scalp psoriasis

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If you’ve ever wondered if it’s possible to unravel the frustrating symptoms of scalp psoriasis with a more natural or integrative approach, you’re in for a treat.

I’m sharing a case study from one of my real-life psoriasis clients who has lived with both scalp psoriasis and guttate psoriasis on her body for nearly 30 years.

When my client first found me, she was pretty sick – struggling with more than just her skin.

And I find that many psoriasis warriors don’t know about the deep connections of psoriasis to other body systems (aka. comorbidities).

By just trying diets, cleanses or detoxes, it can feel like you’re doomed to suffer with psoriasis, but research shows us that there’s so much more going on under the surface.

And as a result, it means that there is actually a lot that you can do – even if diet changes aren’t working.

I shared another case study on an eczema client a few weeks ago and it’s my hope that this will be just as helpful!

So let’s dive in…

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In This Episode:

  • Complex scalp psoriasis case with TONS of inflammation (my own client)
  • What her psoriasis (scalp and guttate) history looked like before we started working together
  • Assessments I used to uncover hidden root causes of her psoriasis
  • Key clinical findings of her guttate and scalp psoriasis (and other symptoms)
  • Other body systems that CAN’T be ignored in psoriasis
  • Where my client is on her psoriasis-healing journey


“The sheer severity and number of times my client had food poisoning while traveling was probably one of the most important details.”

“Current estimates point toward 20% of those with psoriasis also have SIBO.”


Apply to work with my virtual clinic HERE

Healthy Skin Show ep. 148: How I Turned My Psoriasis Around

Healthy Skin Show ep. 217: Health Concerns Linked to Psoriasis

woman scratching her scalp

333: Guttate + Scalp Psoriasis Treatment (Case Study With LOADS Of Hidden Triggers) {FULL TRANSCRIPT}

Welcome back to episode 333 of the Healthy Skin Show! In today’s episode, we’re going to dive into a case study for one of my clients with chronic psoriasis. We’ve been working together in my clinical practice for the past couple of years. AND If you didn’t know – my clinic consults virtually with adult clients struggling with chronic skin issues like psoriasis who live all over the world.

Because I recently shared a case review on a severe eczema client in episode 328, I knew that sharing a case study for psoriasis next would be helpful!

To give you context about this particular client – we’ve been working together for over two years. I know that sounds like a long time, but this client was very sick when we started working together and struggled to tolerate even the most basic of supplements.

She also had many layers of imbalances going on which we really couldn’t tackle all at the same time. In some instances, medications were extremely helpful, but it took time to get her doctors on board. Additionally, some changes we worked on took time to really see the full impact.

I say this because if you’re someone who’s not found diet changes helpful, let alone magical – this is for you.

If you’ve tried working on your health only to throw in the towel after a few months because it seems like it's taking too long – this is for you.

Could I share amazing stories of transformation?

ABSOLUTELY, but I often think showcasing quick wins does a massive disservice to those who have more complex cases.

Because your body doesn’t react as quickly as others, it can be extremely easy to feel like you’re broken and doomed – when you’re not.

Specifically, psoriasis is a journey because it typically involves so many different body systems like liver detoxification, gut microbiome, metabolic balance, inflammation and more.

It’s not just a skin problem – which is a crucial perspective when you’re seeking to unwind years of imbalances crossing multiple body systems.

That’s why my client and I wanted to share her story – to remind you not to give up… and to keep working on and investing in your health because there is a light at the end of the tunnel.

So let’s dive in!


stressed out woman pushing her hair back

Chronic Guttate + Scalp Psoriasis Case Details

My client struggled with a ton of symptoms. Her skin overall was generally itchy with an itchy, flaky, dry scalp. She’d been diagnosed with both guttate and plaque psoriasis, rosacea, perioral dermatitis, and melasma.

The guttate psoriasis started when she was 9 years old (she’s now in her early 40s) after a stressful period for her family and a bout of tonsillitis (like due to a strep infection). She noted that she seemed to get strep throat a lot as a child. Guttate psoriasis mainly impacted her torso, back and chest, with a few small patches on her arms, legs, and face. While the plaque scalp psoriasis started later mainly impacting her scalp and hairline.

Her daily gut-associated complaints were also drastically impacting her quality of life, as she noted that she struggled with nausea, urgency to go to the bathroom, diarrhea and undigested food in her stool, bloating, gas, an itchy bum, as well as mouth ulcers and sensitive lips. This is a significant red flag due to the psoriasis-gut connection.

She also complained of headaches in the morning when she woke up, depression, anxiety, mood swings, and significant fatigue and lethargy in the afternoon. In addition to all of this, she also shared with me that she was struggling with numbness and tingling in her extremities, fragile nails with ridges, muscle cramps and an overall achiness in her body.

