Dermatology/Scalp Psoriasis

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Question
Dr. Fisher,

I have been struggling with what I assume is scalp psoriasis, for quite some time. The reason I presume it to be scalp psoriasis is because of the raised red lesions and silvery, scaly plaques. Also, if I scratch/pick at it, it tends to get and stay sore (no secondary bacterial infx though...not yet anyway). I have tried Lotrisone, Hydrocortisone, Clotrimazole, Selenium sulfide, etc. with little to no relief.

I understand that Coal Tar preparations are quite effective and have recently begun another regimen of coal tar therapy. My first question is: How long does it usually take to see results with coal tar?

Also, I should mention that I have been taking Biotin (Vit B7) supplements (10,000mcg) for the past year or so, which also coincides with my current "flare up". However, I could not find much literature regarding biotin. Do you believe this could be a contributing factor?

I appreciate your time and services on this website!

-Radwa

Answer
Treating Mild Scalp Psoriasis

If your scalp psoriasis is mild, your doctor may recommend treatments like these:

Coal tar products. Available over the counter (OTC) as shampoos, creams, gels, ointments, and soaps. The effectiveness of these treatments varies but they can help slow skin growth and reduce inflammation, itching, and scaling.  To apply a coal tar shampoo, massage it into the scalp and leave on five minutes before rinsing thoroughly. You can leave other tar products on overnight. Staining and odor are the main drawbacks. A non-medicated conditioner after shampooing can reduce the odor of tar shampoo.
Salicylic acid. This peeling agent is available in OTC and prescription shampoos and soaps. It is used to soften scales, making them easier to remove.
Medicated shampoos. Available in coal tar and non-coal tar varieties, these can be used daily for scalp lesions. Use as directed.
Steroids. These may be injected into isolated scalp lesions if you only have a few lesions.
Moderate to Severe Scalp Psoriasis: Topical Treatments

Your doctor may prescribe topical steroids as solutions, lotions, sprays, or foams to treat moderate to severe scalp psoriasis. They range from mild to potent. Some topical treatments that are applied directly to the skin, then shampooed and rinsed out, include:

Anthralin (Psoriatec). Apply this cream once a day for 10 to 30 minutes.
Calcipotriene (Dovonex). This is a prescription form of vitamin D. Apply it at night and cover your scalp with a shower cap. Avoid eye contact.
Calcipotriene and betamethasone diproprionate (Taclonex Scalp).  This combination of a type of vitamin D and a potent steroid is applied once a day. It can be used for two weeks or until the scalp clears -- but usually no longer than eight weeks. Avoid eye contact.
Tazarotene (Tazorac). You apply this type of vitamin A in a cream or gel form. If using at night, let the medication dry before you go to sleep. Applying a moisturizer before tazarotene may help prevent drying.
Do not use stronger steroids for more than a two-week cycle. Closely follow directions for use.

Moderate to Severe Scalp Psoriasis: Systemic Treatments and UV Light

If you have moderate to severe psoriasis elsewhere on your body, one of these medications may help:

Methotrexate inhibits an enzyme involved in the rapid growth of skin cells.
Oral retinoids help control the multiplication of cells.
Cyclosporine suppresses key cells of the immune system.
Biologics target specific parts of the immune system.
Discuss potential side effects of these treatments with your doctor.

Ultraviolet (UV) light is another scalp psoriasis treatment option. However, hair can block the light from reaching your scalp. If you have thick hair, it may help to part it in many rows when using UV treatment. Hand-held devices (UV combs) can directly deliver a higher dose of light.

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Michael S. Fisher, <B>Ph.D., M.D.</B>

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