Speak Clearly: Perspectives on psoriasis

If you have psoriasis like me, you are probably familiar with plaques appearing on the skin of your arms, legs, and back. But did you know half of all people with psoriasis experience symptoms on their scalp, too? If you think your “dandruff” could be something more, it’s possible that psoriasis isn’t just in your head—it’s on it.

As long as I can remember, my scalp was constantly itchy, and you could see silvery-white flakes in my hair. It never occurred to me that my psoriasis could be manifesting on my scalp, too. It wasn't until a few years later, after my dermatologist diagnosed me with scalp psoriasis, that I began to slowly understand the connection. I asked myself why I never associated the psoriasis on my body with the symptoms of my scalp.

This question is what has shaped me over the years and encouraged me to share my story and continue to raise awareness of issues in psoriasis that people may not realize. Since I founded my online platform for people living with psoriasis, I have spoken to many people living with the disease and found more often than not, those struggling with symptoms, including scalp psoriasis, feel the same as I do: confused and misinformed. Here are some things I have learned about scalp psoriasis on my journey:

It’s not dandruff

When I first started noticing flakes in my hair, my first thought (thanks to various advertisements and a lack of information), that I simply suffer from "normal" dandruff and that I could solve it with the right shampoo. The flakes can look like dandruff, but they are not the same and need to be treated differently.¹ True dandruff is caused by dry scalp, but scalp psoriasis is much more complicated and requires a different treatment.² If you’ve tried a special dandruff shampoo and are still experiencing itchiness and flakes, consider talking to your doctor to see if it could be scalp psoriasis.

There are three levels of severity³

Not everyone with scalp psoriasis experiences symptoms to the same extent. Knowing how severe your condition is can help you and your doctor approach treatment:

Mild: Less than 50 percent of the scalp is affected; scaling, itching and redness are kept within limits³

Moderate: Less 50 percent of the scalp is affected; dandruff, itching, and redness are more severe where plaques are³

Severe: More than 50 percent of the scalp is affected; itching, dandruff and redness are often present and very severe³

It can seriously affect your self-esteem

Once I began to recognize my scalp symptoms as psoriasis, I realized how much I had been affected by the constant dandruff and itching over the years. Psoriasis is particularly stressful when you know others can see it. With scalp psoriasis, red plaques can creep out from your hairline, becoming clearly visible to anyone looking at your face.¹ Beyond plaques, some people also report that scalp psoriasis can lead to increased hair loss over time, and so the psychological impact continues.⁴ All of this can lead to psychological strain and increased stress.

And if you’re someone who enjoys doing their hair, it can be especially hard. I remember, I interviewed a woman who loved doing her hair when I was first starting my website. She told me how much she suffers—especially as a woman—from psoriasis on her head. I immediately thought of my own story and put my symptoms into perspective.

There is something you can do about it – now!

There were many dandruff shampoo product purchases in my lifetime that could have been spared if I had brought it up with my physician earlier. The key to getting the treatment you want is to always trust your own feelings and tell your doctor how your psoriasis impacts you as soon as possible. Don’t underestimate how your psoriasis symptoms affect you – the sooner speak up and address the feelings you’re having about your condition, the closer you will be to feeling free from your disease.

If you’re feeling unhappy about your symptoms, don’t wait! Find a physician you can trust and tell them what’s bothering you – even if it’s “just a little dandruff.”

Need help in starting the conversation with your doctor? Check out this doctor discussion guide.

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References:

1. Scalp Psoriasis. National Psoriasis Foundation. Available at: https://www.psoriasis.org/scalp/. Accessed on October 27, 2020.
2. How to Treat Dandruff. American Academy of Dermatology. Available at: https://www.aad.org/public/everyday-care/hair-scalp-care/scalp/treat-dandruff. Accessed on October 27, 2020.
3. Ortonne, JP. Scalp psoriasis: European consensus on grading and treatment algorithm. JEADV. 2009 November 10; 23, 1435–1444.
4. Scalp Psoriasis. UCLA Health. Available at: https://www.uclahealth.org/dermatology/scalp-psoriasis. Accessed on October 27, 2020. 

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