Topical Scalp Psoriasis Treatments
Scalp Psoriasis alongside with other types of psoriasis conditions have been shown to adversely affect the quality of life for those suffering from it. This condition is chronic and is a result of the T-cells within the immune system sending faulty signals that cause skin cells to grow too rapidly. This causes redness and inflammation on the affected areas as too much blood is sent to the area, as well as plague on the skin.
Most of us would approach a dermatologist who will then prescribe several treatment options for scale psoriasis. Topical treatments are one of the most common approaches and are usually in the form of medicated creams or lotions that are applied directly on the skin.
Generally, the dermatologist would first analyze the severity of the psoriasis condition before making a recommendation for treatment. This includes the percentage of the skin area that are affected by psoriasis, which can range from less than 3% for mild cases, to more than 10% for severe cases.
There is also a treatment strategy used to address the condition, with the purpose of first gaining control of the disease, decreasing the severity, maintaining remission and scaling, avoiding relapse and adverse effects, and finally improving the quality of life for the patient.
The most common form of topical scalp psoriasis treatments include:
These steroids are used on mild to moderate cases of scalp psoriasis. The medication acts by suppressing the immune system’s response on the affected areas by reducing the local production of cytokines. This in turns allows for reduced skin inflammation, and stops skin cell hyper proliferation.
Corticosteroids come in many forms and potency, each with different combinations of agents in the content. High potency corticosteroids have been shown in clinical trials to achieve an improvement in the condition for 80% of the patients.
However, with longer-term use of corticosteroids for scalp psoriasis, there is a concern that tachyphylaxis may arise, where the body develops a resistance towards the corticosteroids within a 2 to 4 month period of usage.
Apart from there, there have also been possible side effects from the usage of Topical Corticosteroids such as skin atrophy, allergic contact dermatitis, or even an increase in susceptibility to infection. Additionally, systemic side effects that could arise include Cushing Syndrome or even Adrenal suppression.
2) Topical Retinoids
Derived from Vitamin A and known as Tazarotene, this treatment comes in the form of a cream or gel. It is believed that Retinoids work by inhibiting keratinocyte proliferation, normalize its differentiation and finally, reducing inflammation.
While clinical trials have been performed successfully, Retinoids are usually applied alongside other types of topical treatments such as corticosteroids, or even phototherapy treatments. One of the common side effects with using Retinoids for treatment is skin irritation, particularly when high dosage is used. As skin is also more susceptible to burning when Retinoids are used, sunscreen should be applied on treated skin that is exposed to sunlight.
3) Vitamin D3 Analogs
This type of topical psoriasis treatment works by preventing keratinocytes from proliferation. In the United States, Calcipotriene and Calcitriol are the two Vitamin D3 Analogs that are approved for use. Elsewhere, the other types of Vitamin D3 Analogs used are Maxacalcitol and Tacalcitol.
The benefits of using Calcipotriene as compared to other topical treatments for psoriasis is its ability to be used on a longer term without causing tachyphylaxis. However, the downside of Calcipotriene is that effectiveness is not seen until at least after 2 months of usage.
The other type of Vitamin D3 Analog, Calcitriol, is a relatively newer agent recently approved by the FDA. In clinical trials, improvement in psoriasis conditions is apparent after 2 weeks of treatment, with sustained improvements even after 8 weeks of usage. Some of the side effects found include pruritus, skin discomfort, hypercalciuria and urine abnormality.
4) Combination Therapies
With the need to exploit the benefits and simultaneously reduce the side effects of different treatment options, combination therapies have been introduced. These include combining corticosteroids (betamethasone dipropionate) with Calcipotriene especially for scalp psoriasis therapies. Side effects are reduced when betamethasone prevents inflammation, while calcipotriene prevents against skin atrophy. Combination therapies are also used alongside other types of psoriasis therapies such as phototherapy or even biologics, especially when treating the more severe form of the condition.