Scalp Psoriasis

Scalp psoriasis occurs in at least half of all people with psoriasis. It can range from very mild with fine scaling to very severe with thick, crusted plaques.

Scalp psoriasis may appear as lesions that extend from the hairline onto the forehead and the nape of the neck. It is common for the psoriasis to appear behind the ears. Scalp psoriasis usually accompanies plaques in other areas of the body. S

calp psoriasis scales appear powdery with a silvery sheen. Possible causes of scalp psoriasis include: scalp treatments and severe psoriasis can both cause temporary hair loss; itching, picking and scratching lesions can worsen the psoriasis by causing a Koebner phenomenon (psoriasis appearing on the site of skin injuries).

Psoriasis: Separating Fact From Fiction

Psoriasis is a chronic skin condition affecting approximately 4.5 million people in the United States.

New skin cells grow too rapidly, resulting in inflamed, swollen, scaly patches of skin in areas where the old skin has not shed quickly enough.

Psoriasis can be limited to a few spots or can involve more extensive areas of the body, appearing most commonly on the scalp, knees, elbows and trunk.

Psoriasis is not a contagious disease.

The cause of psoriasis is unknown, and there currently is no cure.

Psoriasis can strike people at any age, but the average age of onset is approximately 28 years.

Likewise, it affects both men and women, with a slightly higher prevalence in women than in men.

Approximately 30 percent of people with psoriasis are estimated to have moderate-to-severe forms of the disease.

Psoriasis can be a physically and emotionally painful condition. It often results in physical limitations, disfiguration and a significant burden in managing the daily care of the disease.

Psoriasis sufferers may feel embarrassed, angry, frustrated, fearful, depressed and, in some cases, even suicidal.

Nail Psoriasis

Psoriasis can affect both the toenails and fingernails. Commonly it appears as pits in the nails of various size, shape, and depth. Sometimes the nails develop a yellowish color and become thick. The nails may crumble easily and be surrounded by inflammation. Another possible symptom is detachment of the nail from the nail bed. Psoriasis can affect the connective tissue that forms the nails. Pitting of the nails may be an early sign of nail psoriasis, although pitting can also occur in other diseases. Other signs of nail psoriasis include the appearance of dark spots resembling oil droplets on the nails, the build-up of flaky skin cells under the nails, and separation or loosening of the nails from their beds (onycholysis). One or more nails may be affected.

Psoriasis of the fingernails and toenails is common but can be very difficult to treat. The nails may start to separate from the nail bed. During this process, the nail becomes whitish in appearance. Sometimes it becomes so badly damaged that it starts to crumble.About 50 percent of persons with active psoriasis have psoriatic changes in fingernails and/or toenails.

In some instances psoriasis may occur only in the nails and nowhere else on the body. Psoriatic changes in nails range from mild to severe, generally reflecting the extent of psoriatic involvement of the nail plate, nail matrix (tissue from which the nail grows), nail bed (tissue under the nail), and skin at the base of the nail. Damage to the nail bed by the pustular type of psoriasis can result in loss of the nail.

Nail changes in psoriasis fall into general categories that may occur singly or all together:
1) The nail plate is deeply pitted, probably due to defects in nail growth caused by psoriasis.
2) The nail has a yellow to yellow-pink discoloration, probably due to psoriatic involvement of the nail bed.
3) White areas appear under the nail plate. These are air bubbles marking spots where the nail plate is becoming detached from the nail bed (onycholysis). There may be reddened skin around the nail.
4) The nail plate crumbles in yellowish patches (onychodystrophy), probably due to psoriatic involvement in the nail matrix.
5) The nail is entirely lost due to psoriatic involvement of the nail matrix and nail bed.

Psoriasis of the nails can resemble other conditions such as chronic infection or inflammation of the nail bed or nail fold. Psoriasis of the toenails can resemble chronic fungal infection of the nails.A person with psoriatic nails should avoid any injury—bumps, scrapes, etc.—that may trigger a worsening of psoriasis (Koebner’s phenomenon). About one-third of people with nail psoriasis may have a fungal infection, which, if treated, could help their nails to improve. Some treatments used for skin psoriasis also may improve the condition of the nails.

Psoriasis Treatment Recommendations

When treating psoriasis, it is important to treat the symptoms of psoriasis in as many ways as possible. If you modify your lifestyles, eating habits and reduce stress you may experience a greater degree of improvement in your psoriasis.

While treating the symptoms of psoriasis that are most visible and distressing, you should try to treat the cause! If we find and treat the cause, then maybe all the symptoms of psoriasis need not occur!

Before implementing the lifestyle changes, take a picture of your psoriasis so you can see the cause and effect of each lifestyle change in your psoriasis skin in 2-3 months by taking an "after" picture.

Lifestyle changes can be an effective addition to any psoriasis treatment.

1. Keep the body well hydrated with water. The smallest person should consume at least 8 eight-ounce glasses of water a day. The average person should consume 10 to 12 glasses daily. A person with an above-average exercise program, or who lives in a cold climate, should have 12 to 16 glasses.

2. Keep the skin hydrated with creams or lotions such as Jojoba oil (found in most health stores), Keri lotion, 10% urea cream, or Eucerin. Vaseline and ointments can block sweat glands and cause rashes to worsen, therefore they should be avoided.

3. Antihistamines, such as Benadryl by Parke-Davis (25 mg.), can be taken after 7:00 PM to control itching, which tends to be worse at night.

4. Keep nails clean and short to prevent scratching, which can cause infection or irritation.

5. Avoid skin irritants such as animal dander (dogs and cats), feathers, harsh fabrics (denim and corduroy), tight clothing, and sometimes even wool and silk. Cotton clothing is recommended as much as possible.

6. Launder clothing with mild soap or detergent (Dreft, Ivory Snow, certain sans-additive detergents such as Tide Free). Avoid additives such as enzymes or fabric softeners. Wash new clothing prior to wearing.

7. Avoid temperature and humidity extremes, don't overdress or overheat. When humidity is low as during the winter in heated homes, a humidifier may be helpful.

8. Avoid swimming in chlorinated pools. Lake and ocean swimming is fine. Apply moisturizers afterwards.

9. Reduce or eliminate coffee and other stimulants, including alcohol.

10. Use soap substitutes such as Cetaphil 'gentle cleansing bar for dry sensitive skin', Emulave, or Neutrogena. Use of Bubble bath should be limited as it may cause dryness and irritation of the psoriasis.