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Scalp psoriasis affects nearly half of those with psoriasis, yet it remains one of the most misunderstood and challenging forms of psoriasis to get under control.
If you’re reading this, you might already know how awful the itching, flaking, and emotional toll can be. Especially as many medications for psoriasis don’t seem to work nearly as well for psoriasis on your scalp.
Unfortunately, many people assume their scalp issues are due to dandruff or seborrheic dermatitis when, in fact, they are dealing with something far more complex. Especially as the inflammation worsens, there’s a greater risk that the hair thinning could turn out to become permanent hair loss.
That’s why I’m thrilled to have Dr. Jenny Bennett back on the Healthy Skin Show. Together, we unpack the complexities of scalp psoriasis AND talk about some really fascinating organisms that could be lurking on the skin that are helping to drive the problem.
Dr. Bennett is a naturopathic doctor, acupuncturist and founder of Aria Integrative Medicine, an autoimmune specialty clinic in Seattle, WA. She utilizes treatments from both Eastern and Western medical practices to find the best approach for treating autoimmune diseases. Dr. Bennett treats a wide variety of conditions such as Hashimoto’s thyroiditis, Graves’ Disease, rheumatoid arthritis, psoriatic arthritis, lupus and scleroderma.
You might recall that Dr. Bennett has shared her knowledge with us in the past on Psoriatic Arthritis and Nail Psoriasis.
If you’re tired of the relentless itching, worried about thinning hair, or unsure where to begin, this scalp psoriasis episode is packed with actionable insights.
Let’s dive in!
Or, listen on your favorite app: iTunes (Apple Podcasts) | Spotify | Stitcher | TuneIn | Subscribe on Android
In This Episode:
- Scalp psoriasis versus plaque psoriasis
- The link between scalp psoriasis + psoriatic arthritis
- Key differences between scalp psoriasis + seborrheic dermatitis
- How both your skin + gut microbiomes play a critical role in scalp inflammation
- Why hormonal changes + stress trigger scalp psoriasis flares
- Treatment options – scalp psoriasis meds + remedies
- Using UVB + red light therapy to help scalp psoriasis
- Can scalp psoriasis cause hair loss?
Quotes
“Scalp psoriasis is often mistaken for dandruff or seborrheic dermatitis, but the key difference is in the texture—psoriasis feels dry, while seborrheic dermatitis feels oily.”
“Psoriasis always starts with damage to the top layer of skin, which allows bacteria or fungi to get inside, triggering an immune response and creating plaques.”
Links
Find Dr. Bennett online | Instagram | Facebook | TikTok
Healthy Skin Show ep. 336: Early Signs & Symptoms Of Psoriatic Arthritis (Don’t Ignore These!)
Bacteria, Fungi, and Scalp Psoriasis: Understanding the Role of the Microbiome in Disease Severity
373: What Causes Scalp Psoriasis + That Awful Itchy Scalp? w/ Dr. Jenny Bennett {FULL TRANSCRIPT}
Jennifer Fugo (00:12)
Dr. Bennett, I am so excited to have you back. We're gonna be digging into scalp psoriasis, and the itchiness, and the just awfulness that is scalp psoriasis to try and help people today. Thank you so much for being back here on the show.
Dr. Jenny Bennett (00:27)
Yeah, I'm excited. This has been really fun. I'm glad to be back.
Jennifer Fugo (00:32)
So one of the cool things in preparing for this, I read some really interesting stats about scalp psoriasis that I thought I would share so that people at least know how prevalent this is. So according to the National Psoriasis Foundation, approximately 45 to 56% of our psoriasis warriors out there have scalp psoriasis. That is a pretty sizable amount of individuals. So my question to you is, what exactly is scalp psoriasis, and is it just plaque psoriasis that's on the scalp or is it something kind of different?