So yes – this guttate + scalp psoriasis case was COMPLEX and we needed to figure out what was driving some of the more urgent symptoms first before we could even really focus on what was driving her skin issues.

Some of these symptoms had me very concerned about her nutrient status since they can be clues of nutrient deficiencies as well as a possible thyroid imbalance.


blood and medical tests

Assessing This Complex Guttate + Scalp Psoriasis Case

Because skin issues are interconnected with other body systems (especially with psoriasis), it’s crucial to assess the overall health picture by getting a detailed case history, family health history, environmental exposures, medication history, current diet (as well as previous diet history), sleep, gut function, travel history, previous infection history, exercise and movement, traumas and significant stressors, allergies or sensitivities, and hormone status (ranging from sex hormones and menstrual cycle information to blood sugar regulation).

Equally as important for me is reviewing historical labs (typically going back at least 2-3 years if possible) to see if trends were beginning to emerge that help us pinpoint issues.

So in this guttate + scalp psoriasis client, her diet assessment revealed…

  • For the past 1.5 years, she’d pretty strictly avoided dairy, gluten, nightshades, soy, peanuts, strawberries, oranges, and almonds
  • Changing her diet didn’t prove to be of much help with her skin, gut and other symptoms – though she did notice that avoiding nightshades from triggering a rash to form around her mouth
  • Pretty substantial alcohol consumption of 3-4 days per week – 2-4 servings each time. This obviously puts a substantial burden on the liver and can also increase the risk of nutrient depletions.
  • Lots of cravings for sugar and caffeine
  • History of binge eating and bulimia – which you know can be retriggered by the use of elimination diets based on the research I’ve done with UC Davis (which I shared in episode 305)

When I assessed her gut function, we found that…

  • She had become very ill with GI issues during three different trips where she traveled to Cuba, Peru, and during a longer journey through Thailand, Malaysia, and Singapore between 2004 and 2008.
  • Even small amounts like ¼ capsule of Megasporebiotic would make her sick. Reactions like this to Megaspore typically mean there’s a high level of dysbiosis present in the GI tract.
  • The gas and bloating had no obvious trigger – this could happen first thing in the morning without having eaten food.

We went through her medication history to discover that she had been prescribed…

  • Topical steroids for about 30 years
  • Low-dose penicillin for 10 years (which absolutely can alter the gut microbiome and increase the risk of fungal overgrowth)
  • Hormonal birth control for 15 years (which depletes important nutrients)

And to look deeper under the surface, I initially recommended the following testing

  • HealthPath Ultimate Gut Test since this client is located in the UK (a functional stool test evaluating for commensal + pathogenic organisms in the large intestine as well as some important gut function markers)
  • A panel of conventional blood labs I requested based on her specific symptoms, diagnoses, and my suspicions and concerns (since historical lab data wasn’t available) to review a wide range of lab markers that I tailored for her complex psoriasis case


woman looking through magnifying glass

What We Uncovered In This Complex Guttate + Scalp Psoriasis Case

Since I believe it’s important for my clients to know what’s going on, I reviewed her results specifically through the lens of clinical nutrition, optimal levels, and what could be driving her severe guttate + scalp psoriasis as well as other symptoms.

Here’s a quick rundown of some of the significant findings

  • Suboptimal nutrients – specifically iron, vitamin D, folate, vitamin B12, protein, and likely a depleted pool of glutathione
  • Her stool test revealed that she had major dysbiosis with an incredibly depleted commensal gut bacteria such as Bifidobacterium, Roseburia and Akkermansia with elevated levels of inflammatory gut bacteria like Enterobacter, Haemophilus, and Fusobacterium. She also was positive for two protozoa (parasites) – Blastocystis hominis and Dientamoeba fragilis.
  • A questionable negative pylori marker which I wasn’t convinced was accurate due to several other factors that showed up on the stool test results.


airplane wing and rays of light

Critical Details For Complex Guttate + Scalp Psoriasis Case

Given that it’s fairly common to have a messed up gut microbiome when you have psoriasis (yes, research confirms this) – I wasn’t surprised to find this given the gut symptoms AND that she had both guttate + scalp psoriasis.

To be honest, the sheer severity and number of times my client had food poisoning while traveling was probably one of the most important details. I realize that it could be very easy to dismiss this because it was 13+ years beforehand, but they were critical moments that introduced unfriendly organisms, including possibly the parasites, and likely set the stage for SIBO (also known as small intestine bacterial overgrowth).

If you didn’t check out last week’s episode with Dr. Allison Siebecker, you might not know that current estimates point toward 20% of those with psoriasis also have SIBO. So my client had issues in both her small and large intestines!

So when you combine the many issues found within her gut microbiome AND couple that with the gut dysfunction she was experiencing – namely poor digestion and absorption which she could visualize as undigested food in her stool, super fast gut transit time causing urgent diarrhea, and the insufficient nutrients identified through lab testing even though she ate a mostly whole foods diet – we really needed to primarily focus here and get her doctor on board because medication as part of her guttate + scalp psoriasis treatment plan would likely get her more comfortable faster.

