Psoriasis affects 8 million Americans. 1.3% of the people affected are African Americans. Scalp psoriasis is an inflammatory scalp condition that most shows on the neck’s hairline, forehead, ears, and back.
In this African American scalp psoriasis guide, you’ll have everything you need to know about it and the best treatments to manage it.
What is psoriasis
It is an autoimmune-mediated scalp condition where the immune system mistakenly identifies the normal skin cells as foreign bodies and initiates an immune attack on them. The autoimmune reaction alters normal skin cell growth.
The skin cell growth takes at least 21-30 days from the beginning of cell division in the innermost layer of the germinal matrix to when the keratinized cells shed off at the skin’s surface. In psoriasis, this cycle is significantly reduced to a few days, which causes abnormal cell growth and skin cells on the scalp to pile up. The immature skin cells build up on the scalp causing silvery scales and crusty patches on the scalp.
One-third of African Americans with psoriasis have a family history of the skin condition and are thought to have a genetic predisposition. On African Americans, scalp psoriasis presents as grey, purple, or dark brown lesions on the scalp. Thick crusty patches are present on the affected areas on the scalp and appear white or silver. The affected area bleeds on scratching or any attempt to peel off the crusts.
Common triggers of psoriatic flares on African Americans
1 out of 4 African Americans with a psoriasis flare gets it from the Koebner phenomenon. Any injury on the scalp from events such as
- Insect bites
- Or any irritation on the entire scalp could cause a flare-up.
Stress is one of the major triggers of scalp psoriatic flares in African Americans. Stress comes in many forms:
- Psychological stress
- Emotional stress
- Physical stress
- Nutritional stress
- Environmental stress
- Behavioral stress
Infections and illnesses
Infection provokes psoriasis is triggered or aggravated by bacterial, viral, or parasitic infections.
Drug-induced psoriasis is common among African Americans. These drugs are:
- Antimalarial – chloroquine
Very cold weather and very hot weather
High temperatures and extremely low temperatures trigger psoriasis. People with psoriasis get more flares over winter and the hottest times in summer.
Management of African American Scalp Psoriasis
Psoriasis management in African Americans aims at:
- removing the flakes
- Resolving the inflammation
- stopping the skin cells from growing and shedding too quickly.
- Reducing the appearance of the psoriatic lesions
- Resolving the scalp itch
- Softening the flakes for easier shedding.
Effective psoriasis treatments include:
- Medicated shampoos
- Creams and ointments
- Topical steroids
- Oral medications
Medicated shampoos that treat psoriasis have salicylic acid or coal tar as their primary ingredients. The shampoos are available as over-the-counter medications. They work on the scalp and not the hair though there is no harm if the shampoo gets in contact with the hair. Apply the shampoo evenly on the scalp and allow it to sit for a few minutes before rinsing it off.
Below are some of the best-medicated shampoos for the management of African American scalp psoriasis:
|MG217 Medicated Conditioning Coal Tar Formula Shampoo||Coal Tar 3% – Coal Tar corrects the altered process of skin cell differentiation and helps restore smooth skin.|
|Scalp Psoriasis & Dandruff Shampoo and Conditioner by DermaSolve||Salicylic acid 3% – Softens the flakes in psoriasis, making it easy to wash them off the scalp.|
|Neutrogena T/Gel Therapeutic Shampoo Original Formula||Coal tar 1%|
|Neutrogena T/Sal Therapeutic Shampoo||Salicylic acid 3%|
Creams and ointments
Creams and ointments are applied directly to the scalp on a daily basis. The active ingredients in the products penetrate the skin and act directly on the affected cells.
Ensure the scalp is free from styling products and debris to allow easier penetration of the treatment creams.
|MG217 Medicated Multi-symptom moisturizing cream||salicylic acid, aloe, bisabolol, shea butter|
|CeraVe Moisturizing Cream for Psoriasis Treatment||coal tar 3%, vitamins D3, A, and E|
|Gold Bond Ultimate Multi-Symptom Psoriasis Relief Cream||salicylic acid, ceramides, gluconolactone, vitamin D, shea butter, and aloe|
|Cortizone 10 Maximum Strength Creme||Hydrocortisone 1% – Corticosteroids act on the immune and inflammatory cells on the skin by activating substances that reduce inflammation, swelling, redness and itching.|
|Basic Care Maximum Strength Hydrocortisone 1 Percent Anti-Itch Cream Plus||vitamins A, D, and E plus aloe, with hydrocortisone 1%|
|NOW Supplements, L-Tyrosine 750 mg||Curb inflammation|
|Vitamin D||Resolve inflammation and slow skin cell growth.|
|Retinoids||Slow down skin cell growth. They are available as creams or gels and applied twice a day on the affected areas.|
How to maintain hair in scalp psoriasis
- Avoid hair products with alcohol or harsh chemicals such as sulfates which can irritate the scalp.
- Avoid relaxers, perms, blowouts, or color treatment during a psoriatic flare. The chemicals used in this process may irritate the scalp and make the condition worse.
- Tight hairstyles like cornrows and braids may trigger or worsen psoriasis. Style hair in loose, comfortable styles that do not cause strain on the scalp.
- Use moderate heat styling. Excessive heat irritates the scalp and may cause psoriasis flare.
- Wear styles that do not obstruct the scalp. Most psoriasis medications require direct application on the scalp. Obstructive hairstyles like weaves may hinder the proper application of the medication.
- It’s preferable to keep the hair open without braids or cornrows during psoriasis treatment. Shampoo the hair once or twice a week with a medicated shampoo.
- Moisturize the scalp to prevent further dryness in patches of skin. Use different products such as olive oil, jojoba oil, coconut oil, or shear butter.
Psoriasis presents and manifests differently in African Americans. The symptoms may be harder to see. The scabs tend to be thicker and may mimic other scalp conditions. Treatment options with ointments, creams, and shampoos are the first option for topical treatment. More severe African American scalp psoriasis cases are treated with oral treatments and corticosteroids.
Consult your doctor if the psoriasis is persistent or in case of a reaction to a certain medication.
Celestine is certified by the International Association of Trichologists (IAT). She has written articles on hair and scalp health to create awareness. Celestine was a key note speaker at the first Virtual World Trichology Society Summit in May 2021 speaking about hair transplant techniques on afro ethnic hair.