Dr. Jenny Bennett (01:12)
Yeah, like you said, scalp psoriasis is really, really prevalent. I mean, it's probably the most common form of psoriasis and most people don't know they have it because they can't see it. They might think it's itchy, they might think it's just dandruff. It is technically a type of plaque psoriasis, but it does differ slightly because it doesn't get, well, it can, it can get really bad. I’ve seen scalp psoriasis look like plaque psoriasis elsewhere on the body, like elbows and the knees. But most of the time you'll see it kind of along the borderline of the hair, like the hairline. And it will get flaky, but it doesn't usually get as thick as your classic plaque psoriasis does. It can, but given the fragility of the scalp, the skin on the scalp, we don't usually see it as thick as your kind of typical plaque psoriasis.
Jennifer Fugo (02:09)
Is it also possible, because we talked about psoriatic arthritis in a former episode, so we'll have to link up to that, is that possibly connected to psoriatic arthritis or no?
Dr. Jenny Bennett (02:23)
Oh, absolutely, because a majority of people don't know they have scalp psoriasis. When I'm teaching rheumatology and I'm talking about psoriatic arthritis and we're looking for a diagnosis of psoriatic arthritis, I tell people to always check the scalp because a lot of times you'll see scalp psoriasis present when people have joint pain, and you can make the diagnosis of psoriatic arthritis based off the fact that they have scalp psoriasis, which is like 50% of the time. So you always want to check the scalp and the hairline to make sure that there's nothing there. Or in the ear, that's really commonplace too, near the scalp and hairline. And so if you see that and people don't know, they're like, oh yeah, my scalp has just been a little bit itchy or kind of flaky, it's just been like that forever. It's always the first place that I'll look, apart from the nails. So it's really common. And if people have scalp psoriasis and they have any kind of joint pain in their family or themselves, then they want to get worked up for psoriatic arthritis.
Jennifer Fugo (03:28)
Yeah, we talked about psoriatic arthritis already, and nail psoriasis. So I feel like this is a really lovely trio to help everybody.
Dr. Jenny Bennett (03:37)
And the nails. So that's the first thing. If I'm looking at psoriatic arthritis, I'm always going to look at the scalp and the nails first, always, because that's usually kind of the dead giveaway.
Jennifer Fugo (03:48)
And so it's interesting, you mentioned flaking of the scalp. And I sometimes wonder when I look at photos online, I'm like, oh, that kind of looks like seborrheic dermatitis, but what's the difference between those two? I think a lot of people might confuse them, or maybe they assume they just have really bad dandruff, but it could be scalp psoriasis. So what is the difference between them?
Dr. Jenny Bennett (04:13)
Yeah, so if we're just talking about symptom presentation, the big difference is the texture and the feel. With psoriasis or scalp psoriasis, if you're feeling it, it's going to feel a lot more dry than seborrheic dermatitis. Both are flaky, both can have flaking, but there's an oiliness to seborrheic dermatitis that you just don't feel, usually, with scalp psoriasis. So sometimes if you're feeling a spot on your head that's kind of itchy and then something flakes off, and then it feels kind of oily or kind of watery underneath, that's probably seborrheic dermatitis. If you're kind of itching your scalp and just flakiness comes off and it still feels dry, or it feels kind of thick, then it's probably psoriasis. That's kind of the two big kickers.
But there are also completely different mechanisms for why that happens, because psoriasis is like this overproduction of the skin cells. So as the skin cells start to flake off, you just get more skin cells underneath. And so it has more of that dry feel, where the seborrheic dermatitis is more similar to eczema where it will kind of damage the inside layer of the skin. So when you take the flakiness or the scabbing off the top, it gets that kind of oily or sebum secretion that you feel.
Jennifer Fugo (05:36)
So the oiliness is actually, is it excess sebum that's under the skin, in a sense?
Dr. Jenny Bennett (05:44)
Yeah, sometimes it can be the sebum under the skin. Sometimes it's just the lymph fluid, because it is an immune cell reaction just like psoriasis is. So it can just be that increased fluid flow that occurs when the immune system is there.