If you remember, she was struggling with nausea daily which was so intense that even something as simple as a B complex would make her feel sick to her stomach.

Liver detox support is especially crucial in psoriasis cases because of the extremely close tie between psoriasis and non-alcoholic fatty liver disease. FYI – liver support is NOT a liver detox or liver cleanse which can make things worse.

In this particular instance, my client really needed liver support because of the massive amount of dysbiosis in her GI tract. The waste products from the bugs living there are processed through the liver – and given her suboptimal nutrient status – we needed to make sure that she could handle addressing this load as we worked on her gut.

Also, I had suspicions at the onset of a potential fungal overgrowth even though it didn’t register on the stool test (which happens more frequently than you think since stool tests often show false negatives for candida overgrowth).

Due to her lengthy exposure to antibiotics, depleted healthy commensal gut bacteria AND that she used to live in a 250-year-old cottage in the UK countryside which likely had mold – candida overgrowth was a hidden factor in her psoriasis case that we later discovered for sure WAS a significant factor for her.

But we couldn’t start by diving into the fungal issue because as I said, those other gut factors were bigger hindrances to her progress – which was admittedly slow.

However, with time and a targeted guttate + scalp psoriasis treatment approach, she was able to tolerate more supplemental nutrition to increase her nutrient stores as well as herbal antimicrobials. This was crucial since her doctor offered a limited amount of medication as part of her guttate + scalp psoriasis treatment plan to deal with the many gut imbalances that were revealed through her tests.


Where My Guttate + Scalp Psoriasis Client Is Now

The most recent visit with this amazing psoriasis client was in January 2024 and she shared with me that her “skin rashes improved so significantly that her husband and daughter really noticed a difference.” It’s “a real turning point,” she said with a proud smile as I know how complicated this journey has been for her.

Complex psoriasis BEFORE AFTER abdomen

We’ve used a mix of supplements, herbs, and medication (specifically antibiotics, antiparasitics and antifungals) in her guttate + scalp psoriasis treatment protocol to get her skin, gut, and overall symptoms to a much more stable place. She’s not using any topical, immunosuppressant, biologic or JAK inhibitor medication to reduce her psoriasis.

You can see that her guttate + scalp psoriasis plaques have really lightened (some are gone and others are to the point of depigmentation) and softened on different areas of her body.

Complex psoriasis BEFORE AFTER side torso

While this journey has definitely NOT been a straight line, I must say that my client is a true inspiration in my eyes, demonstrating a level of commitment, persistence, and generosity that I truly admire. I intentionally use the word “generosity” to describe her because she was so thrilled to have me share a part of her journey with you.

We’ve been at this since 2021 (it’s now 2024). I certainly wish that the process could have been faster for her, but during it, she’s also grown tremendously and I’ve witnessed a beautiful transformation in her as she fully committed to her own health and happiness.

On her journey, I encouraged her to join my Skin Rash Rebuild program to be with a group of like-minded skin rash warriors who understood her worries, fears, and goals – and she shared with me how helpful it was to not feel alone.

Complex psoriasis BEFORE AFTER back

While she’s not at the end of her guttate + scalp psoriasis journey – she wanted you to know that there can be things hiding under the surface. And if her story could help even one person, then she was up for it.

So what’s the message here?

Don’t give up. Having a longstanding health concern like guttate, plaque or scalp psoriasis can take a long time to unravel.

I know how easy it is for people to get frustrated when you don’t see or feel substantial shifts in a month or two or even three. But often the changes are small and shouldn’t be compared to what other people experience.

Your body and health are unique, and so with more underlying complexity, a simple solution that works for one person with psoriasis may not work for you.

It doesn’t mean you’re broken or doomed. You just may need a different approach.

So as a gentle reminder, don’t leave this episode thinking that my client’s issues and imbalances are yours.

Of course, details can pretty drastically vary between different cases so there’s no cookie-cutter approach that works for all.

This client’s journey is an example of just how much can be going on under the surface simultaneously. AND it’s a powerful reminder of the many different things that she could take action on besides just taking medication for life.

Last, but certainly not least, healing – especially with psoriasis – takes time. Quick fixes (like detoxes or cleanses) often don’t get the results you’re hoping for, are generally unsustainable, and can absolutely backfire making things worse.

So if you’re looking for help with your psoriasis case, we consult with adult clients all over the world virtually, so there’s no need to travel to see us in person.


We have a process to assess your case, provide you next steps + see if you’re a good fit to work with my team so you can get the help that you need!

If you’ve got any questions or thoughts to share about this, leave a comment below so I can address them.

Thank you so much for tuning in and I look forward to digging deeper with you in the next episode!

scalp psoriasis