Psoriasis capitis: symptoms, causes and treatment

Psoriasis capitis is psoriasis of the scalp. ‘Capitis’ comes from Latin and means ‘of the head’. Most patients with psoriasis capitis also have psoriasis on other parts of the body. However, psoriasis capitis can also occur in isolation. Some common psoriasis patches may appear on the head, but the entire scalp may also be covered with a silvery, stuck flaking. The complaints may be accompanied by itching, scratching effects and hair loss. The treatment of psoriasis capitis aims to reduce symptoms and prevent complications. Complications can include wounds from scratching and scraping the psoriasis spots on your head. Hair loss can also occur. The prospects vary. You may experience flare-ups alternating with calmer periods when you are less bothered by psoriasis on the scalp.

1. • What is psoriasis?
   • Psoriasis capitis: psoriasis on the scalp
   • Prevent
   • Causes, risk factors and triggers
   • Psoriasis capitis symptoms
   • Treatment of psoriasis capitis

• Three pillars
• Remove flakes and shampoo
• Washing the hair and scalp
• Anti-psoriasis agent

1. • Course of psoriasis capitis
   • Complications: hair loss and bleeding

• Bleeding
• Hair loss

1. • Visibility of psoriasis on the scalp
   • Complications

• Bleed
• Hair loss

1. • Prevention and prognosis

What is psoriasis?

Psoriasis (in full: psoriasis vulgaris) is a common non-contagious chronic autoimmune disease. The condition is characterized by sharply defined (pink) red spots, covered with a layer of white flakes and itching. The spots often appear symmetrically on the body. Preferred locations are elbows, knees, lower back and the hairy scalp. The body’s immune system sends the wrong signals to the skin, causing an overproduction of cells in the outer layer of the skin, which results in an inflammatory response in the skin.

Psoriasis capitis: psoriasis on the scalp

Psoriasis capitis is common in people who have psoriasis. Data show that in approximately 50-75% of psoriasis patients, the hairy scalp is also affected. However, psoriasis capitis can also occur on its own. Psoriasis of the hairy scalp can be very mild, with light, fine flaking, but it can also take on very serious forms where the entire scalp is covered with a silvery, stuck flaking. The spots are mainly present along the hairline and behind the ears. The patches on the scalp may be accompanied by itching, which can vary in severity. In most cases, psoriasis of the scalp does not cause hair loss, even when the entire scalp is affected. Only occasionally, minor hair loss may occur, but psoriasis does not lead to baldness.

Prevent

Scalp psoriasis is quite common. Roughly half of all people with psoriasis vulgaris also suffer from psoriasis capitis. It affects men and women equally.

Causes, risk factors and triggers

Psoriasis, including scalp psoriasis, is a common condition that appears to develop when the immune system sends the wrong signals to the body. When the immune system sends these messages to the skin cells, the cells multiply too quickly. Normally, the formation of new cells on the scalp can take weeks. With psoriasis, cells form within a few days. This makes it difficult for the body to get rid of the excess cells. As the skin cells accumulate on the surface of the scalp, they form scaly patches.

The exact cause of psoriasis on the scalp is unknown in 2023, but research shows that there is a genetic component. People who have a family member with the condition have a higher risk of developing scalp psoriasis. Psoriasis is more likely to occur due to inflammatory factors that occur with obesity and dietary factors, such as gluten sensitivity.

There are a number of other factors that can trigger a flare-up of symptoms in people prone to scalp psoriasis, including:

1. • an injury to the skin, such as a wound
   • an infection, especially strep throat
   • stress, which can worsen symptoms or trigger them for the first time
   • the use of certain medications, such as Indomethacin, used to treat arthritis, and Quinidine, a heart medication.

Psoriasis capitis symptoms

Symptoms can range from mild to severe and include:

1. • dryness;
   • flaking, which resembles dandruff;
   • itching, burning, or discomfort;
   • red spots on the scalp;
   • silvery scale;
   • bleeding or temporary hair loss, scratching effects from trying to remove the plaques on the scalp.

These symptoms usually appear on both sides of the scalp or they can affect the entire scalp. They can also occur on the neck, ears, forehead, or other parts of the face.

Treatment of psoriasis capitis

Three pillars

Because of the hair, the treatment of psoriasis capitis differs from psoriasis elsewhere on the body. Scalp treatment consists of three pillars:

1. 1. loosening the flakes on the scalp;
   2. washing the hair and scalp; and
   3. the treatment of the (affected) scalp.

Special shampoo for psoriasis / Source: Jackmac34, Pixabay

Remove flakes and shampoo

Thick flakes must first be removed so that the active substance in the anti-psoriasis agents can reach the skin. Descaling can be done with adeps suillis, or pork fat, lard or axungia. Pork fat is ideal for loosening thick flakes from the hairy head. (An ointment containing Vaseline is not very suitable, as it cannot be easily washed out.) The product should be massaged in before going to sleep. A generous amount should be applied. Then put on a hair cap or place a towel on the pillow and let it sit all night.

Washing the hair and scalp

The next morning, wash with warm water, for example in the shower, and a special shampoo (Denorex Rx, shampoo 75 mg/g coal tar solution and 15 mg/g menthol).

Anti-psoriasis agent

When all ointment residues and flakes have been washed out, the scalp can be treated with an anti-psoriatic agent (a corticosteroid and/or a vitamin D derivative). These prevent itching, redness and flaking. If the flakes are gone, step 1 can be skipped.

Course of psoriasis capitis

Psoriasis often has an irregular course with periods of spontaneous absence. During the summer months, psoriasis often improves significantly because the ultraviolet rays in sunlight help reduce symptoms.

Complications: hair loss and bleeding

Scalp psoriasis can cause two complications:

Bleeding

Psoriasis capitis can cause itching and discomfort. The scalp can bleed by scratching or removing the plaques on the scalp.

Hair loss

The effect on the hair follicles, heavy plaque formation and excessive scratching can cause noticeable hair loss. Significant hair loss can also occur when the scalp is damaged. Certain treatments and stress can worsen hair loss.

Visibility of psoriasis on the scalp

Having psoriasis on the scalp can be challenging to deal with. Embarrassment can arise, as can stress. The treatment is usually effective and helps reduce the appearance of the plaques. Contact with fellow sufferers can help to exchange experiences and receive support.

Complications

Scalp psoriasis can cause two complications.

Bleed

Psoriasis of the scalp can cause itching and discomfort. Bleeding may occur as a result of scratching or removing the scabs.

Hair loss

The effect on the hair follicles, heavy flakes and excessive scratching can cause noticeable hair loss.

Prevention and prognosis

It is difficult to prevent psoriasis on the scalp because the exact cause is unclear in 2023. However, treating the condition as soon as symptoms occur can prevent it from getting worse. Psoriasis capitis affects each person differently. Some people have occasional flare-ups, while others suffer from them all the time. You can try to avoid the triggering factors.

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