Jennifer Fugo (06:05)
Wow, so different. And it's good to know that because, obviously too, if you were talking to a doctor and looking for a scalp psoriasis remedy, that probably would be helpful information for you to share too, about your experience with things. So they are different.
Dr. Jenny Bennett (06:21)
And they should, and the doctor should be feeling the skin. They should be in the office feeling it to make sure it's dry. They shouldn't just be looking at it, because looking at it will only tell you so much.
Jennifer Fugo (06:35)
So one thing I noticed is that there's a sort of scale in terms of severity of scalp psoriasis. Usually things, and a lot of times, I read at least, it has to do with like the PASI score. But maybe there's some clear signs that you could help us understand what separates a mild case versus moderate case versus severe.
Dr. Jenny Bennett (06:59)
For the scalp psoriasis. A lot of that has to do with size, it has to do with area covered, it has to do with the thickness of the area, like how much skin is flaking off. And it also has to do with the response to any kinds of scalp psoriasis treatment that you might do. And so if you have small patches, and there's a little bit of redness and only mild scaling, then that would be considered a more mild form. If you have a patch that goes all the way across the bottom of the hairline, and it's thick and it's producing lots of scaling, that would be a more moderate to severe form. And then if you try to treat it with something like steroids and it just doesn't go away, or it has a really hard time going away, then that's usually considered much more severe.
Jennifer Fugo (07:57)
So are there any potential triggers specifically for scalp psoriasis that maybe are different than psoriasis found in other parts of the body?
Dr. Jenny Bennett (08:08)
Yeah, I mean, with all psoriasis and especially scalp psoriasis, we always look at the microbial triggers. The stuff that's on the skin and in the scalp, like the bacteria and other weird funguses and stuff that might be interacting with the immune system in that area. So if that bacteria or other types of microbes are off, then it can create inflammation in that area that leads to psoriasis.
Jennifer Fugo (08:38)
I also know too, there can be drug triggers, right? Stress, maybe hormonal changes, that kind of stuff.
Dr. Jenny Bennett (08:47)
Oh yeah. The hormone changes can be really big. There's a big connection to vitamin D, to psoriasis and vitamin D, and vitamin D in and of itself is a type of hormone. But there's also big changes, you mentioned stress, the fluctuation of cortisol can impact the inflammation that someone has, especially related to the psoriasis. And then fluctuations in reproductive hormones can too, like changes in estrogen or testosterone will change oil secretions in the skin, so it'll change the dryness but it will also increase some of the inflammation as well. So you might see people who are going into menopause have more recurrence of psoriasis, or if they're on certain forms of hormone replacement therapy they might get more psoriasis, so that can happen too.
Jennifer Fugo (09:41)
And you mentioned about the microbiome. And before we started talking, I was asking you some questions about this and I was like, what, really? So I have to ask you, because you kind of alluded to going there, and I know my audience loves all of this stuff about the skin microbiome and we always like talk about the gut microbiome and whatnot. But if we're just, right now, if we focus on some of the issues with skin and the skin microbiome in terms of the scalp.
So I was reading some papers, which I will link up in the show notes here. And one of the cool things that I read was that, and this is the quote, is that Pseudomonas and Staphylococcus were quote, abundantly present in both the moderate and severe groups, end quote, of the scalp psoriasis cases that they had looked at in this particular study, which was about 39 patients. And obviously that's not a huge amount of patients, but I thought that it was really, really fascinating. And I saw other papers that also sort of found the same thing. So can you talk a little bit about this maybe connection between Pseudomonas and Staph that people might not realize is the case? Because I don't think, in fact, I have not heard many people even mention this at all.
