Use the medication selected by your dermatologist. The choices will depend on the severity of your scalp involvement.

Tar Shampoo:

Wet the scalp thoroughly in the shower.  Then apply a shampoo containing tar (Polytar, T-gel, Ionil T,) one containing tar ( polytar, T-gel, Zetar, Ionil T, Denorex, DHS tar gel, Neutragena T/Gel, Tegrin, and others) or one containing tar plus salicylic acid (Beta Tar Gel, Sebutone, Van-Seb T, X-Seb T, Neutragena T-Sal, Ionil-T-Plus, and others). None of these require prescriptions. Rub vigorously for at least 5 minutes.  Do not use fingernails since scratching can induce new lesions of psoriasis.

Longer periods of application are even more effective.  After 5 minutes of rubbing, it is best to cover the hair with a warm moist towel, wait 15 minutes, then rinse.  Since the coal shampoo is mainly to treat the scalp, you may wish to use your normal shampoo to clean your hair.  The use of a cream rinse, conditioner, or small amounts of bath or baby oil will combat the dry hair caused by tar shampoos.  Daily use of the tar shampoo is recommended at first.  After the scalp is clear, it may be possible to use it less often.

Tar can stain bleached hair, light blonde hair, or gray hair.  Tar gels may cause less staining and may be tried in place of regular shampoos.  Examples include Estar Gel, Psorigel, T-Derm, and Baker’s p & S Plus Tar Gel (all available without a prescription).

Oils:  Sometimes, oils alone can help to loosen psoriasis scale on the scalp.  Examples include baby oil and mineral oil.  Leave on the scalp for a few hours or overnight, covered with a plastic shower cap or towel.  After these treatments, the scalp may then be worked loose with a fine toothed comb. This must be done gently since digging the scalp with a sharp-toothed comb can cause injury to the skin with worsening psoriasis!

Steroid lotion (prescription required):

At first, you may also need to use on of these after your shampoo.  Examples are (triamcinolone, synalar, Valisone, Halog, and Lidex).  Part the hair sequentially in several different places applying and massaging the steroid along each part in order to cover the whole scalp.  Use this twice per day (one time being after the tar shampoo) until the scalp clears.  Then stop using it, but continue to use the tar shampoo as often as needed.  If you are unable to keep the scalp clear with daily use of the tar or tar plus salicylic acid shampoo, add the steroid lotion or solution only as frequently as needed to stay clear.

Other:

Your doctor will tell you which of the following to use.  It should be applied overnight under a shower cap.  If scaling is severe, it may also be use in the daytime.  For less severe scaling or as scaling improves, it need only be applied for several hours.  This medication must be stopped once the thick scaling has subsided.

Non-prescription items:                                                           

• Neutrogena T/Gel Scalp solution                                                           
• P&S liquid                                                                                   
• P&S plus gel
• Pragmatar cream

Prescription items:

• Keralyt gel
• Anthralin 0.25% or 0.5% (Dritho-scalp)

Preventing recurrence:

After clearing, the tar shampoo should be continued intermittently as needed.  If you are unable to keep the scalp clear with the tar (or tar plus salicylic acid) shampoo alone, add the steroid lotion or solution only as frequently as needed to stay clear.