Scalp psoriasis is a chronic autoimmune condition that accelerates the life cycle of skin cells, causing them to build up rapidly on the scalp surface. This quick turnover results in thick, scaly, and often itchy patches. The core dilemma is finding the correct balance: washing removes scale buildup, but washing too often or too aggressively can strip the scalp of natural protective oils and increase irritation. This guide provides an approach to hair care that manages the condition without aggravating the skin.
Finding the Right Washing Frequency
Daily washing is generally discouraged because it often causes excessive dryness and inflammation. The goal is to balance clearing away dead skin cells and residue with protecting the skin barrier. Over-washing strips the scalp’s natural oils (sebum), which provide a protective, moisturizing layer.
Dermatologists typically suggest washing the hair and scalp two to four times per week. This frequency allows for the consistent application and removal of medicated shampoos necessary for effective treatment. Individuals with very dry or sensitive scalps may need to wash only twice a week to prevent irritation. Conversely, during periods of heavy scaling or oil production, increasing the frequency to four times a week helps keep plaques clear and receptive to topical treatments.
The washing schedule is highly individualized and requires adjustment based on the severity of the flare-up. When scales are thick, more frequent washing with medicated products helps soften and lift plaques, improving the penetration of subsequent treatments. Monitor how the scalp reacts: if it feels tight, inflamed, or excessively itchy after washing, reduce the frequency or choose a milder product.
Essential Medicated and Non-Medicated Cleansers
Selecting the correct shampoo is a significant part of managing scalp psoriasis, using specific over-the-counter active ingredients. Salicylic acid and coal tar are the two most commonly recommended ingredients. Salicylic acid is a keratolytic agent that softens, loosens, and sheds thick, built-up flakes. By dissolving the bonds holding dead skin cells together, it clears the surface and allows other treatments to penetrate the skin more effectively.
Coal tar works primarily by slowing the rapid growth of skin cells, the hallmark of psoriasis. It also has anti-inflammatory properties that help reduce associated redness and itching. Regular use of coal tar can reduce plaque thickness and restore the skin’s appearance.
To minimize irritation and product buildup, “shampoo rotation” is often recommended. This involves alternating between a medicated shampoo (salicylic acid or coal tar) and a gentle, non-medicated, moisturizing shampoo. This strategy provides therapeutic treatment without constantly subjecting the scalp to harsh, drying active ingredients. For severe or treatment-resistant cases, a healthcare provider may prescribe stronger options, such as shampoos containing corticosteroids or Vitamin D analogs.
Gentle Washing and Drying Techniques
The physical act of washing requires a gentle approach to minimize trauma to the inflamed scalp tissue. When applying shampoo, massage the product into the scalp using only the pads of the fingertips, avoiding fingernails. Scratching can cause micro-abrasions and worsen psoriasis, potentially leading to a new flare-up in the injured area known as the Koebner response.
Water temperature requires careful consideration during washing. Hot water strips natural oils and increases blood flow, which can exacerbate redness and itching. Use lukewarm or room-temperature water to keep the scalp calm and prevent excessive dryness. Rinse the scalp and hair thoroughly afterward to ensure no shampoo residue remains, as leftover product can become an irritant.
Avoid friction when drying hair to protect sensitive skin. Gently pat the hair and scalp dry with a soft towel rather than rubbing vigorously. Minimize high heat from styling tools, as intense heat can trigger or worsen inflammation and dryness. If a blow dryer is necessary, set it to the lowest heat setting and hold it far from the scalp.
Scalp Care Between Washes
Scalp maintenance between washes is necessary to manage symptoms and prepare the skin for subsequent treatment. For individuals with thick, adherent scales, applying emollients or oils before washing helps soften them for easier removal. Products such as mineral oil, olive oil, or coconut oil can be gently massaged into affected areas and left on, sometimes overnight, to loosen the scales.
Topical prescription treatments, such as lotions or foams, are often applied when the hair is dry. It is crucial to ensure these treatments reach the skin itself, not just the hair shaft. Parting the hair and applying the product directly to the scalp allows the medication to target affected skin cells. These leave-in treatments are essential for the long-term control of underlying cell overgrowth.
Managing itching without scratching is an important part of inter-wash care. Applying a cool compress can offer temporary relief from localized itchiness. Specialized leave-in products containing ingredients like menthol provide a cooling sensation that helps soothe the persistent urge to scratch.