Scalp Psoriasis
Scalp psoriasis causes thick, silvery, well-defined plaques that often spill past the hairline and behind the ears. At least half of people with psoriasis get it, and it’s one of the itchiest, most visible spots. The trick is to lift the scale first, then treat the skin underneath.
Psoriasis or dandruff?
- Psoriasis: thick, silvery scale on red plaques with sharp edges; often past the hairline, behind the ears and on the neck
- Seborrhoeic dermatitis (dandruff): thinner, greasier, yellowish flakes, more diffuse, often eyebrows and beside the nose
- Some people have features of both (“sebopsoriasis”), and treatments overlap
- Psoriasis elsewhere (elbows, knees, nails) supports the diagnosis
Dandruff flakes. Psoriasis builds plaques with planning permission.
What helps
Lift the scale, then treat. Most people need 2 or 3 steps.
- Step 1 · PharmacyMedicated shampoos: coal tar, salicylic acid or ketoconazoleLeave on for 5–10 minutes before rinsing. Rotate if one stops working.
- Works
- Helps mild scaling and itch
- Cost
- $15–30
- How long
- 2–3 times a week, ongoing
- Watch for
- Tar smells and can stain light hair.
- Step 2 · PharmacyDescale: salicylic acid or tar-based scalp ointment, or oil, overnightMassage in, cover with a shower cap, wash out in the morning, comb scale gently.
- Works
- Makes every other treatment work better
- Cost
- $15–25
- How long
- Nightly for a week, then as needed
- Watch for
- Don’t pick or scratch scale off: it triggers more psoriasis.
Gentle combing, not excavation.
- Step 3 · GPStrong steroid scalp lotion, foam or short-contact shampooClobetasol shampoo left on for 15 minutes, or betamethasone lotion.
- Works
- Clears or nearly clears many people in 2–4 weeks
- Cost
- PBS or $20–40
- How long
- Daily for 2–4 weeks, then twice weekly
- Watch for
- Fine for the scalp short term; don’t use on the face.
- Step 4 · GPCalcipotriol plus betamethasone gel or foamCombines vitamin D and steroid; often the most effective cream-type treatment for scalp.
- Works
- Better than either ingredient alone in trials
- Cost
- PBS or about $50–90
- How long
- Daily for 4 weeks, then twice weekly
- Watch for
- Mild irritation; limit the amount per week.
- Step 5 · DermatologistTablets or biologic injections for severe or stubborn diseaseMethotrexate, apremilast, or biologics targeting IL-17 or IL-23, which clear scalp psoriasis well.
- Works
- IL-17 and IL-23 biologics clear the scalp in most people in trials
- Cost
- PBS for severe chronic psoriasis that meets criteria
- How long
- Weeks to months; ongoing
- Watch for
- Blood tests and infection screening.
Costs are rough Australian prices and vary by pharmacy and provider. PBS co-payment: $25, or $7.70 with a concession card. Results are typical figures from trials, not promises.
Hair loss
- Thick plaques and scratching can thin the hair temporarily
- Hair grows back once the psoriasis is controlled
- Be gentle: no tight hairstyles, harsh brushing or very hot hair dryers on active plaques
Save your money
Popular, heavily marketed or often asked about, but the evidence is weak or says no.
- Apple cider vinegarCan sting and burn broken skin, with no trial evidence.
- Expensive “natural” psoriasis shampoosOften tar or salicylic acid with a markup.
- Shaving the headNot needed: lotions, foams and shampoos are made to reach the scalp through hair.
Covering it with a hat treats the embarrassment, not the plaques.
Common questions
How do I get rid of thick scale on my scalp?
Soften it first with a salicylic acid or tar scalp ointment, or oil, left on overnight under a shower cap, then wash and comb gently. Then use a steroid or combination scalp treatment.
Is scalp psoriasis the same as dandruff?
No. Psoriasis has thick, silvery scale on sharply edged plaques, often past the hairline. Dandruff (seborrhoeic dermatitis) is thinner, greasier and more diffuse. They can overlap.
Does scalp psoriasis cause hair loss?
It can thin the hair temporarily, mainly from scratching and scale removal, but hair usually grows back once it’s controlled.
Helpful resources
- Psoriasis AustraliaPatient support and information. Free.
- Arthritis AustraliaInformation on psoriatic arthritis and living with it. Free.
- Australasian College of Dermatologists: A–Z of skinDermatologist-written patient information. Free.
Evidence and more information
- Zhang S et al. Biologics targeting IL-17/IL-23 in scalp, nail and palmoplantar psoriasis: network meta-analysis (Front Immunol 2026)
- Australasian College of Dermatologists: A–Z of skin
maladywise.com/scalp-psoriasis/