Dr. Jenny Bennett (11:12)
Okay, so Staphylococcus aureus is one of the most prevalent or common bacterias out there. mean, you cannot exist in this world without coming into contact with staph. Staph is also subsequently what MRSA is, right? So if we get MRSA, that's like a resistant form of staph. And staph will always be part of our body and present in our body, but it's the imbalance of the staph in relationship to what your good microbiome is on your skin. Like we talked about probiotics and stuff with the gut, but you also have to have good bacteria on your skin as well. And it has to do with how much you're cleaning or scrubbing your skin, it has to do with what type of secretions you have on your skin. And all that will change the good and bad bacteria. So the staph being present is not uncommon because it is really prevalent and it just is about the balance.
The Pseudomonas is a really interesting one. For the longest time, we were like, oh, people only get Pseudomonas infections if they hang out in hot tubs, like gross dirty hot tubs. And that was the first thing that we looked at. But we've been seeing more and more cases of Pseudomonas just being transferred back and forth to people, more resistant forms of Pseudomonas. It's also really prevalent on the skin. So you can pick it up from contact with fluids, that's why we had the hot tub thing. You can get it from just rubbing secretions or spreading that from human to human. And the Pseudomonas is a lot more difficult to kill or treat if it's present.
If there are issues with things like Pseudomonas or staph, there are scrapings you can take where you can test for these types of microbes and see if they're there. Most people who have scalp psoriasis will be prescribed some form of topical steroid at some point, but I can usually guess that they have an issue with their microbiome on the scalp if they use the steroid and then they stop the steroid and everything comes back. Because the steroid doesn't treat the infection, that steroid just suppresses the immune function, and if that bacteria is still present it will continue to be a problem.
Jennifer Fugo (13:42)
I want to share too, the one study found that, quote, that worsening severity correlated with increases in Pseudomonas found in scalp psoriasis plaques. It was like in the plaques. And Dr. Julie Greenberg had mentioned to me a while back that she had found that there were also instances where she saw increases of different fungal organisms. So you can have, in the plaques themselves, so it's not just even on the top layer, in the plaques there could be organisms living?
Dr. Jenny Bennett (14:24)
Yeah. So to understand this piece is kind of to understand how psoriasis works. So psoriasis always starts with damage to the top skin layer. So if you had a microbe like Pseudomonas on your skin and it caused damage in that epithelial layer, which is like the top layer, the immune system would go in and it will try to kill it. And when the immune system goes in and tries to kill it, if you're more predisposed to having psoriasis, what will happen is two things. One, the immune system will start to kind of damage the cells around that area where the bacteria is.
But then on top of that, and this is part of the autoimmune process, your body starts making tons of extra cells. And so the skin cells start piling up on top of where the kind of wound, inflammation is, this is why you get the red underneath and then all this like scaling sort of silvery stuff that builds up. But the bacteria, if the bacteria doesn't get rid of it, if it's not gone by the immune system, the cells will just build up on top. And so it gets inside the plaque because it's building up on top of it and into it. It's kind of like a wart. Like a wart is a virus, right? That's herpes, and the herpes is in the skin, and then the body builds like a cocoon around the virus and that's the wart. But psoriasis is similar, it's building, sloughing off skin layers, and then whatever microbe is underneath is inside and underneath.
Jennifer Fugo (15:36)
So is there a way, because I know this is what somebody's gonna say, okay, well if it's underneath, is there a way, like how do you impact what's hiding underneath the skin? Is there a way to do that from a topical perspective in regards to a scalp psoriasis remedy?
Dr. Jenny Bennett (16:21)
From a topical perspective, yeah, I mean, there's several options that we use topically. Like a steroid, which is the most common form, it will decrease the flaking and the inflammation. So it will take away the extra layers of skin so you can get down underneath there. But again, it's not treating the microbes. So it will wipe it clear and it'll create a space, but unless you're providing something that is going to help reduce those microbes, it's not going to do that much.
