When it is psoriasis, not just dandruff

Psoriasis is a skin disorder that causes cells to multiply up to 10 times faster than normal. This causes skin cells to build up on the surface, forming red patches usually covered with scales.

It is not a contagious disease, so a person cannot ‘catch it’ from someone else. However, the disorder has a genetic element so people who are affected may often have a family history of the same. Symptoms of psoriasis are often first seen in early adulthood and can manifest anywhere, including the elbows, knees, lower back and even the scalp.

Difference between scalp psoriasis and dandruff

Of the different types of psoriasis, scalp psoriasis can be particularly difficult to recognise and treat. It can affect any area of the scalp and cause extreme itching. In some cases, the skin may become so dry that it cracks and bleeds.

Hair loss is a common problem in scalp psoriasis and is not a result of the psoriasis itself but is seen because of damage to the hair shaft or hair follicles. This damage can occur from rubbing, scratching, excessive combing, and from chemicals or ingredients in treatments and products.

Scalp psoriasis can look very similar to dandruff, which is why it may be difficult to diagnose. Young individuals with high stress levels can develop both dandruff and scalp psoriasis, it may become hard to tell the difference and treat appropriately.

Unlike dandruff, psoriasis is a problem rooted in the immune system that is caused when special proteins called autoantibodies mistakenly attack healthy tissue. Moreover, psoriasis is a chronic disease that can extend to the forehead, the region around the ears and the back of the neck; dandruff is usually caused because of dry skin and the flaking may come and go. Consulting a dermatologist to start the appropriate treatment immediately is the best solution.

Treatment for scalp psoriasis

A dermatologist is likely to recommend one or more of the following remedies and treatment for patients with psoriasis:

Avoid using hard combs: Sharp combs could increase the itching and cause the scales to crack and even lead to bleeding.

Use hair conditioner: Using a conditioner after shampooing the scalp can help to relieve the itchiness.

Avoiding heat application on the scalp: Hot hairstyling dryers and tools should be avoided as far as possible. Instead, patients should use wet towels, cold packs, or cold water to ease the itchiness.
In addition, medicated creams and treatments may be prescribed based of the severity of psoriasis.

Vitamin D and psoriasis

It is important to consider the link between vitamin D deficiency and psoriasis. Vitamin D is made by the skin on exposure to sunlight and helps to strengthen immunity. The lack of vitamin D does not ‘cause’ psoriasis, but it may affect the body’s ability to keep the skin healthy. Lack of sunlight coupled with dry skin is a common trigger for psoriasis flare-ups. People with psoriasis are likely to wear clothes that completely cover their skin in order to hide any lesions, which further reduces their ability to absorb UVB light from the sun and leads to vitamin D deficiency. This can further trigger psoriasis flares.
People working night shifts often have lower levels of vitamin D and a relatively higher chance of getting psoriasis. There are a number of different treatment options for patients with psoriasis. If a dermatologist believes that vitamin D can help patients, different forms of vitamin D might be suggested. These could include phototherapy and exposure of the skin to ultraviolet light; oral vitamin D supplementation; increased intake of vitamin D rich foods such as egg yolks and cheese; and topical treatment with vitamin D oils. These are general treatments that are effective for psoriasis, though scalp psoriasis needs additional care.

In general, there are a lot of common misconceptions about psoriasis, its triggers and its treatment. It is important to know that psoriasis can be treated and managed with several effective medications.

(The author is consultant dermatologist, aesthetic and laser physician, AsterCMI Hospital)