Dr. Lyn Guenther
On October 21, 2010 at the 19th Regional Conference of Dermatology 2010 and 2nd annual meeting of the Asian Academy of Dermatology and Venereology in Koto Kinabalu Malaysia, Dr. Guenther gave a presentation on “Scalp psoriasis – An overview.”
The scalp is often the first site of involvement in patients with plaque psoriasis. Up to 80% of patients have scalp disease and approximately 25% only have psoriasis on the scalp. The scales on clothing, itching and visible lesions negatively affect quality of life, rendering patients self conscious, embarrassed, frustrated and depressed. The disease can vary from mild with slight fine scaling, to severe with sharply demarcated, red, scaly, crusted plaques covering the entire scalp. In half of patients, more than 50% of the scalp is involved. Scalp lesions often extend beyond the hairy area to the face or behind the ears. Itching is common; hair loss is rarely seen.
Scalp disease is often difficult to manage acutely as well as chronically. Since there is no cure, long-term control is needed. The scalp is relatively inaccessible and topical treatments often stay on the hair. In addition, since the scalp abuts on sensitive facial skin, topical treatment may cause irritation. Topical treatment should ideally not affect hair grooming and should not be smelly. The use of a shower cap can lower self-esteem. Patient compliance can be a challenge. Compliance increases with first-time use, once-daily treatment, simple regimes, when there are fewer adverse effects and high efficacy, and in the case of topical treatment, when treatment is cosmetically elegant.
The 2009 published US treatment algorithm recommends first line treatment with topical corticosteroids short-term or intermittently, vitamin D analogues, salicylic acid, anthralin, coal tar shampoo, topical retinoid (tazarotene) and combination topical therapy (e.g. Xamiol®. Intralesional corticosteroids are second line, while phototherapy, conventional systemics (methotrexate, cyclosporine, acitretin) and biologics are third line.
The 2009 European maintenance algorithm recommends intermittent as needed use of potent to very potent corticosteroids and/or vitamin D3 analogs when symptoms recur, or continuously twice a week if there are frequent relapses.
Xamiol® is a once daily treatment which has a rapid onset of action. After only 2 weeks of use, over half of treated patients are clear/almost clear. Control is maintained over 52 weeks with as-needed use.