The appearance of psoriasis
varies from person to person, however, the condition is mostly
characterised by patches of silvery scale overlaying a red, inflamed
looking skin. The scalp may be irritated and itchy in some cases,
but not in others. Psoriasis can affect any part of the body,
but the scalp, knees and elbows are the most common sites.
Psoriasis is thought to be an inherited,
'auto-immune' condition which means the body is 'doing it to itself'.
You may find that it will be worse when you are stressed and generally
run down and during the winter months if you don't get any sun.
So one of the things that can help is ultra violet.
Don't feel shy or embarrassed of
your hairdresser though, this condition is really quite common
and definitely not infectious, so they will not treat you like
a leper. Your hairdresser may recommend that you try using permanent
colour as a temporary cure, and whilst this may remove any scale,
it generally stings very badly and can worsen the condition.
Psoriasis can be triggered by stress,
damage to the skin or exposure to a substance not previously encountered.
There is presently no cure for psoriasis, so treatment is aimed
at control. See a trichologist or your family doctor for an accurate
- Facts and Tips
kind permission of Tony Pearce RN., RPN.
Psoriasis is reputedly
the most common scaling problem seen by health professionals.
The condition is a genetically determined autoimmune disorder
believed to affect 2-5% of the world's population.
With psoriasis the skin cells (epidermis)
shed about seven times faster than the usual 28 days. Furthermore,
the skin cells in unaffected people shed easily. By contrast,
psoriatic skin cells are immature, sticky, and resist shedding.
This results in scale formation on the skin surface.
The appearance of psoriasis varies
from person to person; there may be heavy scale and redness in
some whereas others have little of either. However the classic
feature of psoriasis is a palpable bright pink plaque covered
in silvery scale.
Although people who experience psoriasis
have a genetic predisposition to develop it, it's believed that
it still takes something to trigger the problem. That could be
a bacterial or viral infection, a vaccination/injection, stress,
trauma to the skin or exposure to a substance not previously encountered.
Stress influences psoriasis through
its effects on the Sympathetic Nervous System. Stress causes sympathetic
nerves to increase their production of chemicals in the skin called
neuropeptides. These neuropeptides can increase the autoimmune
reaction in the skin.
Psoriasis is extremely variable in
its duration and course. A single lesion may persist for a lifetime,
or many lesions may be present. Some sufferers are never free
of the problem whereas others may have long remissions. This same
variation occurs in people's response to treatment; what helps
one person may not help another.
As psoriasis is believed to be an
autoimmune condition, it can be suppressed but not presently cured.
Remission may be spontaneous or induced, and last for weeks, months
or years. Treatments are many, and help to control the condition
in different ways:
- one therapy trichologists use
for psoriasis involves the oral intake of the amino acid Tyrosine.
Tyrosine decreases neuropeptides in the skin which, in turn,
decreases the skin's immune response. By doing this, the scaling
and redness with psoriasis diminishes. Psoriasis should respond
to this therapy within a month.
- Zinc sulphate 5% with 3% salicylic
acid is a preparation used by some trichologists to relieve
the symptoms of itch, redness and scaling.
- tar preparations are keratolytic,
anti-inflammatory, and thought to be antimitotic. Coal tars
can be compounded into ointments, creams, oils or shampoos.
Often used in combination with salicylic acid for mild to moderate
- Anthralin(Dithranol) is extracted
from coal tar and inhibits epidermal mitosis. Applied topically;
anthralin irritates the skin and increases the immune response
to that area. Anthralin should be applied to the scalp in "quarters".
Look for a reaction in first quarter before moving on. *Daivonex
(calcipotriol) is a non-steroidal vitamin D derivative.
- Roaccutane and Tigason are vitamin
- severe chronic psoriasis may require
treatment with potent oncological drugs such as methotrexate
or cyclosporin. Oral or intravenously, these drugs can only
be prescribed by a medical specialist and are generally only
used when other treatments have failed. Regular monitoring of
the patient's white cell count and liver function are essential.
- ultraviolet light, PUVA, or judicious
exposure to sunlight has proven beneficial to many psoriatics.
Topical Corticosteroids: topical
steroids are anti-inflammatory and immunosuppressive. They can
be very effective in controlling mild to moderate psoriatic lesions.
Steroids are easy to use and offer a relatively quick response.
Topical steroids are not considered adequate treatment when used
as the only therapy for severe psoriasis. However they may augment
other treatments that are used to treat severe psoriasis.
- There are several topical steroid
medications specifically for use on the scalp. Some of these
prescription products are: Cormax scalp application, Derma-Soothe/FS
topical oil, Kenolog spray, and Temovate scalp application.
- Topical steroid medications don't
necessarily produce long remissions. Thus the early return of
psoriasis can contribute to sufferers using steroids for long
periods of time, or using a steroid that is too potent for a
particular body area. This often heralds the appearance of common
side effects associated with topical steroid use:
- Skin damage: skin atrophy, thinning
of the skin, stretch marks (stirrer), steroid redness, and dilated
inflamed surface blood vessels are possible side effects with
the careless use of topical steroids.
- Rebound effect: as topical corticosteroids
are essentially immunosuppressive, psoriasis tends to worsen
if the steroids are discontinued suddenly. This is termed a
psoriasis "rebound" or "flare". This rebound
effect may be stalled by slowly reducing or tapering the use
of steroids as the psoriasis starts to remit. Some medicos prefer
to gradually lower the strength of steroid medications to avoid
- Lack of Response (Tachyphylaxis)
in long-term topical steroid use: changing from one steroid
to another may delay this effect, but the only way to prevent
it is to temporarily cease using topical steroids. The substitution
to non-steroidals such as Daivonex, Anthralin, tars or retinoids
can be a useful interim alternative.
Psoriasis of the Scalp:
Psoriasis can affect any area of the skin but the scalp is
a common site, where psoriasis tends to stay within the hairline.
The crease of the ear is also often involved, and, sometimes scaling
can be seen in the ears.
Where there are plaquey lesions,
the scalp hair appears lustreless. The hair is dry and tends to
break easily. There is an increased shedding of telogen (falling
phase) hairs, and a decreased hair density. There may be extensive
hair loss in the erythrodermic forms of psoriasis.
Heavy scale may cause hairs to be
'funneled' together to form the distinguishing "tepee sign"
of scalp psoriasis. Other characteristic features of psoriasis
are 'Auspitz' sign', where bleeding points are revealed beneath
removed scale. 'Koebner Phenomenon' is where injury to the skin
can induce the development of psoriatic lesions at the site of
injury. It is believed the presence of large numbers of the yeast
micro-organism, Pityrosporum ovale, may be adequate to provoke
a Koebner reaction in susceptible persons. Shampoos that are antipityrosporum-specific
(e.g.: Nizoral 2%) have been advocated as an adjunct to therapy
for scalp psoriasis.
You can go
trichology section if you would
like to find out how to get treatment for this condition.