Scalp Psoriasis (Psoriasis of the Scalp)

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Medical Author:

Gary W. Cole, MD, FAAD

Gary W. Cole, MD, FAAD

Dr. Cole is board certified in dermatology. He obtained his BA degree in bacteriology, his MA degree in microbiology, and his MD at the University of California, Los Angeles. He trained in dermatology at the University of Oregon, where he completed his residency.

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Medical Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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Psoriasis is an inflammatory disease of the skin estimated to affect about 2.2% of the adult population. Psoriasis is influenced by the genes that are inherited from parents. The genes affected seem to be involved with control of the immune system. Psoriasis appears as red scaling papules the combine into plaques that are classically present on the elbows and knees but can affect any part of the skin. The scalp is also characteristically affected in many patients with psoriasis. Like psoriasis anywhere, scalp plaques produce excess scale and can itch. Severe disease can cause a loss of scalp hair, which usually will return if the disease can be controlled.

The belief that "emotional stress" is a cause of psoriasis is difficult to support experimentally. There is no question, however, that psoriasis of the scalp is an extremely stressful experience.

As mentioned above, psoriasis appears as a small bump, a papule, surmounted by scale. When these papules combine, a plaque is formed that is covered by excessive layers of horny skin that is perceived as a silvery scale. This scale is shed and appears as dandruff. The scale and shedding can be quite profuse and unsightly. Scratching these plaques, either because of itching or because of the impulse to remove it, is a very poor idea because of what is called the Koebner phenomenon (also known as the Koebner response or isomorphic response). This is a peculiar predisposition of psoriasis to develop in areas of trauma. Scratching off the scale will only make things worse. Occasionally seborrheic dermatitis of the scalp can be confused with psoriasis since both can produce excess scale and can itch.