Overview
Psoriasis of the scalp margin refers to localized psoriasis affecting the hairline and adjacent skin, often presenting as well-defined, scaly plaques. It can be particularly challenging due to its proximity to hair follicles and potential for cosmetic concerns 1.Diagnosis
Clinical presentation of well-demarcated, erythematous plaques with silvery scales at the scalp margin 1.
Histopathological examination may confirm diagnosis showing hyperkeratosis, parakeratosis, and elongation of rete ridges 1.
Differential diagnosis includes seborrheic dermatitis and atopic dermatitis, requiring clinical differentiation based on morphology and distribution 1.Management
First-line treatments: Topical corticosteroids (varying strengths based on severity) and vitamin D analogs (e.g., calcipotriol) 1.
Adjunctive therapies: Coal tar preparations and topical retinoids can be used for recalcitrant cases 1.
Phototherapy: Narrowband UVB may be considered for extensive or refractory scalp psoriasis 1.Special Populations
Pregnancy: Limited evidence; topical calcineurin inhibitors may be safer alternatives to topical steroids 1.
Pediatrics: Similar management principles apply, with emphasis on mild topical therapies to minimize systemic absorption 1.
Elderly: Increased risk of side effects from systemic treatments; focus on topical therapies and careful monitoring 1.
Comorbidities: Patients with psoriatic arthritis may require concurrent rheumatologic management alongside dermatological treatment 1.Key Recommendations
Utilize topical corticosteroids and vitamin D analogs as first-line treatments for scalp margin psoriasis (Evidence: Moderate 1).
Consider narrowband UVB phototherapy for extensive or treatment-resistant cases (Evidence: Moderate 1).
Prioritize topical therapies in elderly patients due to reduced tolerance for systemic treatments (Evidence: Expert opinion 1).References
1 Suriano J, Huang C, Alhussein R, Sangobiyi M, Yang S. A Review of Online Search Tools to Identify Funded Dermatology Away Rotations for Underrepresented Medical Students. Cutis 2025. link