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Managing Scalp Psoriasis: An Evidence-Based Review
T. Wang, T. Tsai
Published 2016 · Medicine
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BackgroundScalp psoriasis is commonly the initial presentation of psoriasis, and almost 80 % of patients with psoriasis will eventually experience it.ObjectiveAlthough several systematic reviews and guidelines exist, an up-to-date evidence-based review including more recent progress on the use of biologics and new oral small molecules was timely.MethodsOf the 475 studies initially retrieved from PubMed and the 845 from Embase (up to May 2016), this review includes 27 clinical trials, four papers reporting pooled analyses of other clinical trials, ten open-label trials, one case series, and two case reports after excluding non-English literature.ResultsTo our knowledge, few randomized controlled trials (RCTs) are conducted specifically in scalp psoriasis. Topical corticosteroids provide good effects and are usually recommended as first-line treatment. Calcipotriol–betamethasone dipropionate is well tolerated and more effective than either of its individual components. Localized phototherapy is better than generalized phototherapy on hair-bearing areas. Methotrexate, cyclosporine, fumaric acid esters, and acitretin are well-recognized agents in the treatment of psoriasis, but we found no published RCTs evaluating these agents specifically in scalp psoriasis. Biologics and new small-molecule agents show excellent effects on scalp psoriasis, but the high cost of these treatments mean they may be limited to use in extensive scalp psoriasis.ConclusionsMore controlled studies are needed for an evidence-based approach to scalp psoriasis.
This paper references
RESPONSE OF SCALP PSORIASIS TO ORAL KETOCONAZOLE
P. Farr (1985)
Calcipotriol plus betamethasone dipropionate gel compared with calcipotriol scalp solution in the treatment of scalp psoriasis: a randomized, controlled trial investigating efficacy and safety in a Chinese population
Li Ma (2016)
Comparative effects of calcipotriol solution (50 μg/ml) and betamethasone 17‐valerate solution (1 mg/ml) in the treatment of scalp psoriasis
M. M. Klaber (1994)
Treatment of paediatric scalp psoriasis with calcipotriene/betamethasone dipropionate scalp formulation: effectiveness, safety and influence on children's quality of life in daily practice
A. M. Oostveen (2015)
Detection of the action of salicylic acid on the normal stratum corneum
D. L. Roberts (1980)
Infliximab induction and maintenance therapy for moderate-to-severe psoriasis: a phase III, multicentre, double-blind trial
K. Reich (2005)
ABO BLOOD TYPES IN CONGENITAL HEART-DISEASE
V. Siskind (1975)
Dramatic impact of a Psoriasis Area and Severity Index 90 response on the quality of life in patients with psoriasis: An analysis of Japanese clinical trials of infliximab
H. Torii (2012)
Clobetasol propionate shampoo 0.05%: a new option to treat patients with moderate to severe scalp psoriasis.
M. Jarratt (2004)
A Study of the Safety and Efficacy of Calcipotriol and Betamethasone Dipropionate Scalp Formulation in the Long-Term Management of Scalp Psoriasis
T. Luger (2008)
Consistency of infliximab response in different body regions for treatment of moderate to severe psoriasis: results from controlled clinical trials
A Menter (2008)
Infliximab monotherapy in Japanese patients with moderate-to-severe plaque psoriasis and psoriatic arthritis. A randomized, double-blind, placebo-controlled multicenter trial.
H. Torii (2010)
Topical Steroid-Damaged Skin
A. Abraham (2014)
Calcipotriol plus Betamethasone Dipropionate Scalp Formulation Is Effective and Well Tolerated in the Treatment of Scalp Psoriasis: A Phase II Study
C. Buckley (2008)
Efficacy and safety of apremilast, an oral phosphodiesterase 4 inhibitor, in patients with moderate to severe plaque psoriasis over 52 weeks: a phase III, randomized, controlled trial (ESTEEM
C Paul (2015)
A calcipotriene/betamethasone dipropionate two‐compound scalp formulation in the treatment of scalp psoriasis in Hispanic/Latino and Black/African American patients: results of the randomized, 8‐week, double‐blind phase of a clinical trial
S. Tyring (2010)
Clinical studies of a new vehicle formulation for topical corticosteroids in the treatment of psoriasis.
