Scalp Psoriasis: Symptoms, Causes and Early Signs
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Scalp Psoriasis: Symptoms, Causes and Early Signs
What scalp psoriasis looks like, the early signs, why it itches, what causes and triggers it, how it differs from dandruff, and when to see a GP.
Part of our scalp psoriasis health guides.
Key fact: Scalp psoriasis is a long-term immune condition, not an infection or a hygiene problem. It isn't contagious, and although it can't be cured, treatment usually controls the scale, itch and flares.
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See scalp psoriasis treatments →What is scalp psoriasis?
Scalp psoriasis is psoriasis on the scalp. It causes raised, well-defined patches covered in thick, silvery-white scale, and it can spread past the hairline onto the forehead, the back of the neck and the skin around the ears. It's usually plaque psoriasis, the most common type, and many people with psoriasis on their elbows, knees or body have it on their scalp too.
It ranges from a few fine, flaky patches that look like stubborn dandruff to thick, crusted scale covering most of the scalp. It tends to come and go in flares, with calmer spells in between.
For psoriasis elsewhere on the body, see our guide to psoriasis.
Symptoms and early signs
Early, mild scalp psoriasis can be easy to mistake for dandruff. These are the signs that point to psoriasis:
- Raised, well-defined patches, pink or red on white skin, and purple, grey or darker brown on brown and black skin
- Silvery-white scale that sticks to the scalp and can bind to the hair, rather than loose flakes
- Patches past the hairline, on the forehead, behind the ears or at the nape of the neck
- Itching, soreness or burning, or a tight feeling of the scalp
- Bleeding or cracking when scale is scratched or picked off
- Temporary hair loss over thick patches, usually from scratching or removing scale (see our guide to scalp psoriasis and hair loss)
- Psoriasis elsewhere, such as elbows, knees or nails, or a family history of it
Early signs: one or two small patches of fine silvery scale, often behind the ears or along the hairline, that keep coming back in the same place. Dandruff tends to be spread through the hair rather than in defined patches.
Hairline, forehead, ears and neck
Scalp psoriasis often doesn't stop at the hair. A rim of scaly, pink or darker skin along the hairline is common, and the skin behind and around the ears can crack and become sore. Psoriasis can also affect the ear canal, which can cause itching and blocked ears; see a GP rather than putting anything into your ears.
The skin on the face and ears is thinner, so it needs milder treatment than the scalp. Don't use a scalp steroid on your face unless a prescriber has told you to. Our guide to psoriasis on the face, ears and eyelids explains what's used there.
Why scalp psoriasis itches
The inflammation in psoriasis patches makes them itchy, and many people say the itch is the worst part. Scratching damages the skin, which can make psoriasis worse in that spot and pull out hair, so it's worth breaking the itch-scratch cycle:
- Treat the inflammation: a steroid scalp application is usually the quickest way to ease the itch
- Keep nails short, and press or pat an itchy patch rather than scratching it
- Soften thick scale with an oil or ointment rather than picking it off (see our guide to home remedies and removing scale)
- Avoid very hot water and hot hairdryers, which can make itching worse
Our psoriasis itch guide covers itch relief in more detail.
What causes scalp psoriasis?
Psoriasis happens when the immune system becomes overactive and speeds up the production of skin cells. Skin cells that normally take weeks to replace themselves are replaced in a matter of days, and they build up on the surface as scale.
Genes play a part: psoriasis often runs in families. It isn't caused by poor hygiene, by washing your hair too little or too often, or by anything you've caught. Scalp psoriasis isn't contagious, so you can't pass it on by sharing a hairbrush, a pillow or a hairdresser.
What triggers a flare?
Something often sets off the first episode or a later flare. Common triggers include:
Stress
One of the most commonly reported triggers. Flares often follow a stressful few weeks.
Injury to the scalp
Scratching, picking, harsh brushing or sunburn can bring psoriasis up in that spot.
Infections
A throat infection in particular can trigger a flare, or a type called guttate psoriasis.
Cold, dry weather
Many people find their scalp is worse in winter and better in summer.
Smoking and alcohol
Both are linked with psoriasis and with more severe psoriasis.
Some medicines
Including lithium, some antimalarials, some anti-inflammatories, ACE inhibitors and beta-blockers. Don't stop a medicine without advice.
See our guide to psoriasis triggers for how to spot and manage yours.
Is it scalp psoriasis or dandruff?
Dandruff causes loose white or yellowish flakes spread through the hair, without raised patches. Seborrhoeic dermatitis, a more inflamed form of dandruff, causes greasy, yellowish scale and redness, and often affects the eyebrows and the sides of the nose. Scalp psoriasis causes thicker, silvery scale on well-defined, raised patches that often go past the hairline.
They need different treatment, and some people have features of both. Our guide to scalp psoriasis vs dandruff, dry scalp and scalp eczema sets out the differences side by side. If it's dandruff, see our dandruff treatments.
How scalp psoriasis is diagnosed
A GP can usually diagnose scalp psoriasis by looking at your scalp, hairline and ears, and checking the rest of your skin and your nails for psoriasis. They'll ask about your family history and whether you have any joint pain, because psoriasis is linked with a type of arthritis. A skin sample (biopsy) is only needed if the diagnosis isn't clear. If treatment isn't working, or it's severe, your GP can refer you to a dermatologist.
