Psoriasis capitis L40.8

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 13.03.2024

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Head Psoriasis; psoriasis capillitii; Psoriasis of the scalp; scalp psoriasis; Scalp Psoriasis

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Very common (possibly the most common manifestation of psoriasis- good epidemiological data are missing!), localized or in combination with other body foci, a form of psoriasis of the head that manifests itself up to 80% on the hairy scalp (psoriasis capillitii).

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Pathogenetically, there is no clear picture of psoriasis capitis. Histologically, the classical phenomena of psoriasis can be proven, whereby the hair apparatus is obviously not involved. Possibly, high hair density as well as pruritus and scratching effects act as mechanically irritating factors. In addition, a special germ colonisation (e.g. Malazessia furfur) could be an activating factor (Sticherling M 2017).

Indication for natural remedies
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Formulation for a 5% coal tar solution that can be used as a substitute for a standard tar shampoo.

  • Rp.
  • Coal tar spirit 5,0 g
  • Sodium lauryl ether sulphate 27% 60.0 g
  • Sodium chloride 6,0 g
  • Purified water ad 100,0 g

Formulation for a 5% coal tar solution for the treatment of psoriasis capillitii

Alternatively, preparations with sulphonated oil from sulphur-rich slate can be used. As ready-to-use preparations, the Medical Shampoo® from Dermasence or Bionatar® from Faroderm is available.

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Hairy head, especially in the area of the temporal bones. Characteristically and diagnostically important (differentiation from seborrhoeic scalp eczema) is the crossing of the forehead hair line by the psoriatic lesions. This also affects the lateral hairline.

Clinical features
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Mostly affecting the hairy parts of the scalp, (usually) sharply demarcated, strongly scaling, frequently also itchy, clearly consolidated plaques. The maximum variant is pityriasis amiantacea, which is characterized by keratotic deposits on the hair shafts (almost always with accompanying hair loss).

Color: Vivid red or with a more or less distinct, white, adherent, dry or greasy scaly coating, depending on the pretreatment.

Not uncommon are less spectacular, little indurated only small lamellar (seborrhoid) scaling plaques, which do not cause any other discomfort except disturbing desquamation and gfls. slight itching.

At the hairline of the forehead and the lateral hairlines, the psoriatic changes often spread to the hairless skin(pathognomic sign of psoriasis of the hairy scalp - differentiation from seborrheic eczema of the scalp).

Hair loss is not a typical accompanying phenomenon of psoriasis capitis. However, in severe and extensive psoriatic scalp infestation, there may be relevant hair loss, usually reversible but also extending to alopecic areas (see alopecia, scarring). The cause of this is not clear.

Pustular forms of psoriasis of the capillitii are little known. They are sometimes subsumed under the clinical picture of folliculitis decalvans.

Differential diagnosis
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In case of strong (asbestos-like), pronounced dandruff formation, the hair may break off or irreversible hair loss may occur.

External therapy
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Initial: First desquamative therapy, e.g. treatment with 2-5% salicylic acid-containing gels (e.g. Squamasol gel, Stieproxal shampoo) or a well washable salicylic acid-containing oil (see below salicylic acid).

Alternative: application of a head cap (e.g. Lygal head ointment N) for several hours.

Alternative: application of a solution of dicaprylyl carbonate and dimethicone. This mixture of a fatty acid ester and a silicone oil flows under the scales and infiltrates the cellular cohesion (Loyon®, Cetiol®).

Mild infestation:

  • Treat with 2-5% salicylic acid-containing gel (e.g. Squamasol gel) or shampoo (Stieproxal) spread on capillitium 2-3 times/week. Leave for 20-30 min. and then rinse with clean water.
  • Follow up the affected scalp with Liquor carbonis detergents-(LCD) containing O/W emulsion ( R154 ). Alternate 2 times/week with tar-containing scalp pack and wash (e.g. Tarmed Shampoo- currently out of trade). Always make sure that this therapy does not irritate the scalp too much (itching!).
  • Alternative: Topical application of vitamin A derivatives or D derivatives: Tazarotene (Zorac® 0,05-0,1%) 1 time/day or local vitamin D3 analogues. In this case, solutions, e.g. Psorcutan® solution 2 times/day or emulsions, e.g. Curatoderm® emulsion, 1 time/day, are preferred. Indication in adults and children > 12 years with infestation of the hairy scalp.

Moderate infestation:

  • Treat scalp with ointments containing salicylic acid (e.g. Lygal head ointment) 2-3 times/week overnight. Cover head with TG tubular bandage (Cave: contamination of pillow possible). In the morning wash out with liquid syndet (e.g. Seba-med® liquid).
  • Alternative: In"dithranol-experienced" patients, a preparation containing dithranol can be applied 1-2 times/week for 7-8 hours or as short-term therapy for 2-3 hours (e.g. R074 ). Caution. Discoloration may occur with light hair color!
  • Alternative. A good alternative is the combination of calcipotriol and betamethasone dipropionate in a gel base (Xamiol Gel®; Daivobet Gel®). At the beginning of the treatment, 1xt daily applications are recommended.

