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

<p class="abstract"><strong>Background:</strong> 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.</p><p class="abstract"><strong>Methods:</strong> 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.<strong></strong></p><p class="abstract"><strong>Results:</strong> 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.</p><p class="abstract"><strong>Conclusions:</strong> 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.</p>