Which is the best treatment to put on my scalp? – Best topical treatment for scalp psoriasis?

Coconut oil. This is good if your scalp is dry but not necessarily covered with active psoriasis. The coconut oil is solid at room temperature but melts on contact with the skin and is therefore quite greasy; it has a very light but not unpleasant smell. Use as much as you need to make your scalp feel comfortable. Olive oil or some of the bath oil you might have been prescribed can also be used. This can be applied overnight under a shower cap and can be very effective at removing scale, allowing some of the more active treatments to work.

• Coal tar solution (Cocois). If the psoriasis on your scalp is thick and active, this is the best treatment to use as it moistens the plaques and encourages them to lift off. Because it has tar in it, it does tend to be a bit messy and has a distinctive smell. The amount you need to use will depend on how thick your psoriasis is, but apply enough to turn the scale from white to the colour of the ointment. As with the oils, you might want to wear a shower cap to prevent staining the pillows as it is a good treatment to leave on overnight.

• Steroid (e.g. Betnovate) scalp application. This is useful for short-term treatment if the scalp is inflamed but the plaques are not particularly thick. It is relatively clean and odour free. Beware, though: the scalp application is an alcohol based solution and can sting when applied. There is a mousse-style preparation available if the stinging is a problem for you.

• Vitamin D scalp application. This is useful when the plaques are thin but active. It is clean and odour free. One or two drops are enough to cover an area of your head about the size of a postage stamp.

With scalp treatment, the method of application is almost as important as which treatment you use. Applying the treatment involves parting the hair in sections and rubbing the treatment along the exposed area. It is best to do this in a sequential fashion, starting at the front of the scalp and working your way round. If the scale/plaques are very thick, they can be gently lifted up using a comb once they have been moisturised with the treatment (especially with Cocois).

It is easier to get someone else to do this for you as it is difficult to see the top of your own head to (a) rub the treatment in where it is needed and (b) lift the scale where appropriate.

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The best time to do a scalp treatment is before going to bed as the treatment (especially Cocois and coconut oil) will make your hair look greasy and can smell. Try wearing a cotton ‘night cap’, a shower cap or something similar, and cover your pillows with old pillowcases to protect them. (You can buy pillowcase protectors, which give useful extra protection to your pillows, from bed linen shops or departments.) Wash your hair the next morning with an anti-psoriasis (i.e. tar-based) shampoo. An advantage of the coconut-based treatments is that they are wonderful conditioners for your hair!

Once you have removed the scale, you can move on to a creamier treatment like vitamin D, which can be applied in the morning. Some people find that a combination approach works best, applying the greasy descaler at night and the creamier vitamin D in the morning after washing their hair.