Scalp psoriasis, clinical presentations and therapeutic management

Background: The scalp is a well-known predilection site for psoriasis. Many patients indicate that scalp psoriasis is both psychologically and sociall y distressing. Objective: The aim of the present investigation is to provid e epidemiological data on the various manifestations of scalp psoriasis, as well as on its therapeutic management. Methods: A questionnaire, targeted on scalp psoriasis, was mailed to patient subscribers of a Dutch journal on psoriasis. In total 1,023 forms were returned and evaluated. Results: Rema rkably, a relatively high occurrence of facial psoriasis (25%) and nail pso riasis (40%) was recorded. The dynamics of scalp psoriasis were rather simi lar to psoriasis at other sites with respect to the total duration of the d isease and exacerbations/remissions. In 57% of the patients, psoriasis was psychologically and socially distressing, at least occasionally. Itch and s caling proved to be the leading symptoms, in terms of frequency of occurren ce as well as in terms of distress. Therefore, these parameters should be r egarded as primary efficacy criteria in the treatment of scalp psoriasis. O n average, most patients were seen by the dermatologist 5 times a year. The majority of prescriptions (76%) was given by the dermatologist. The applic ation of topical corticosteroids was by far the most frequent treatment mod ality. To our surprise, calcipotriol was used by 28% of patients. At the ti me of investigation calcipotriol was only available as ointment. Tar shampo os were used by 51% of the patients, although the clinical efficacy of such a shampoo has never been demonstrated in a controlled study. A remarkable observation was the lack of instruction on the duration of treatment and th e frequency of applications. In fact, 72% of the patients used topical trea tments, including topical corticosteroids, for more than 8 weeks, and 42% o f the patients used an intermittent schedule of a few applications per week . Conclusions: Based on the present survey, the following profile for an op timal treatment of scalp psoriasis can be constructed: (1) effective applic ations a few times per week; (2) either a lotion or an emulsion, and (3) sa fety for long-term use.