Scalp psoriasis is often undiagnosed or inadequately treated. 

The objective new study published in the Journal of European Academy of Dermatology and Venereology was to create a correlation between the clinical patterns and trichoscopy of scalp psoriasis—in a way to help the clinician to make the diagnosis and select the appropriate therapy.

Here, 156 patients affected of scalp psoriasis were evaluated through clinical, trichoscopic examination; a skin biopsy was done only in doubtful cases. Severity of the disease with several objective and subjective parameters were quantified every 4 months, up to 1 year. 

Seven clinical patterns were identified through trichoscopical correlation. In the order of frequency, the clinical patterns were as follows – plaque psoriasis (with a prevalence of erythema, silver-white scales and twisted red loops vessels and red dots); thin scales (with silvery-white scales, simple red lines and signet red ring vessels); sebopsoriasis (with greasy scales, erythema with red dots, globules and twisted and bushy red loops at high magnification); psoriatic cap (with silver-white scales, erythema and polymorphic vascular pattern); pityriasis amiantacea (with yellowish adherent scales, erythema and simple red loops capillaries); cicatricial psoriatic alopecia (with erythema associated with yellowish, silver-white scales with twisted and bushy red loops capillaries) and pustular psoriasis (with flower shape pustular lesions, erythema simple red loops capillaries).

It was stated that the description of different clinical patterns of scalp psoriasis and its trichoscopical correlations may help the clinician in diagnosing even atypical presentations, and to prescribe an adequate therapeutic regimen.

Source: Journal of European Academy of Dermatology and Venereology. 2021 May 15. doi: 10.1111/jdv.17354.