Scalp Psoriasis: A Review of the Current Therapies and Case Report of the Successful Use of the Excimer Laser in Recalcitrant Disease

Abstract

Psoriasis vulgaris is an extremely common immune-mediated inflammatory disease that affects about 0.6% to 4.8% of the general population worldwide. As reported by several surveys, the most common anatomic location affected by psoriasis is the scalp. The clinical presentation varies from mild to severe and typically presents with asymmetric, sharply demarcated, silvery white erythematous scaly plaques that are often pruritic. Additionally, serious psychosocial consequences are often experienced by patients with scalp psoriasis. Despite the fact that scalp disease is so frequent and debilitating, it remains particularly difficult to treat because of the lack of patient compliance and a paucity of evidence-based data to help guide treatment. In 2009, however, the medical board of the National Psoriasis Foundation created an algorithm to facilitate the treatment of scalp psoriasis. In this case review, we describe a scenario in which this algorithm was used successfully. Our patient suffered from psoriasis limited to the scalp for almost 14 years. After several first- and second-line therapies failed, this patient was treated successfully 4 years ago and currently remains in remission after therapy with the ultraviolet B narrowband (308 nm) excimer laser. Therefore, for patients with recalcitrant plaques limited to the scalp, the excimer laser should be considered as a third-line therapy.