Guidelines for the Treatment of Scalp Psoriasis

General comments

  • If there are any doubts about the diagnosis then refer.
  • Try each treatment for 1 month before moving to the next.
  • Depending on the clinical situation one or more options may be tried from stage 2 and 3 before moving up to the next stage i.e. in more severe cases that are not responding satisfactorily it will be appropriate to move to the next stage having only tried one option.
  • The response is unsatisfactory if the patient is not happy with the level of control. The degree of control that is satisfactory is very personal and highly variable.

Guidelines

  1. Make the correct diagnosis
  1. Try anti-inflammatory shampoos (4 weeks at night)
  1. T gel
  2. Polytar
  3. Capasal
  1. Try an anti-inflammatory agent (4 weeks at night)
  1. Coconut oil, tar, salicylic acid compound (Sebco) scalp application
  2. Coal tar 5% (Exorex)
  3. Betamethasone valerate 0.1% scalp application (Betnovate)
  4. Psoriderm scalp lotion
  5. Diprosalic scalp application
  6. Dovonex scalp solution
  1. Calcipotriol 50 micrograms/ml plus betamethasone diproprionate 0.05% (Dovobet gel)
  • To be used for 2-4 weeks then stop for 2-4 weeks
  • During the weeks off Dovobet use a tar product or shampoo
  • Repeat if needed
  • Continued use, without breaks, will lead to tachyphylaxis and could cause skin atrophy
  1. Should I refer the patient? Only if –
  2. They are willing to attend the dayunit for intensive nurse supervised topical treatment
  3. The scalp psoriasis is severe enough to warrant systemic treatment and the patient is prepared to take tablets – usually methotrexate.

NOTE

Successful treatment of scalp psoriasis by topical agents requires lots of patient motivation. Rotation of treatments is often needed. Assistance in applying treatments is often necessary.

Created by Newcastle upon Tyne Hospitals NHS Foundation Trust Dermatology Department 22.03.2016. Review date 22.03.2018