External therapy of scalp psoriasis: From relieving exacerbations to persistent remission

Psoriasis often occurs with desquamative lesions of the scalp. The clinical symptoms of the disease vary from limited papulosquamous rashes to sharply infiltrated plaques distributed over the entire area of the scalp. Localization of the rash on open areas and pronounced subjective symptoms of psoriasis negatively affect the quality of life of patients and can lead to the development of social maladjustment and depression. The mechanisms of the formation of the clinical picture are due to the complex interaction of genetic, immunological and exposome factors, as well as the anatomical and physiological characteristics of the scalp. It is assumed that there is a bidirectional pathogenetic relationship between the physiological activity of hair follicles and psoriatic rashes. Another feature of the scalp is the presence of a large number of sebaceous glands with high activity, which determines a certain composition of the microbiome, which, through the activation of immune mechanisms, can also affect the exacerbation of the disease. According to the accumulated data, topical therapy is the first line for patients with any severity of psoriasis. At the same time, the high density of follicles and sebaceous glands in the scalp, as well as the need for long-term therapy, cause certain difficulties in the selection of external drugs. The article focuses on the features of the use of topical glucocorticosteroids during exacerbation and remission of the disease. It is noted that combining these drugs with salicylic acid can reduce the duration of their use. To reduce the risk of adverse reactions, such treatment during exacerbation of psoriasis is recommended to be used in a short course, after which switch to maintenance therapy in an intermittent mode. An important aspect of the effectiveness of treatment is the use of compliant external forms of drugs. The article presents our own clinical observations of patients with scalp psoriasis, in whose therapy a solution containing betamethasone and salicylic acid was used.

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