Transcript Related Guidelines

Treatment of Scalp Psoriasis

Linda F. Stein Gold, MD · Henry Ford Health System

Disclosures

July 26, 2021

Key Takeaways:

  • Mild to moderate scalp psoriasis can be treated with topical steroids (eg, liquid, foam, shampoo, suspension).

  • Roflumilast is a phosphodiesterase type 4 inhibitor under investigation in a foam formulation for the treatment of scalp psoriasis.

  • Resistant-scalp psoriasis can be treated with an oral therapy such as apremilast.

This transcript has been edited for clarity.

Mild to moderate scalp psoriasis can be treated with topical therapy.[1,2] I generally start with a mid-potency topical steroid. What's important to remember is that the vehicle is critical. If patients don't like the vehicle, they're not going to be compliant with therapy. Some people prefer a liquid or foam. Some people like a heavier or greasier vehicle, and they might prefer an ointment. 

Steroid shampoos do have some efficacy.[3] However, I advise patients they have to be careful of transfer of the active drug to the face and especially around the eyes. There is a fixed combination of calcipotriene and betamethasone dipropionate in a suspension formulation that has modest efficacy.[4] For plaques that are really thick on the posterior scalp, sometimes I'll use an intralesional Kenalog injection just to jumpstart therapy.[5] 

There is a new phosphodiesterase type 4 inhibitor [roflumilast] being studied in a foam formulation that showed some very promising results in phase 2 clinical trials.[6] Finally, for patients who have more resistant scalp psoriasis, I might consider an oral therapy like apremilast.[7] 

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