Updated Review Highlights Diagnostic Tools and Treatment Strategies for Scalp Psoriasis
Scalp psoriasis, affecting up to 80% of patients with psoriasis, remains a common and often difficult-to-treat manifestation, according to a recent review summarizing advances in diagnosis and management. The findings emphasize a structured, stepwise approach to care while highlighting emerging therapies for refractory disease.
Diagnosis of scalp psoriasis is primarily clinical, supported by trichoscopy. In cases of diagnostic uncertainty, additional tools, such as histopathology, optical coherence tomography, reflectance confocal microscopy, and line-field confocal optical coherence tomography, may provide further clarification. The authors note that these modalities “may offer valuable insights in doubtful cases,” particularly when distinguishing psoriasis from other scalp disorders.
For treatment, topical therapies remain the cornerstone for mild-to-moderate disease. Common first-line options include glucocorticosteroids, fixed combinations such as betamethasone-calcipotriol, and calcineurin inhibitors. These therapies are widely used but may be limited by adherence challenges and incomplete response in hair-bearing areas.
Patients with more severe disease or inadequate response to topical treatment may require systemic therapy. Established options include tumor necrosis factor inhibitors, interleukin-17 inhibitors, interleukin-23 inhibitors, and conventional agents such as methotrexate or cyclosporine. The review highlights that newer therapies are expanding the treatment landscape, noting that “recent studies have demonstrated promising outcomes with novel treatments, including Janus kinase inhibitors and other new small molecules.”
The authors conclude that a combination of accurate diagnosis and individualized therapy selection is essential for optimizing outcomes in scalp psoriasis, given its impact on quality of life and treatment resistance.
Reference
Kuchnicka A, Fałkowska U, Konopelski P, et al. Application of trichoscopy and novel non-invasive imaging techniques in the diagnosis and management of patients with scalp psoriasis. Psoriasis (Auckl). 2026;16:549372. doi:10.2147/PTT.S549372
