up any detached scales.
Gently run the comb through wet hair for removal, cleaning the comb and discarding the flakes as you go.
Consistent use of medicated shampoo should help improve the symptoms of psoriasis and limit flaking.
But you should speak with a doctor before deciding which one to use for your skin and hair.
If you need to remove scales quickly, but you’re not in a position to go through the three steps above, consider keeping an oil or occlusive ointment handy. A quick pat of oil or petroleum jelly to the affected area can help flatten the scales, easing your symptoms and disguising the flakes temporarily.
Improving the symptoms of flaking associated with scalp psoriasis involves consistent treatment. Here are a few scalp treatments you can consider trying at home or discussing with a doctor.
- Coal tar. This is most commonly found in shampoos. It counteracts the rapid skin growth caused by psoriasis and improves the overall appearance of the skin.
- Keratolytics. Just like salicylic acid, lactic acid, and urea, these can be found in creams, shampoos, or foams. They’re peeling agents that help loosen and remove scales.
- Hydrocortisone. This is an ingredient that helps reduce the itching and inflammation associated with scalp psoriasis.
- Steroid injections. Applied directly into scalp plaques, these injections must be administered at a doctor’s office. They can help reduce inflammation.
- Prescription medicated shampoo. This may be necessary if you find that over-the-counter shampoos don’t work well enough for you. A doctor might be able to prescribe something stronger to treat your scalp plaques and ease your symptoms.
- Oral retinoids. These help reduce redness and swelling while slowing rapidly growing skin cells.
- UV light treatment. This treatment can work to combat psoriasis by applying UV light directly onto the plaque. This can be done by parting the hair carefully (to expose the affected area) or by using a hand-held UV comb.
If you notice that home treatments worsen your symptoms, or if your symptoms persist, see a doctor.
They’ll be able to properly diagnose your symptoms and help devise a treatment plan that works for you.
Removing the scaling caused by scalp psoriasis is safe to do when done with care.
Avoid pulling at existing scales. Instead, treat psoriasis scales with active ingredients that soften them and help them break off from the scalp. The safest physical removal of scales is from shampooing and gently combing the scalp.
With some patience, and the help of a doctor, you can reduce the discomfort caused by scalp psoriasis.