This was my most recent article for Black Girl Long Hair. Enjoy!
Scalp challenges go far beyond dandruff and excess oil. There are some scalp conditions that require medical attention and regular treatments and if left uncared for, can result in hair loss and damage. Not to mention, they can be unsightly, embarrassing, and carry self-esteem crushing social stigmas. Three of the most common scalp conditions are psoriasis, eczema, and seborrheic dermatitis. I suffer from psoriasis.
Psoriasis is a non-contagious, auto-immune condition characterized by skin redness and irritation .With psoriasis, the skin growth/regeneration process is accelerated, causing scaly plaques of skin to surface rapidly. Psoriasis can be aggravated by stress, fragrant lotions/sprays/body washes, alcohol consumption, dry skin, and injuries to the skin. There is no cure for psoriasis, only various medications and treatments to help those with it cope.
During my 10th grade year in high school, my dermatologist diagnosed me with psoriasis. I remember being frustrated, confused, sad, and ashamed, among other things. Being in high school was hard enough -- but now I've got to walk around with red flaky scales all over my body, and in my hair, like some kind of contagious freak. Even as an adult, dealing with flaky scalp (Black shirt? No thank you!) and skin scales has been difficult and at times, embarrassing. But as time ticked along, I began to accept my psoriasis and learned how to effectively cope with it on my skin. Wearing long sleeved shirts and long pants was inconvenient, but simple. The challenge? Trying to camouflage scalp scales, or even better -- get them to go away.
Over the past twelve years that I've dealt with psoriasis, I have tried a number of remedies that didn’t work at all, worked but wrecked my hair, or worked well but required regular upkeep. Having psoriasis presents a particular set of challenges to sufferers:
- Frequent flaking makes wearing scalp-showing styles embarrassing (no cornrows or braids).
- Scales surface quickly (every 3-4 days), requiring frequent washing/lifting from scalp, which leads to high manipulation, and drying of hair.
- Scales are itchy, and frequent scratching lends itself to damaging skin, making sufferers more prone to infections (and hair loss at site of infection).
- Frequent scale removal increases hair loss (because strands of hair become caught in the flaking skin).
- Straightened styles (i.e. flat iron or blowout) last no more than a week, because of flaking.
- Psoriasis adapts to treatments quickly, which requires a rotation of products to maintain effectiveness.
There are a lot of products out there that claim to provide relief from psoriasis. Let's explore them -- breaking down the good, the bad, and the overall effectiveness.
Solution 1: Coal Tar & Salicylic Acid Shampoos
Needless to say, Head & Shoulders isn't going to do the trick. Coal tar and salicylic acid are two additives to shampoos like Neutrogena T-Gel and T-Sal that are believed to help psoriasis sufferers. Coal tar extract is dark brown in color, and is a byproduct of the coal carbonization process. Coal tar works topically, slowing the growth of skin cells and helping to reduce inflammation. Salicylic acid (yes, the same product in acne/blackhead face washes) also works topically, helping to remove the thick layers of dead skin from psoriatic plaques, which allows other medications and treatments to penetrate the skin more effectively. Both coal tar and salicylic acid are effective, but have long-term implications. Frequent use renders them less effective. In fact, it is recommended that psoriasis sufferers alternate between the two shampoos. Unfortunately, all coal tar and salicylic acid shampoos contain sulfates, which are drying to the hair and can lead to breakage. Also, frequent washing (which is necessary for sufferers) leads to increased (and sometimes premature) hair loss.
Solution 2: Clobetasol Propionate Foam (Clobex, Rx Only)
Clobetasol Propionate is a corticosteroid available in an array of forms (ointment, gel, etc.) but for the scalp, most doctors prescribe it in foam form. It is a very strong steroid, and is not recommended for use beyond two weeks. It is effective in reducing plaques and inflammation, but has a laundry list of potential side effects. Not only is the foam solution in alcohol (yes, the drying kind that we run away from), but it can cause allergic contact dermatitis, burning, cracking, dryness, folliculitis, hair loss, hyperpigmentation, itching, finger numbness, skin atrophy, and more. I would stay away from this, unless you are desperate for relief and are all out of options. My dermatologist prescribed this to me at the beginning of the year, and I have yet to touch the stuff.
Solution 3: Tea Tree Oil
Tea Tree Oil is an anti-bacterial, anti-fungal natural oil believed to help psoriasis sufferers. In truth, it is excellent for keeping the scalp clear and preventing infection (from frequent scratching/itching), but does nothing to relieve the psoriasis itself. Shampoos containing tea tree oil are often ineffective, have nominal amounts of tea tree oil (they mislead you by adding peppermint oil or menthol for scent/that tingly feeling), and can contain sulfates. Tea tree oil is most effective purchased in pure 100% concentration, and a few drops can go a long way. It is best used in a mixture with coconut oil, and applied directly to the scalp.
Solution 4: Shea Moisture African Black Soap Shampoo
This shampoo has been a godsend. It is all natural and sulfate free. The black soap and plantain enzymes definitely provide relief in terms of reducing itching and inflammation, much like coal tar. The willow bark extract has the same exfoliating effect as salicylic acid, and the tea tree oil provides that necessary anti-bacterial/anti-fungal layer of protection. It is an excellent all-natural alternative to the sulfated shampoos. It does not dry out or irritate the scalp, but does have a clarifying effect on the hair. It performs best in conjunction with the accompanying African Black Soap Purifying Masque. However, much like any psoriasis treatment, it requires regular use and rotation. It will not make psoriasis disappear, but will provide noticeable relief.
Oh lawsonia inermis, how do I love thee? Let me count the ways… Back in January, I began a quest to strengthen and thicken my hair and discovered henna. My hair was thinner than normal, and weak/brittle from frequent manipulation due to psoriasis. At the time, I wasn’t thinking about relief from psoriasis – but rather a solution to make my hair more resilient. I sauntered down to Whole Foods and purchased my first of many boxes of Light Mountain Red Henna (I know it’s not the fancy online herbal mystic brand, but it IS 100% lawsonia inermis and that is good enough for me). I did a four hour treatment of henna, water, and coconut oil, and was in for the surprise of my life. After washing out the henna with the Shea Moisture African Black Soap Shampoo, I discovered my scalp was completely clear. Like, I could part my hair clear. I figured it was an anomaly, and that the shampoo was just working really well that day. Weeks later, my scalp was still clear. After about a month, I experienced some slight itching towards the nape, and felt a few small flakes. So I henna’d again, and it went away. Twice is nice, but the 3rd time is the charm. After my March henna treatment, I realized that this plant was providing something I hadn’t had in YEARS – a clean scalp. There isn’t a lot of research on henna, nor a solid explanation for why (beyond it carrying anti-bacterial/anti-fungal properties, and that is irrelevant for psoriasis) – but for me, the proof is in the pudding. Henna smells awful (although creating a henna mix with a yummy smelling conditioner does help), and is incredibly messy, but I am committed to monthly treatments at the beginning of every month. I am on month 7 of henna treatments, and I will continue them until it becomes ineffective.
Hopefully, this helps provide some relief and sheds some light on alternative treatments for psoriasis. It is difficult to deal with, and a definite hurdle in the race for healthy hair. Over 6 million people in the US suffer with it, and every little bit of information helps. Pass this on to someone you know.