How scalp psoriasis is treated
Most scalp psoriasis is treated with topical treatments, applied straight to the scalp. NICE guidance for adults starts with a potent steroid scalp application once a day for up to 4 weeks, then steps up through a different form of steroid and descaling products, a combined calcipotriol and betamethasone gel, and coal tar or a short course of a very potent steroid.
| Type | Examples | Read more |
|---|---|---|
| Steroid scalp lotions and applications | Betacap, Betnovate Scalp, Elocon, Dermovate Scalp | Steroid scalp lotions compared |
| Medicated shampoos | Coal tar shampoos; Etrivex (steroid shampoo) | Psoriasis shampoo guide |
| Combined gel | Dovobet gel (calcipotriol and betamethasone) | Dovobet gel guide |
| Descaling and coal tar | Oils and ointments, salicylic acid, Cocois | Home remedies and removing scale |
| Specialist treatments | Light therapy, tablets and injections | Tablets, injections and light therapy |
To compare every option, see our scalp treatment options guide. Adults can order scalp psoriasis treatment online after a consultation with one of our pharmacist prescribers.
Hair care, hair dye and hairdressers
- Wash your hair as often as you normally would with a gentle shampoo; washing doesn't cause or worsen psoriasis
- Use a wide-toothed comb or soft brush, and avoid scraping the scalp
- Dry your hair on a cool or low setting, and keep hot styling tools away from the scalp
- Hair dye can irritate inflamed skin: do the patch test the dye maker recommends, and avoid dyeing during a flare or on broken skin
- Let your hairdresser know you have psoriasis. It isn't contagious, and a good hairdresser will be used to it
When to see a GP
See a GP if: you think you have scalp psoriasis but it hasn't been diagnosed; treatment hasn't helped after 4 weeks; it's affecting large areas of your body; you have patches of hair loss that aren't growing back, or scarring; your scalp is weeping, crusted or looks infected; or you have joint pain, stiffness or swelling, which can be a sign of psoriatic arthritis.
Get urgent help: call 999 or go to A&E if your skin quickly becomes red all over, or you develop spreading pus-filled spots, especially with a fever, chills or a fast heartbeat. Call NHS 111 for urgent advice that isn't an emergency.
Can scalp psoriasis be cured?
There's no cure, but scalp psoriasis can be controlled. Treatment clears or thins the patches, eases the itch and shortens flares, and many people have long spells when their scalp is clear or nearly clear. Because it tends to come back, it helps to know your triggers and to have a plan with your GP or prescriber for treating flares early.
Psoriasis UK (psoriasisuk.org.uk) offers support and information.
Frequently asked questions
What does scalp psoriasis look like?
Scalp psoriasis looks like raised, well-defined patches covered in thick, silvery-white scale. On white skin the patches are pink or red; on brown and black skin they can look purple, grey or darker brown. The patches often spread past the hairline onto the forehead, behind the ears or onto the back of the neck.
What are the early signs of scalp psoriasis?
Early scalp psoriasis often starts as one or two small patches of fine, silvery scale, commonly behind the ears or along the hairline, that keep coming back in the same place. The patches may itch or feel tight. Unlike dandruff, the scale sits on defined patches rather than being spread through the hair.
Is scalp psoriasis contagious?
No. Scalp psoriasis is caused by the immune system, not by an infection, so you can't catch it or pass it on by sharing a hairbrush, a pillow or a hairdresser.
What triggers scalp psoriasis?
Common triggers include stress, scratching or injuring the scalp, infections such as a sore throat, cold and dry weather, smoking, alcohol and some medicines. Triggers vary from person to person, so it can help to note what was happening before each flare.
Can stress cause scalp psoriasis?
Stress doesn't cause psoriasis on its own, but it's one of the most commonly reported triggers for a first episode or a flare. Managing stress won't replace treatment, but it may help flares come less often.
Can scalp psoriasis spread to the face?
Scalp psoriasis often spreads just past the hairline onto the forehead and around the ears. It can also appear on the face, but the skin there is thinner and needs milder treatment, so don't use a scalp steroid on your face unless a prescriber has told you to.
Does scalp psoriasis go away on its own?
Scalp psoriasis tends to come and go. A flare can settle by itself, but it usually comes back, and treatment helps clear the patches and ease the itch sooner. If it's not settling, or it's spreading, see a GP or pharmacist prescriber.
Is there a permanent cure for scalp psoriasis?
There's no permanent cure, but scalp psoriasis can be controlled. Treatment can clear or thin the patches, and many people have long spells when their scalp is clear or nearly clear.
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Start Scalp Psoriasis Consultation →References
- NICE. Psoriasis: assessment and management (CG153), recommendations 1.3.1 and 1.3.4 (scalp psoriasis). nice.org.uk/guidance/cg153
- NICE Clinical Knowledge Summaries. Psoriasis. cks.nice.org.uk/topics/psoriasis
- NHS. Psoriasis. nhs.uk/conditions/psoriasis
- Guy's and St Thomas' NHS Foundation Trust. Treating scalp psoriasis. guysandstthomas.nhs.uk
- Psoriasis UK (formerly the Psoriasis Association). Scalp psoriasis information. psoriasisuk.org.uk
Medical disclaimer: This page is for information only and isn't a substitute for medical advice. Steroid scalp treatments, Etrivex and Dovobet are prescription-only, so a clinical consultation is needed before they can be supplied. Always follow your prescriber's advice and the leaflet. In a medical emergency, call 999.
