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SUMMARY
In psoriasis, the scalp is the most common affected area, and frequently represents the first site of disease involvement. Isolated scalp psoriasis affects about 2% of the general population.
Scalp lesions are typically located behind the ear and neck but may appear anywhere on the scalp.
Trichoscopy may be considered a useful and non-invasive technique in diagnosing scalp psoriasis, particularly to differentiate the atypical presentations.
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TIPS FOR DIAGNOSIS
In clinical practice, scalp psoriasis (SP) can present with different clinical patterns that are not always easily to diagnose.
The diagnosis is mainly based on the clinical appearance, and usually pathology is not needed to confirm the diagnosis.
Trichoscopy can be useful in excluding other diseases characterized by erythema and desquamation.
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TIPS FOR TREATMENT
Treatment of SP includes corticosteroids or corticosteroids–vitamin D combination as first choice agents.
Mild forms, presenting with erythema, dandruff and itching, may benefit from frequent use of shampoo designed to remove scales and with an anti-inflammatory action.
In severe forms, systemic therapy is mandatory.
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DON’T FORGET
Despite its high rate of remission, scalp psoriasis can be very worrisome and upsetting for affected individuals and may significantly impact their quality of life, causing stress, depression, and anxiety.
Moreover, the persistent inflammation of psoriasis scalp plaques may, in rare cases, end in a form of cicatricial alopecia.
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PITFALLS AND CAUTIONS
For a better use of trichoscopy, it is advisable to start with a dry method and then, after removing the scales, to use a liquid as interface to better observe at high magnification the distribution and shape of the vessels.
The great discomfort for patients is mainly related to the presence of furfuraceous flaking with itching, with a considerable social distress.
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EXPERT PEARLS
Scalp psoriasis is classified in seven different types, with specific clinical-trichoscopic features.
The most common patterns are plaque psoriasis, thin scales, sebopsoriasis, and psoriatic cap.
Pityriasis amiantacea, cicatricial alopecia, and pustular psoriasis are less represented.
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PATIENT EDUCATION POINTS
Hair loss usually affects only the psoriatic areas of the scalp, but generalized telogen effluvium involving the whole scalp with consequent hair thinning can also occur.
Patients must avoid removing mechanically the scales to prevent a Koebner phenomenon, which can worsen SP.
As skin psoriasis, SP can induce significant emotional discomfort to patients, reducing their quality of life with very high DLQI scores.
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Psoriasis of the scalp is usually described as erythematous plaques covered with white-silvery scales, located behind the margin of the hairline, or extended to the peripheric skin of the forehead, ears, and occipital area. However, in clinical practice, scalp psoriasis (SP) can present with different clinical patterns that are not always easily diagnosed. The diagnosis is mainly based on its clinical appearance, and usually pathology is not needed to confirm the diagnosis. Trichoscopy can be useful in excluding other ...