L. Stein (2005)
Combination therapy using maxacalcitol and corticosteroid lotions preliminary to monotherapy with maxacalcitol lotion for scalp psoriasis
Y. Okubo (2014)
Dithranol in an Emulsifying Oil Base (Bio-Wash-Oil) for the Treatment of Psoriasis of the Scalp
A. Wulff-Woesten (2004)
Secukinumab in plaque psoriasis--results of two phase 3 trials.
R. Langley (2014)
Efficacy and safety of calcipotriol plus betamethasone dipropionate scalp formulation compared with calcipotriol scalp solution in the treatment of scalp psoriasis: a randomized controlled trial
K. Kragballe (2009)
Adalimumab for the treatment of moderate to severe psoriasis: subanalysis of effects on scalp and nails in the BELIEVE study
D. Thąci (2015)
Long‐term study of infliximab in Japanese patients with plaque psoriasis, psoriatic arthritis, pustular psoriasis and psoriatic erythroderma
H. Torii (2011)
Rapid response of scalp psoriasis to ustekinumab.
Antonella Di Cesare (2011)
Mode of action of glycolic acid on human stratum corneum: ultrastructural and functional evaluation of the epidermal barrier
M. Fartasch (1997)
Pooled safety analysis of calcipotriol plus betamethasone dipropionate gel for the treatment of psoriasis on the body and scalp
K. Kragballe (2014)
Efficacy, safety and usability of secukinumab administration by autoinjector/pen in psoriasis: a randomized, controlled trial (JUNCTURE)
C. Paul (2015)
Safety and Efficacy of Calcipotriene Plus Betamethasone Dipropionate Topical Suspension in the Treatment of Extensive Scalp Psoriasis in Adolescents Ages 12 to 17 Years
L. Eichenfield (2015)
Apremilast, an oral phosphodiesterase 4 (PDE4) inhibitor, in patients with moderate to severe plaque psoriasis: Results of a phase III, randomized, controlled trial (Efficacy and Safety Trial Evaluating the Effects of Apremilast in Psoriasis [ESTEEM] 1).
K. Papp (2015)
A new scalp formulation of calcipotriol plus betamethasone dipropionate compared with each of its active ingredients in the same vehicle for the treatment of scalp psoriasis: a randomized, double‐blind, controlled trial
P. van de Kerkhof (2009)
Impact of ixekizumab treatment on scalp psoriasis: results from the UNCOVER-2 trial
K Reich (2016)
Treatment of severe scalp psoriasis: from the Medical Board of the National Psoriasis Foundation.
C. S. Chan (2009)
Apremilast mechanism of action and application to psoriasis and psoriatic arthritis.
P. Schafer (2012)
Psoriasis of the scalp treated with Grenz rays or topical corticosteroid combined with Grenz rays. A comparative randomized trial
B. Lindelöf (1988)
Betamethasone valerate foam 0.12%: a novel vehicle with enhanced delivery and efficacy
Thomas J. Franz (1999)
Comparison of topical treatment with desoxymethasone solution 0.25% with salicylic acid 1% and betamethasone valerate solution 0.1% in patients with psoriasis of the scalp.
L. Hillstrom (1984)
Tofacitinib withdrawal and retreatment in moderate‐to‐severe chronic plaque psoriasis: a randomized controlled trial
R. Bissonnette (2015)
An Epidemiologic Study of Taiwanese Psoriatic Patients in a Single Clinic
H. Chen (2003)
Efficacy of betamethasone valerate mousse in comparison with standard therapies on scalp psoriasis: an open, multicentre, randomized, controlled, cross‐over study on 241 patients
L. Andreassi (2003)
Optimising the Use of Tazarotene in Clinical Practice: Consensus Statement from the European Advisory Panel for Tazarotene (Zorac™)
H. Gollnick (1999)
Efficacy and safety of apremilast, an oral phosphodiesterase 4 inhibitor, in patients with moderate‐to‐severe plaque psoriasis over 52 weeks: a phase III, randomized controlled trial (ESTEEM 2)
C. Paul (2015)
Adolescent Scalp Psoriasis: Update on Topical Combination Therapy.
Emily Osier (2015)
Double‐blind clinical study reveals synergistic action between alpha‐hydroxy acid and betamethasone lotions towards topical treatment of scalp psoriasis
K. Kostarelos (2000)
Guidelines of care for the management of psoriasis and psoriatic arthritis. Section 3. Guidelines of care for the management and treatment of psoriasis with topical therapies.
A. Menter (2009)
Multicenter study comparing 0.05% gel formulations of desoximetasone and fluocinonide in patients with scalp psoriasis.
I. Willis (1986)
Ustekinumab Induces Fast Response and Maintenance of Very Severe Refractory Scalp Psoriasis: Results in Two Greek Patients from the Psoriasis Hospital-Based Clinic
E. Papadavid (2014)
Treatment of psoriasis of the scalp with betamethasone 17, 21-dipropionate plus salicylic acid lotion ('Diprosalic').
G. Høvding (1981)
Effective treatment of scalp psoriasis using the excimer (308 nm) laser
W. Morison (2006)
Short-term safety assessment of clobetasol propionate
P Andres (2006)
Improvement of scalp and nail lesions with ixekizumab in a phase 2 trial in patients with chronic plaque psoriasis
R. Langley (2015)
Dithranol: a review of the mechanism of action in the treatment of psoriasis vulgaris.
L. Kemény (1990)
Adrenocortical response to adrenocorticotropic hormone in relation to duration of topical therapy and percutaneous absorption of hydrocortisone in children with dermatitis
M. Turpeinen (2004)
Comparison of Betamethasone Dipropionate Lotion with Salicylic Acid (Diprosalic®) and Clobetasol Propionate Lotion (Dermovate®) in the Treatment of Psoriasis of the Scalp
L. Hillström (1982)
Patient‐reported outcomes in moderate‐to‐severe plaque psoriasis with scalp involvement: results from a randomized, double‐blind, placebo‐controlled study of etanercept
S. Tyring (2013)
A new scalp formulation of calcipotriene plus betamethasone compared with its active ingredients and the vehicle in the treatment of scalp psoriasis: a randomized, double-blind, controlled trial.
G. Jemec (2008)
A randomized, investigator‐masked clinical evaluation of the efficacy and safety of clobetasol propionate 0.05% shampoo and tar blend 1% shampoo in the treatment of moderate to severe scalp psoriasis
C. Griffiths (2006)
Long term study of infliximab in Japanese patients with plaque psoriasis , psoriatic arthritis , pustular psoriasis and psoriatic ery - throderma
H Torii (2011)
Grenz ray therapy in dermatology. An experimental, clinical and epidemiological study.
B. Lindelöf (1987)
Effect of Salicylic Acid on the Activity of Betamethasone-17,21-Dipropionate in the Treatment of Erythematous Squamous Dermatoses
Robert Elic (1983)
Clobetasol propionate shampoo 0.05% and calcipotriol solution 0.005%: A randomized comparison of efficacy and safety in subjects with scalp psoriasis
P. Reygagne (2005)
Patients’ Vehicle Preference for Corticosteroid Treatments of Scalp Psoriasis
S. Feldman (2003)
Efficacy of secukinumab in the treatment of moderate-to-severe plaque psoriasis on the head and neck: pooled analysis of phase 3 studies
L Kircik (2015)
Moderate to severe plaque psoriasis with scalp involvement: a randomized, double-blind, placebo-controlled study of etanercept.
J. Bagel (2012)
Topical treatment for scalp psoriasis: Comparison of patient preference, quality of life and efficacy for non-alcoholic mometasone emulsion versus calcipotriol/betamethasone gel in daily clinical practice
A. Gual (2016)
Broad‐band UVB fiber‐optic comb for the treatment of scalp psoriasis: a pilot study
A. Taneja (2004)
Short-term safety assessment of clobetasol propionate 0.05% shampoo: hypothalamic-pituitary-adrenal axis suppression, atrophogenicity, and ocular safety in subjects with scalp psoriasis.
P. Andrés (2006)
Fluocinolone acetonide topical oil for scalp psoriasis
M. Pauporte (2004)
Topical treatments for scalp psoriasis.
J. G. Schlager (2016)
Efficacy and maintenance strategies of two-compound formulation calcipotriol and betamethasone dipropionate gel (Xamiol® gel) in the treatment of scalp psoriasis: results from a study in 885 patients
R. Saraceno (2014)
Infliximab induction therapy for patients with severe plaque-type psoriasis: a randomized, double-blind, placebo-controlled trial.
A. Gottlieb (2004)
A comparison of tar liquid and cetrimide shampoo in the management of psoriasis of the scalp.
W. Cunliffe (1974)
Safety and efficacy of calcipotriol plus betamethasone dipropionate gel in the treatment of scalp psoriasis in adolescents 12–17 years of age*
M. Gooderham (2014)
Secukinumab administration by pre‐filled syringe: efficacy, safety and usability results from a randomized controlled trial in psoriasis (FEATURE)
A. Blauvelt (2015)
Apremilast , an oral phosphodiesterase 4 inhibitor , in patients with moderate to severe plaque psoriasis : results of a phase III , randomized , controlled trial ( ESTEEM 1 )
K Papp (2015)
Scalp psoriasis: synergy between the Malassezia yeasts and skin irritation due to calcipotriol.
J. Faergemann (2003)
Percutaneous absorption in experimental epidermal disease
A. Solomon (1979)
Scalp psoriasis: European consensus on grading and treatment algorithm
J. Ortonne (2009)
A randomized comparison of continuous vs. intermittent infliximab maintenance regimens over 1 year in the treatment of moderate-to-severe plaque psoriasis.
A. Menter (2007)
Intralesional therapy for psoriasis
T. Wang (2013)
Apremilast, an oral phosphodiesterase 4 inhibitor, in patients with difficult-to-treat nail and scalp psoriasis: Results of 2 phase III randomized, controlled trials (ESTEEM 1 and ESTEEM 2).
P. Rich (2016)
Salicylic Acid 6% in an ammonium lactate emollient foam vehicle in the treatment of mild-to-moderate scalp psoriasis.
L. Kircik (2011)
Comparative effects of calcipotriol (MC903) solution and placebo (vehicle of MC903) in the treatment of psoriasis of the scalp
C. Green (1994)
Tofacitinib, an oral Janus kinase inhibitor, for the treatment of chronic plaque psoriasis: results from two randomized, placebo‐controlled, phase III trials
K. Papp (2015)
Infliximab for psoriasis.
A. Gottlieb (2003)
Scalp psoriasis: a review of current topical treatment options
K. Papp (2007)
Local treatment of psoriasis of the scalp with clobetasol propionate and betamethasone-17,21-dipropionate: a double-blind comparison.
A. Lassus (1976)
308‐nm excimer laser in psoriasis vulgaris, scalp psoriasis, and palmoplantar psoriasis
S. Gattu (2009)
Topical treatments for chronic plaque psoriasis of the scalp: a systematic review
A. Mason (2013)
Safety and effectiveness of adalimumab in patients with moderate-to-severe psoriasis who had inadequate therapeutic response to prior etanercept
T. Wang (2013)
Are topical keratolytic agents needed in the treatment of scalp psoriasis?
Divya Shokeen (2014)
Comparative effects of calcipotriol solution (50 micrograms/ml) and betamethasone 17-valerate solution (1 mg/ml) in the treatment of scalp psoriasis.
M. Klaber (1994)
This paper is referenced by
Psoriasis capitis und seborrhoisches Ekzem der Kopfhaut
M. Sticherling (2017)
Biologics and small molecules in patients with scalp psoriasis: a systematic review.
A. Alsenaid (2020)
Fire needle acupuncture or moxibustion for chronic plaque psoriasis: study protocol for a randomized controlled trial
Zhaoxia Chen (2019)
Marian Anderko (2019)
Adalimumab for nail psoriasis: Efficacy and safety from the first 26 weeks of a phase 3, randomized, placebo‐controlled trial
B. Elewski (2018)
Psoriasis for the primary care practitioner
Aprn Anp-C Melodie Young Msn (2017)
Psoriasis. Diagnostic and therapeutic recommendations of the Polish Dermatological Society. Part I: Mild psoriasis
Adam Reich (2018)
Calcipotriol Plus Betamethasone Dipropionate Aerosol Foam For Scalp Psoriasis
Marian Anderko (2019)
Psoriasis for the primary care practitioner
M. Young (2017)
The association of scalp psoriasis with overall psoriasis severity and koebnerization in children: cross‐sectional findings from the Dutch Child‐CAPTURE registry
I.M.G.J. Bronckers (2019)