One size does not fit all when it comes to psoriasis treatments. How you ease symptoms of this chronic disease depends in large part on where psoriasis appears on your body. “We think of the skin as one organ, but it’s different in different places,” says Steven Feldman, MD, PhD, professor of dermatology at the Wake Forest University School of Medicine in Winston-Salem, N.C.
“The skin of the eyelid is completely different than the skin on the palm or the sole of the foot,” Dr. Feldman says. Because the skin in these areas will absorb medications differently, you need a tailored approach.
“When dealing with the sensitive skin of the face, you don’t need high potency. But when dealing with the palms or sole of the foot, you have to use the stronger stuff to get the adequate anti-inflammatory effects,” Dr. Feldman says. If your psoriasis is all over your body, systemic oral medications or biologics might be your best bet.
Here’s a rundown of common areas affected by psoriasis—and what you should know about treating them.
Scalp
Treat the scalp topically with medicated liquids, mousse, shampoo, sprays, gels, tar products, and soaps made especially for this difficult area. “Scalp psoriasis can be among the most recalcitrant,” says Neil Korman, MD, PhD, clinical director of the Murdough Family Center for Psoriasis in Cleveland. “Systemic therapy—pills or shots—may be necessary if a patient does not improve with an aggressive topical regimen.” Not only is psoriasis on the scalp stubborn, but treating it “can be incredibly time consuming and difficult to do,” Dr. Feldman says. It’s time consuming to get medication directly onto the scalp while avoiding the hair; tar products, while effective, can be smelly and stain light hair; and some scalp treatments must be left on overnight, which can be a messy proposition.
To make scalp treatments easier and more effective, the National Psoriasis Foundation recommends first removing any scales on the scalp so the medication can seep in more easily. Loosen them by soaking the scalp in warm water. The foundation also recommends rubbing some heated olive oil onto the scalp, wrapping your head in a towel and leaving it on for several hours, or using a hair dryer. Remove the scales carefully with a fine-tooth comb or brush before applying the treatment. If you need to leave the medicine on overnight, invest in a good, comfortable shower cap for less mess.
It’s common to use these treatments for about two months; once the psoriasis has cleared you can maintain this by using a medicated shampoo several times a week. Steroid creams and injections are also used for the scalp, although ideally in moderation. Other topical medications derived from vitamin D and A are also sometimes used.
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