DOI: http://dx.doi.org/10.18203/issn.2455-4529.IntJResDermatol20193235

A prospective study on the etiopathogenesis, clinical types and causes for recalcitrant nature of scalp psoriasis

Shrinidhi Ramalingam, Rajkumar Kannan, Muthusubramanian Chandrasekar

Abstract


Background: Psoriasis, a common chronic disfiguring inflammatory and proliferative papulosquamous disorder of the skin in which both genetic and environmental influences have a critical role. Scalp becomes the most common site of involvement, both at the time of onset of the disease and also throughout the course of the disease. This prospective study is designed to have a thorough insight into the etiological factors, clinical types and to unearth the factors behind the recalcitrant nature of scalp psoriasis.

Methods: A prospective study, conducted in the Department of Dermatology, Chengalpattu Medical College, Tamilnadu. 50 patients of scalp psoriasis enrolled between April 2017 and March 2018 were included in the study.

Results: It was found in our study that lesions of scalp psoriasis took longer time (on an average 6-8 weeks more) to resolve than lesions of psoriasis elsewhere in the body following treatment with systemic drugs like methotrexate and topical agents like 0.1% betamethasone + salicylic acid ointment and liquid paraffin. Out of 50 patients, 30 were female (60%) and 20 were male (40%). Following were the clinical types of scalp psoriasis encountered in our study. Chronic plaque psoriasis- 25 (50%), sebopsoriasis- 13 (26%), erythrodermic scalp psoriasis- 8 (16%), pityriasis amiantaceae- 4 (8%), pustular psoriasis of scalp- 0.

Conclusions: The density of scalp hair leading to reduced absorption of topical treatment and the social reasons affecting the quality of life of patients are crucial factors that determine treatment outcome. All these inconveniences result in non compliance of treatment. Hairy scalp, rich vascular supply, patient’s non-compliance, adverse effects of topical agents-all throw a challenge to the treating dermatologist where it poses recalcitrant nature to treatment.


Keywords


Psoriatic corona, Sebopsoriasis, Pityriasis amiantacea, Spondyloarthropathy

Full Text:

PDF

References


Griffiths C, Barker J, Bleiker T, Chalmers R, Creamer D (eds). Rook’s Textbook of Dermatology. 4th volume. 9th edition. London, UK: Wiley Blackwell; 2016: 4696.

Phiske MM. Scalp psoriasis: a brief overview. J Cosmo Trichol. 2016;2:2.

Ortonne J, Chimenti S, Luger T, Puig L, Reid F, Trüeb RM. Scalp psoriasis: European consensus on grading and treatment algorithm. J Eur Acad Dermatol Venereol. 2009;23(12):1435-44.

Hägg D, Sundström A, Eriksson M, Schmitt-Egenolf M. Severity of psoriasis differs between men and women: a study of the clinical outcome measure psoriasis area and severity index in 5438 Swedish register patients. Am J Clin Dermatol. 2017;18(4):583-90.

Jheeta A, Faucett JM, De Berker D. Topical treatments of scalp psoriasis: evidence based guide. Wiley online library. 2016: 38-41.

Sawan S, Descamps V. Scalp psoriasis: a paradigm of “switch-on” mechanism to anagen hair growth. Arch Dermatol. 2008;144(8):1064-6.

Langan SM, Seminara NM, Shin DB, Troxel AB, Kimmel SE, Mehta NN, et al. Prevalence of metabolic syndrome in patients with psoriasis: a population‐based study in the United Kingdom. J Invest Dermatol. 2012;132:556–62.

Naldi L, Conti A, Cazzaniga S, Patrizi A, Pazzaglia M, Lanzoni A, et al. Diet and physical exercise in psoriasis: a randomized controlled trial. Br J Dermatol. 2014;170:634–42.

Gladman DD. Clinical aspects of spondylo arthropathies. Am J Med Sci.1998;3(16):234-8.

Busse K, Liao W. Which psoriasis patients develop psoriatic arthritis? Psoriasis Forum. 2010;16(4):17–25.

Eder L, Gladman DD. Psoriatic arthritis: phenotypic variance and nosology. Curr Rheumatol Rep. 2013;15:316.

de Vlam K, Szumski A, Mallbris L, Jones HE. SATO395 scalp psoriasis as a surrogate marker for psoriatic arthritis severity and treatment response. Ann Rheum Dis. 2014;3(2):737.

Kim GW, Jung HJ, Ko HC, Kim MB, Lee WJ, Lee SJ, et al. Dermascopy can be useful in differentiating scalp psoriasis from seborrheic dermatitis. Br J Dermatol. 2011;164(3):652-6.

Sarkar R, Garg VK. Erythroderma in Children. Indian J Dermatol Venerol Leprol. 2010;76:341-7.

Farber EM, Mullen RH, Jacobs AH, Nall L. Childhood psoriasis. Pediatr Dermatol. 1986;3:237-43.

Al-fouzan AS, Nandha A. A survey of childhood psoriasis in Kuwait. Paediatr Dermatol. 1994;11:116-9.

Morris A, Rogers M, Fischer G, Williams K. Chilhood psoriasis: clinical review of 1262 cases. Paediatr Dermatol. 2001;18:188-98.