Scalp Itching in Psoriasis: Don't Forget about "Psoriasitch"

Scalp Itching in Psoriasis Affects Quality of Life

Psoriasis is an immune disease that affects multiple organs and structures. Dermatologists treat skin psoriasis on a daily basis. Rheumatologists treat psoriatic arthritis on a daily basis. 
The scalp is involved a large proportion of patients with psoriasis. In fact, nearly two thirds of patients with psoriasis have scalp psoriasis and it is often the first area where the disease shows up. 

Having scalp psoriasis affects people’s quality of life. Scalp itching is often present and the itching can be troublesome for many. In fact, when I teach other physicians about scalp psoriasis I always encourage them to remember the word “psoriasitch.” It’s a completely made up and completely invented word but it helps clinicians remember the often debilitating effects of the itching that comes with having psoriasis. Not only do we need to remember the flaking and redness and sometimes hair loss that goes with it - but we absolutely need to address the itching these patients live with. And so I call it “psoriasitch.”

The mechanisms that lead to itching are actually quite complex for patients with psoriasis and involve parts of the immune system, nervous system, endocrine system and blood vessels. The mast cell, a key cell normally involved in “allergic responses” in the body, seems to be a key cell type involved in generating itching in patients with psoriasis.

Trichoscopic image from a patient with psoriasis. The patient was extremely itchy. Scalp itching impacts qualify of life and must be addressed by practitioners.

A wide variety of traditional anti-psoriasis agents can reduce itching. Topical steroids, vitamin D analogues, methotrexate, retinoids, and the newer biologics can reduce inflammation and reduce itching. But whether other non traditional strategies that affect the nervous system, endocrine system, blood vessels can also help stop itching is the subject of intense research interest worldwide.

The image here is a trichoscopic image from a patient with scalp psoriasis. The scale is white in contrast to the yellow of seborrheic dermatitis. There is scale around hairs (“perifollicular scale”) and certainly other conditions such as lichen planopilaris could be considered.