Psoriasis brings a myriad of pains. First, there's the blunt physical pain: Our hands and elbows and knees and scalps itch and burn and ache; thick red plaques of inflamed skin calcify over with rough, silver scales. Then, there is the shame of trying to avoid the stares, pitying and disgusted alike.
What is scalp psoriasis?
Roughly 7.5 million Americans have been diagnosed with psoriasis, in which skin cells multiply 10 times faster than usual; these cells eventually break the surface of our skin, and when they die, they simply pile up on top of each other, creating those dense, dry and unruly patches of sore skin.
In some cases, these lesions meld with each other to menace broader swathes of the body — like the scalp. People with scalp psoriasis face a unique set of challenges, like finding over-the-counter hair products that won’t agitate our already angry skin or wondering if pulling our hair into ponytails will cause our scales to crack and bleed.
Washing your hair with scalp psoriasis
Your instinct may be to leave your hair alone as much as possible to avoid irritating your scalp, but according to experts, that's not the right move.
Washing our hair semi-regularly — about two or three times a week — refreshes our scalps. “Washing away the scaliness,” is how Dr. Lindsey Bordone, dermatologist at Columbia Doctors and assistant professor of dermatology at Columbia University Medical Center, describes the process. “If hair is unwashed for longer periods of time, the scaliness can build up so patients [must] balance scalp care with [the] dryness of [their] hair,” she says. That’s why she cautions patients against over-drying our hair — since dryness, particularly the heat blast of a hair dryer, can irritate psoriasis.
Choosing your products
Though anyone with scalp psoriasis should seek out a dermatologist, we can still use many of the common shampoos and conditioners found at the local grocery store. “Most shampoos are safe for psoriasis,” says Dr. Andrea Hui, board-certified dermatologist of Bay Area Cosmetic Dermatology in San Francisco, California. “I recommend occasionally using over-the-counter shampoos with ingredients such as zinc pyrithione (helps with itching), salicylic acid (helps with flaking) and coal tar (helps with itching).” However, in some more severe cases, a doctor will prescribe a steroid shampoo that should be used about three times a week.
We must treat our scalps tenderly, explains Dr. Bobby Buka, a dermatologist in New York City and section chief for the Mt. Sinai school of medicine. “Any irritation of the scalp makes scalp psoriasis worse… we ask that patients use only gentle products on the hair and scalp.”
Buka says there’s been some promising data about the healing effect that omega-3s in fish oil can have on scalp psoriasis; currently, he recommends products with salicylic acid to remove “excess scale from the scalp.”
Dying your hair with scalp psoriasis
We've covered the basics of hair hygiene, but what do we do when we want to prettify our locks? There’s hope for those of us who’ve toyed with going Monroe blond or even Elvira black — if we’re careful. “I would recommend hair dyes that are free of harsh ingredients such as paraphenylenediamine or ammonia, which may cause irritation to the scalp,” says Hui.
Still, we’d probably do best to let a trained colorist, who will be trained to know the best products for each hair and skin type, baby our tresses.
Once we’ve got our new shade of honeyed brown or those beach-ready highlights, we also have options about how to do our ‘do — the old wives’ tale that wearing ponytails or updos exacerbates inflammation isn’t true. “Wear all the ponytails you want,” jokes Bordone.
Of course, we should take care not to accidentally knock against scaly patches of skin while combing our hair, pull our hair up too tightly or use harsh hairsprays that can dry out our scalps.
Feeling better, inside and out
One of the worst aspects of psoriasis — beyond the bodily pain it causes — is the way it can steal our sense of poise and beauty. So knowing that we can give our hair a good wash and a fabulous new color and that we can play with some styles (or simply deploy the on-the-go ponytail like everyone else) heals more than the body. It’s good for the soul.
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