Scalp Psoriasis: What It Looks Like, Symptoms, and Causes

Scalp flaking is most often blamed on dandruff: you buy a shampoo, wait a week, and nothing changes. Sometimes the cause is different — psoriasis, a chronic skin disease that often affects the scalp and the skin behind the ears. Let's look at what it looks like and what the doctor checks.

What scalp psoriasis is

Psoriasis is a chronic non-infectious autoimmune disease, a dermatosis that mainly affects the skin. The cause is a malfunction of the immune system: skin cells divide too quickly. Normally the journey from the deep layer to the surface takes about a month; with psoriasis it takes just a few days, and the skin builds up in scales. The incidence does not depend on sex: plaques occur in 2–4% of the population, and in Russia the rate varies by region from 0.72 to 11.8%. The scalp and the area behind the ears are among the typical sites. It is not contagious.

What scalp psoriasis looks like

The patches are usually 1–2 cm, oval or irregular in shape. On light skin they are pink or red, then become silvery-white, sometimes waxy-yellow or orange-brown; on brown and black skin they look gray and leave dark marks behind. The plaque is raised above the surface of healthy skin, its scales are pale, gray, or silvery, resembling hardened wax or paraffin — the so-called "paraffin lakes." The silvery layer flakes off easily, and the skin underneath is injured and bleeds because it contains many small vessels. Plaques tend to grow and merge into larger areas.

Symptoms of scalp psoriasis: itching, flaking, plaques

The main feature is dry, itchy, painful flaky areas with silvery-white scales. The course is wave-like: flare-ups alternate with improvements. It can start at any age, more often at 15–25 or 50–60 years, and one in three patients notes the first symptoms before age 20. Besides the skin, the nails are affected — pits and depressions appear, along with thickening and whitish areas at the tip. In 10–15% of patients, psoriatic arthritis develops, an inflammation of the joints. Flare-ups are triggered by stress, alcohol, smoking, excess weight, pregnancy, certain medications, infections such as group A streptococcus and HIV, cuts and scratches, and sunlight.

Mild scalp psoriasis: what its signs are

Most people develop only a few plaques, and some have many small flaky spots. Severity varies from small localized lesions to full-body coverage with plaques. How to treat depends on the type of psoriasis, its severity, and its location; the doctor determines this. There can be periods of remission, and over time the disease often progresses: flare-ups become more frequent, the affected area grows, and new areas are involved.

How psoriasis differs from seborrheic dermatitis and dandruff

Psoriasis is easily confused with other skin diseases, so diagnosing it can be difficult. There is also a seborrhea-like form — it resembles seborrheic dermatitis externally, so the conclusion "looks like dandruff" settles nothing. If the picture is unclear, the doctor takes a small skin sample and examines it under a microscope.

How it is diagnosed and when to see a dermatologist

The diagnosis is made by a dermatologist: examination, and if necessary, microscopy of a skin sample. You should seek help if characteristic plaques appear, if the treatment already prescribed does not work or causes side effects, and also if recurring pain, stiffness, and joint swelling are added to the psoriasis.

Signs that require examination:

• itchy, dry, flaky spots with silvery-white scales;
• psoriasis in which treatment does not help or causes side effects;
• pits, depressions, and thickening have appeared on the nails;
• joints hurt, swell, and bend poorly, and this recurs;
• the spots have spread beyond the scalp — to the elbows, knees, back, and skin folds.

Scalp psoriasis on its own is not a reason to call an ambulance. Numbers 103 and 112 are needed if the skin rapidly reddens and becomes covered with white pustules that merge into extensive areas (on brown and black skin, redness is harder to notice), if plaques on the feet become yellow-brown and fill with pus, if red flaky pustules appear on the fingertips and toes, and also with rapid heartbeat, high fever, a feeling of heat, cold, or chills.

This material is for reference: it helps you recognize the problem, but it does not replace a doctor's consultation — the diagnosis is made by a dermatologist.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer