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Managing Scalp Psoriasis: An Evidence-Based Review

  • Evidence-Based Review
  • Published:
American Journal of Clinical Dermatology Aims and scope Submit manuscript

Abstract

Background

Scalp psoriasis is commonly the initial presentation of psoriasis, and almost 80 % of patients with psoriasis will eventually experience it.

Objective

Although 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.

Methods

Of 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.

Results

To 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.

Conclusions

More controlled studies are needed for an evidence-based approach to scalp psoriasis.

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Authors and Affiliations

  1. Department of Dermatology, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan

    Ting-Shun Wang

  2. Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, #7, Chung-Shan South Road, Taipei, Taiwan

    Ting-Shun Wang & Tsen-Fang Tsai

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  1. Ting-Shun Wang
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Correspondence to Tsen-Fang Tsai.

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Dr. Tsai has conducted clinical trials or received honoraria for serving as a consultant for Pfizer, Novartis, Celgene, Eli-Lilly, and Janssen-Cilag Pharmaceuticals and has received speaking fees from Abbvie. Dr. Wang has received speaking fees from Abbvie and Janssen-Cilag Pharmaceuticals.

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Wang, TS., Tsai, TF. Managing Scalp Psoriasis: An Evidence-Based Review. Am J Clin Dermatol 18, 17–43 (2017). https://doi.org/10.1007/s40257-016-0222-4

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