Psoriasis affects 2-4% of adults in France, both men and women. The scalp is one of the most common sites, affecting almost half of all affected patients. Dr. Charlotte Fitt, head of the Dermatology Department at Saint-Joseph Hospital in Paris, tells us more about the treatment options for this skin disease that is still poorly understood and above all poorly recognized.
What is scalp psoriasis?Psoriasis is an inflammatory skin disease that can affect any area of the body, including the scalp (elbows, knees, lower back, anogenital area, nails, armpit folds, groin folds, buttock folds, etc.). It is not contagious (infectious) or an autoimmune disease. However, the WHO recognizes it as a serious, although not life-threatening, illness. “Psoriasis is an exaggerated immune response limited to the skin and hairy areas, with no easily identifiable cause,” defines Dr. Charlotte Fitt, head of the Dermatology Department at Saint-Joseph Hospital in Paris. All we know is that 30% of cases are a disease with a familial predisposition. “
This dysregulation accelerates the renewal of the skin surface, leading to the accumulation of dead skin (or whitish “scales”), which can flake off in the form of thick patches, leaving behind bright red lesions. Psoriasis develops in fits and starts over time. It affects men and women of all ages. “Thus, breakouts can appear delayed after a difficult life event as a signal to take care of yourself,” explains the dermatologist.
Hair psoriasis symptoms
Psoriasis often appears as red patches covered with white flakes called scales. Hair psoriasis manifests in a similar way. Patients with the disease alternate between two phases: catagen (plaque formation and growth) and telogen (disappearance of symptoms). Psoriatic plaques often cause itching and, if present on the hair, can spread to the forehead.
Impact of scalp psoriasis
The majority of people with psoriasis lead completely normal lives, experiencing one or two flare-ups in their lifetime, but not necessarily long-lasting disease. About 20% of patients are more severely affected, due to the duration of the lesions, the recurrent nature of the disease (attacks occur at relatively short intervals), and extensive damage. “The majority of patients have moderate damage, with persistent, although not very extensive, patches. The hair is particularly affected (affected in 40% of patients), causing significant discomfort to the patient and affecting their personal and social life,” points out Dr. Charlotte Fitt. Treatment of scalp psoriasis Currently, there is no treatment that can reliably cure psoriasis. However, complete cure may occur naturally without medication, although the exact mechanism is unknown. In addition, patients with chronic or recurrent scalp psoriasis are now well-treated. “In fact, research has advanced significantly over the past 20 years, and we now have an arsenal of treatments that can effectively reduce the symptoms associated with psoriasis, especially those on the scalp,” emphasizes Dr. Charlotte Fitt. About 15 new molecules with proven efficacy and tolerability have actually been launched on the market. A real therapeutic revolution for patients!
No excessive hygiene for psoriasis
The first element of treatment: avoid touching the plaques too much. “One of the problems with psoriasis is that it itches. People immediately associate this disease with an unclean disease, which is a mistake,” continues the dermatologist. In fact, excessive friction can paradoxically worsen scalp psoriasis. Shampoos that cause too much friction can promote the formation of psoriatic plaques. Therefore, it is necessary to avoid rubbing, scratching or removing the plaque, since this manipulation has the effect of preserving the plaque.
“Local” treatment of lesions
These locally applied treatments can quickly improve the patient’s state of health and comfort. The most common are dermal corticoids (with or without vitamin D derivatives). These have shown the most interesting results and can be applied regularly to the scalp for many years without causing side effects.
In the case of very thick scales, treatments based on dermal corticoids and salicylic acid are more suitable to “remove” the thickness. However, the choice of treatment is left to the dermatologist who treats the patient. “Pharmacognosy is very important in the choice of topical treatment for scalp psoriasis,” points out Dr. Charlotte Fight. Foams, gels, lotions, etc. are best for this area. In any case, ointments and creams that contain a fatty carrier (usually Vaseline) and are very difficult to wash off should be avoided. “The application of all these treatments is simple:
Use a comb to draw small lines and apply the product to the affected area only once a day, preferably at night before going to bed.
If necessary, lightly shampoo the next morning (this treatment can also be combined with a medicated anti-dandruff shampoo).
Repeat the treatment daily until the spots and itching have completely disappeared (after 10-20 days the scalp should be smooth again). If symptoms improve, space out applications (e.g., twice a week) before completely stopping until the next possible outbreak.
Caution: If your scalp is overly irritated (severely itchy sores), do not use lotions containing alcohol, as this may cause a burning sensation. For small sores, use gels or foams instead.
Get a skin care routine for your skin and scalp
a routine by spacing out your treatments by assigning specific treatment days to encourage adherence to your treatment (for example, Monday and Thursday, or Wednesday and Saturday). A regular routine will help prevent recurrences in the long term. “If this seems too restrictive for you, combine the treatment with more comfortable, full-fledged treatments, such as scalp massage, relaxation, sophrology. Make sure to take advantage of this mandatory appointment for complete care and relaxation,” advises the dermatologist. .
For stubborn forms, apply special treatments
If flare-ups are too severe despite the proper use of topical treatments, tablet treatments or even injections may be prescribed. These immunomodulators help control the excessive inflammatory response. The most commonly prescribed molecule when topical treatment is insufficient is methotrexate, taken once a week.
The course after the first attack is unpredictable: difficult events in life can cause new attacks over a month or a decade, so that relapses may never occur again. “We must still be reassured: the vast majority of patients will not develop chronic, bothersome symptoms,” asserts Dr. Charlotte Fitt. Skin and hair psoriasis: preventing relapses Lifestyle is especially important when treating scalp psoriasis. Obesity and smoking are associated with the occurrence of flare-ups. Eating a healthy, balanced diet (avoiding processed foods, eating organic, local and seasonal produce, etc.), starting to exercise again and quitting smoking (with a doctor’s help if necessary) are all positive self-care steps. “Finally, in the event of a traumatic event, psychological support is essential,” the dermatologist points out. A large proportion of people with severe psoriasis suffer from alexithymia. h. Inability to put feelings into words. This is a critical opening if individual attacks follow each other too quickly.
