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Treatment Of Scalp Psoriasis

Topical Therapy:

Topical therapy includes corticosteroids, calcipotriol/calcipotriene, tazarotene, tars, and anthralin. Tars and anthralin are discussed above. If the psoriasis is thick, measures must be taken to thin down the plaques. Since creams and ointments are hard to apply to the scalp and wash out of the hair, they are rarely used to treat scalp psoriasis. Lotions, solutions, and gels are generally used since they are easier to apply, and do not give a greasy appearance to the hair, and are easier to wash out.

Topical Corticosteroids:

Topical corticosteroid gels, lotions, solutions, oils, and shampoos may be used to treat scalp psoriasis. They work quite quickly, often within 1-2 weeks however, with long-term use, steroids often lose their effectiveness.

Examples of topical steroid preparations:

Corticosteroid lotions

  • Valisone® lotion
  • Cyclocort® lotion

Corticosteroid gels

  • Topicort®gel
  • Topsyn® gel

Corticosteroid shampoo

  • Capex® shampoo

Corticosteroid - oil combination

  • Dermasmoothe F/S®

Corticosteroid mousse

  • Betamethasone and clobetasole mousse

Topical Calcipotriol/Calcipotriene:

Calcipotriol/calcipotriene is a derivative of vitamin D. The scalp solution may be easily applied to the scalp, the onset of action is usually slower (could take up to 2 months) than with topical steroids, but it is usually effective and safe for long term use. Since it may cause irritation, you should take care to limit application to your scalp and avoid use on your face.

Example of topical calcipotriol/calcipotriene scalp solution:

  • Calcipitriol scalp solution (Dovonex®)

Topical Tazarotene:

Tazarotene is a selective retinoid with properties that are similar to vitamin A. The gel formulation is generally applied once daily overnight to the scalp patches, it can be easily worked into your scalp. Scalp irritation may occur with this product, but less commonly than elsewhere. To minimize irritation, apply a thin layer of the medication only to the patches and avoid the uninvolved surrounding skin. You should not use this medication if you are pregnant.

Systemic Therapy:

Most of the time, oral medications are not required for scalp psoraisis, but if you have a very resistant case or if your itch is uncontrollable, they may be used.

Methotrexate:

Methotrexate is usually given once a week orally (pills) or occasionally by injection (with a needle). It helps control psoriasis affecting your skin, nails, and joints. Side effects include upset stomach, mouth ulcers, suppression of the bone marrow with low blood counts, and liver damage. Careful monitoring by your physician is essential on this medication. Liver biopsies may be required.

Acitretin:

Acitretin is a retinoid with properties similar to vitamin A. For most patients, it does not appear to be as effective as methotrexate or cyclosporine in the treatment of plaque psoriasis. However, it works quite well for pustular psoriasis. Side effects include dryness of your skin, lips, eyes, and nose, elevation of your cholesterol and triglyceride levels, liver toxicity, and bone changes. Since it may cause birth defects, it is used mainly in men, and women who are post-menopausal or have had a hysterectomy. Monitoring by your doctor, and regular blood tests are required while taking this medication.

Cyclosporine:

Cyclosporine is an immunosuppressant medication that is used in organ transplantation. It is very effective, but because of its cost and side effects (kidney toxicity, high blood pressure, numbness and tingling, hair growth, skin cancer, and lymphomas), it is usually reserved for people with severe, disabling, resistant disease. Careful monitoring by your doctor is required while taking this medication.


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