Shampoo in the treatment of scalp psoriasis

Abstract

Psoriasis, one of the most common chronic skin disease, is thought to have an immunemediated pathogenesis whereby activated T cells infiltrate the dermis and stimulate cytokines, thus promoting keratinocyte proliferation. Psoriasis affects 1–3% of the world’s population. The scalp is the site of predilection for psoriasis, as 50–75% of all psoriasis individuals have scalp psoriasis sometime during their disease. Scalp psoriasis can be associated with psoriasis vulgaris (types I and II), guttate psoriasis, pustular psoriasis or erythroderma. Scalp psoriasis is characterized by sharply demarcated erythematosquamous lesions with silver-white scaling; plaques often advancing beyond the hair border onto the face and retroauricular area. Several authors have reported that chronic plaque psoriasis may impair hair growth and even result in scarring. Patients with scalp psoriasis frequently complain of pruritus and scaling. Scalp psoriasis can severely impair patient quality of life, restricting lifestyle and daily functioning. Furthermore, it is embarrassing in social settings and associated with psychological distress in many patients. Despite a vast number of therapies, scalp psoriasis remains difficult to treat. The scalp is an area relatively inaccessible because of thick scales, hair density and proximity of the sensitive facial skin. Furthermore, many topical therapy options are unpleasant to apply, resulting in decreased adherence and efficacy. Current topical treatment modalities are based on new formulations - shampoos, lotions and foams. Shampoos are safe, well-tolerated, efficacious and preferable by the patients. Active ingredients include keratolytics (e.g. salicylic acid, sulfur), tars and corticosteroids. Topical corticosteroids (e.g. clobetasol propionate shampoo) and vitamin D analogues (not available in shampoo formulation) are the drugs of choice during the induction phase, and tar-blend shampoos (and vitamin D analogues) continue to be drugs of choice for maintenance therapy. None of the preparations evaluated stands out over the others in all clinical situations and their use must therefore be individualized in each patient.