Q: I am a 22 years old male and I have been suffering from psoriasis vulgaris of the scalp. The symptoms include red-painful spots on my scalp and also lesions filled with some fluid on my face and scalp. I have consulted a lot of doctors for treatment but, in vain. Please help

A:The scalp is a favoured site for psoriasis. Scalp psoriasis is characterised by widespread or focal, scaly, erythematous, hyperkeratotic plaques often involving the back of the head and skin behind the ear. Scalp psoriasis is seen in up to 50% of patients with psoriasis and in some patients it may be the only affected site. Seborrhoeic dermatitis may look similar to scalp psoriasis, but there are differences. Seborrhoeic dermatitis scales often appear yellowish brown and greasy while scalp psoriasis scales appear powdery with a silvery sheen. Moreover, scalp psoriasis diagnosis is suggested by more demarcated plaques, extension of lesions beyond the hairline and the silvery character of the scaling. Regular use of a tar containing shampoo may be sufficient to control mild scalp psoriasis. The treatment of severe scalp psoriasis is likely to involve two stages. First treatment is required to soften and remove the scales (Scales can be softened effectively using olive oil, almond oil or coconut oil; Products containing keratolytic agents such as salicylic acid or sulphur can help to lift scales.). This allows active treatments (topical corticosteroids, coal tar, vitamin D derivatives, diathranol, tazarotene) used in the second stage to have maximum potential benefits in controlling the disease process. Since the treatment is prolonged, education and emotional support are also important aspects in treatment. You can have relief and remission, only under the care and supervision of a good dermatologist.