title: Managing Scalp Psoriasis: An Evidence-Based Review.
abstract: BACKGROUND
  Scalp psoriasis is commonly the initial presentation of psoriasis, and almost 80 % of patients with psoriasis will eventually experience it.
  
  
  OBJECTIVE
  Although several systematic reviews and guidelines exist, an up-to-date evidence-based review including more recent progress on the use of biologics and new oral small molecules was timely.
  
  
  METHODS
  Of the 475 studies initially retrieved from PubMed and the 845 from Embase (up to May 2016), this review includes 27 clinical trials, four papers reporting pooled analyses of other clinical trials, ten open-label trials, one case series, and two case reports after excluding non-English literature.
  
  
  RESULTS
  To our knowledge, few randomized controlled trials (RCTs) are conducted specifically in scalp psoriasis. Topical corticosteroids provide good effects and are usually recommended as first-line treatment. Calcipotriol-betamethasone dipropionate is well tolerated and more effective than either of its individual components. Localized phototherapy is better than generalized phototherapy on hair-bearing areas. Methotrexate, cyclosporine, fumaric acid esters, and acitretin are well-recognized agents in the treatment of psoriasis, but we found no published RCTs evaluating these agents specifically in scalp psoriasis. Biologics and new small-molecule agents show excellent effects on scalp psoriasis, but the high cost of these treatments mean they may be limited to use in extensive scalp psoriasis.
  
  
  CONCLUSIONS
  More controlled studies are needed for an evidence-based approach to scalp psoriasis.
authors.affiliation: Department of Dermatology, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan.|Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, #7, Chung-Shan South Road, Taipei, Taiwan.
authors.forename: Ting-Shun
authors.initials: TS
authors.lastname: Wang
authors.affiliation: Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, #7, Chung-Shan South Road, Taipei, Taiwan. tftsai@yahoo.com.
authors.forename: Tsen-Fang
authors.initials: TF
authors.lastname: Tsai
mesh_terms: D001688:Biological Products / Q000008:administration & dosage / Q000627:therapeutic use; D003879:Dermatologic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D010789:Phototherapy / Q000379:methods; D011565:Psoriasis / Q000473:pathology / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D012535:Scalp / Q000473:pathology*
chemical_list: D001688:Biological Products; D003879:Dermatologic Agents; D005938:Glucocorticoids