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.
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.
Psoriasis is an inflammatory disease of the skin that is estimated to affect about 2.2% of the adult population. Some people may have a genetic predisposition to psoriasis. The genes affected seem to be involved with control of the immune system. Psoriasis appears as red scaling, slightly raised areas (papules) that combine to form plaques. Psoriasis classically appears on the elbows and knees, but it can affect any part of the skin. The scalp is also characteristically affected in many people 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.
Picture of scalp psoriasis. Source: iStock.com.
What is the cause of scalp psoriasis?
It is generally accepted that scalp psoriasis, like all psoriasis, is related to genetic defects that affect certain parts of the immune system. There are undoubtedly environmental factors that trigger its initial development in genetically predisposed individuals. The belief that "emotional stress" plays a causal role or at least exacerbates psoriasis has been difficult to prove. There is no question, however, that psoriasis of the scalp can be 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 its 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.
Psoriasis PUVA Treatment Can Increase Melanoma Risk
The treatment of psoriasis depends on its severity
and location. Treatments range from local (cortisone cream
application, emollients, coal tar, anthralin preparations, and sun exposure)
to systemic (internal medications, including methotrexateand