A 29-Year-Old Woman with Treatment-Resistant Dandruff

Abstract

Scalp psoriasis is one of the most common form of plaque psoriasis, with up to 80% of patients experiencing scalp involvement at some time. Scalp lesions can be the first manifestation of psoriasis and persist for many years. The characteristic lesions of scalp psoriasis consist of sharply demarcated erythematous plaques with silvery-white scales, which may extend beyond the hairline. Pruritus is one of the most frequent and distressing symptoms in scalp psoriasis impacting quality of life. Hair loss associated with scalp psoriasis can add to the already substantial burden of the disease. The diagnosis of psoriasis in mainly established based on clinical manifestation. Dermoscopy may be helpful to confirm the initial diagnosis. In case of ambiguity, especially in skin lesions limited to the scalp area, skin biopsy with histopathological examination is suggested. Scalp psoriasis often requires different treatment strategies from those used on other body areas, remaining one of the most difficult-to-manage form of the disease. Topical agents are considered as the first-line therapeutic option. The combination of calcipotriene and betamethasone dipropionate is most commonly used. Other topical therapies include intralesional corticosteroids, retinoids, anthralin, tar and keratolytic agents. Recalcitrant or more severe disease may require systemic treatment. However, effectiveness of conventional oral systemic agents, such as methotrexate, acitretin and cyclosporine, have been studied in the treatment of generalized psoriasis. Other therapeutic options commonly used for scalp psoriasis are apremilast etanercept, and secukinumab. KeywordsDandruffDermatologyPsoriatic arthritisPsoriasisScalpTrichoscopy