Scalp psoriasis - what worked best for you?

The last thread on this looks to be five years sold so I’d thought I’d ask if there is anything new under the sun. I have a bit but my adult daughter has a couple of large, itchy, stubborn patches on her scalp. The dermatologist prescribed topical steroids but they don’t seem to be having much impact.

I use a combination of T-Gel shampoo and P&S solution. Both are available without a prescription, but you may need to ask the pharmacy to order the P&S because not all of them just have it, so call first to see if they have any in stock.

I’d have your daughter use the P&S solution just at night (it’s oil-based, so make sure she has a towel on her pillow). You just firmly rub it into the scaly parts before going to sleep. She can wash it out with T-Gel shampoo and then use her favorite conditioner when she wakes in the morning. It smells like medicated shampoo, but the T-Gel really helps with the itching and the P&S helps reduce the appearance of the scaliness and the flaking.

I had large psoriasis flares from about 5th grade through high school all over my forehead and scalp and, as a 45-year old woman, they come back now and again during times of extreme stress, but it’s way more manageable than it used to be. The P&S was honestly more helpful than the steroid ointments on my scalp; the steroids worked better on my forehead. You just have to find what works. Good luck to you guys!

Current evidence-based medicine recommendations for scalp psoriasis:

Scalp psoriasis — The presence of hair on the scalp can make topical treatment of psoriasis challenging because patients may find certain products messy or difficult to apply. Recognizing the patient’s preference for a drug vehicle may help to improve adherence to therapy. For many patients, solution, shampoo, lotion, gel, foam, or spray vehicles are preferable to thicker creams or ointments for use on the scalp.

Topical corticosteroids are the primary topical agents used for psoriasis on the scalp. Support for the use of these agents is evident in a systematic review of randomized trials that found that very potent or potent topical corticosteroids are more effective treatments for scalp psoriasis than topical vitamin D analogs. Combining a corticosteroid and vitamin D analog may offer additional benefit; in the systematic review, combination treatment with a potent topical corticosteroid and a vitamin D analog appeared slightly more effective than potent topical corticosteroid monotherapy. However, in clinical practice, complicating the treatment regimen with more than one topical product may reduce the likelihood of consistent adherence to the treatment regimen. Thus, we usually prescribe a topical corticosteroid alone as initial therapy. Commercial betamethasone dipropionate-calcipotriene combination products are available but are more expensive than most generic topical corticosteroid preparations.

Other topical therapies used for psoriasis (eg, tazarotene, coal tar shampoo, anthralin and intralesional corticosteroid injections) also may be beneficial for scalp involvement, though data on efficacy specifically in scalp disease are limited. Salicylic acid can be a helpful adjunctive treatment because of its keratolytic effect, but prescribing it alongside a separate topical corticosteroid makes the treatment regimen more complicated and, therefore, could adversely affect adherence to treatment. Phototherapy (eg, excimer laser) and systemic agents are additional treatment options for patients who cannot achieve sufficient improvement with topical agents.

Excellent info Q_t_M. Thanks.