Heavy infestation:

  • Initially treat the capillitium occlusively (e.g., overnight) with medium-strength glucocorticoid in a gel or oil base such as 0.1% dexamethasone gel ( R063) or 0.05% clobetasol-17-propionate top oil ( R054A; Rp 219 from NFA) or 0.1% triamcinolone acetonide oil for several hours under foil. Gel and oil can be rinsed out with clear water.
  • Alternative: Application of a steroid-containing shampoo (Clobex Shampoo) or of salicylic acid oil 2/5% or 10% in combination with triamcinolone acetonide 0.1%. Followed by therapy with tazarotene or calcipotriol solution. In patients with understanding, a trial with a 0.25-2.0% washable dithranol ointment can also be performed on an outpatient basis.(Important is the signature with the notes on dithranol side effects). Start with a 0.25% ointment (initially also lower dosage if necessary), increase to double concentration every 2 weeks!

In case of very severe affection with weeping psoriasis:

  • Initially, gel containing betamethasone (e.g. Diprosis® Gel) for several days under foil occlusion.
  • In the meantime, wash out hair with tar shampoo (e.g. Tarmed® currently out of stock). As an alternative to tar shampoo, "Medizinal Shampoo®" with ichthyol from Dermasence can be used.
  • Alternatively: use a shampoo containing steroids (Clobex Shampoo) alternating daily with a tar shampoo. (Subsequently, under the standardized stationary conditions, transition to a washable dithranol ointment see above).

Basically, it is always recommended to temporarily "grease up" the scalp with an O/W emulsion (e.g., after washing out the dexamethasone gel, spread a few ml of a lotion - e.g., Abitima Lotion, Excipial U Hydrolotio, Sebamed Lotion- on the previously moistened scalp; blow-dry hair).

Radiation therapy
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In addition to the external treatment, the use of local UVB rays has proven to be effective. In the area of the hairy head, the so-called UV combs are suitable (e.g. Hönle company, Saalmann).

Internal therapy
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Systemic therapy with fumaric acid esters (Fumaderm, dimethyl fumarate) or acitretin (Neotigason) should certainly be considered in cases of resistance to therapy. When making this decision, it may be necessary to choose between the local therapeutic "sysiphosis effect" and the undesirable systemic "overtreatment". In the case of chronically active psoriasis capitis (capillitii), especially in the case of thick and long hair, a satisfactory clinical result can only be achieved locally through a considerable and constant, sometimes unaffordable, "therapeutic effort".

In this therapeutic dilemma, a suitable systemic therapy (see psoriasis vulgaris) should be considered as an alternative after taking all aspects into account. Similar considerations should be made for intertriginous psoriasis, nail poriasis or pityriasis amiantacea.

Fumaric acid esters are a therapeutic option. Good effects were achieved in a double-blind randomized study with secukinumab (Bagel J et al. 2017).

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Often a course lasting years, usually recurrent.

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Psoriasis capitis, together with ingtertriginous psoriasis and nail psoriasis, is classified in the group "difficult to treat". There is often the dilemma between the "psychosocial limitation" (57% of cases) due to the visibility of the skin changes, the accompanying itching (26% of cases) and the therapeutic options (Sticherling M . 2016).

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  1. Bagel J et al (2017) The effect of secukinumab on moderate to severe scalp psoriasis: Results of a24-week
    , randomized, double-blind, placebo-controlled phase 3b study. J Am Acad Dermatol 77:667-674.

  2. Eichenfield LF et al (2014) Safety and efficacy of calcipotriene plus betamethasone dipropionate topical suspension in the treatment of extensive scalp psoriasis in adolescents ages 12 to 17 years. Pediatric Dermatol 32:28-35

  3. Elewski BE (2005) Clinical diagnosis of common scalp disorders. J Investig Dermatol Symp Proc 10: 190-193
  4. Hengge UR (2014) Topical, Non-Medicated LOYON(®) in Facilitating the Removal of Scaling in Infants and Children with Cradle Cap: a Proof-of-Concept Pilot Study. Dermatol Ther (Heidelberg) 4:221-232

  5. Radtke MA et al (2010) Calcipotriol plus betamethasone dipropionate gel in the treatment of scalp psoriasis. Dermatologist 61: 770-775
  6. Wilsmann-Theis D et al (2014) Psoriasis and eczema on the scalp. dermatologist 65:1043-11049

  7. Kim TW et al (2014) Clinical characteristics of pruritus in patients with scalp psoriasis and their relation with intraepidermal nerve fiber density. Ann Dermatol 26:727-732

  8. Sticherling M (2017) Psoriasis capitis and seborrheic eczema of the scalp. Dermatologist 68: 457-468


Please ask your physician for a reliable diagnosis. This website is only meant as a reference.


Last updated on: 13.03.2024