Transcript Related Guidelines

Treatment of Scalp Psoriasis

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


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] 


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.