We've been using more recently urea cream, which I think is so fascinating. So urea cream, which you can get over the counter, reduces the keratinization, so it sloughs the cells as a scalp psoriasis cream. But the other part about it is that it's also antimicrobial. So not only is it taking away some of the cells that are there, but it's helping to reduce any kind of bacterial or fungal load that's on top of the skin once it gets down into that area.
Jennifer Fugo (17:25)
Wow, that’s so cool, oh my gosh. It's so cool to like, this is why I love doing this because I think about how many people can be possibly helped by this, even if it helps bring their level of severity and suffering down to a more manageable level where also too, then they can do this kind of more root cause, focused work. Because we've talked about how there's always other things under the surface as well that can be triggering and driving the inflammation within the gut and whatnot. The other thing you had mentioned was strep. Is there any specific connection between strep infections and the scalp psoriasis, or is it just more psoriasis in general? I know there's that guttate psoriasis connection with that.
Dr. Jenny Bennett (18:14)
So strep infection like a strep throat infection? Yeah, sometimes. So there's many different forms of strep, and the type of strep that we usually see is like the Strep pyogenes or it's like the group A or group B strep. So yes, those things that cause sore throats and stuff can get on the skin and cause issues. But there are so many different forms of strep and they can create issues internally in our gut that can actually aggravate psoriasis. But if they're on the skin, similar to staph, because there's strep everywhere, just like staph is, and there's not good balance, it can aggravate the psoriasis, absolutely.
Jennifer Fugo (18:54)
Well, so we have obviously something that's driving this inflammation, and the inflammation has a consequence. The two most common things that clients will complain about, and then I've seen plenty online and in Facebook groups, is the thinning of hair. It's like they feel like they're losing their hair, and then it's super itchy. So let's just start with why is it that, when people have scalp psoriasis, they could end up with some sort of issue with their hair thinning or hair loss, and is it permanent? Can psoriasis cause hair loss?
Dr. Jenny Bennett (19:28)
I know, hair is so, it's a big topic. So the reason that people lose their hair with scalp psoriasis is because of the inflammatory process that happens with scalp psoriasis, you will get kind of that inflammation and that buildup of tissue that we were sort of talking about. And if that happens with the follicles, it can damage the follicles and the hair will thin because, if you're you have a lot of inflammation in a place where hair is growing and you kind of reduce that area, the hair itself will start to thin. But if you damage the follicle in any way or it's so inflamed that it's swollen, the hair won't grow or it'll just fall out. And you have to reduce the inflammation in that area so that you can make space for the hair to grow and also to be able to allow that process to happen.
Usually, it's not permanent if the psoriasis has been there for a limited period of time, and when I say limited, it's less than a couple of years. If it's moderate, okay. If it's really severe psoriasis, and it's been there for several years, and it's not well controlled by anything, including the topical steroids, then it's possible that it can damage the follicle so much that the hair will not grow back in that area. But I would say that's fairly rare. Like I had someone in-office recently that had head-to-toe psoriasis, head, legs, arms, everywhere. And for the most part, their hair grew back in the majority of places, but there were areas of patchy spots where it just is not growing. And I'm gonna assume that those areas are probably permanently damaged.
Jennifer Fugo (21:23)
Yeah, when thinking about can scalp psoriasis cause hair loss, I have talked with so many people who were like, yeah, I could deal with the rashes, but when the hair loss started, that was what broke me. I mean, that is a very, I don't know why, I mean, I do, it's really hard when you start to lose your hair, it starts to thin to a point where people notice it. So I'm glad that you can shed some light on that. And then the other thing that I mentioned that's so hard is the itchiness. Why can scalp psoriasis be so incredibly itchy?
Dr. Jenny Bennett (21:32)
Well, part of that is just the immune system response, right? I mean, any time that your immune system goes into something and it releases histamine, it can be itchy, but it's also an active wound that is trying to heal. So there's damage that happens and then the body is trying to repair it. That's part of why all the cells build up on top of each other. And that repair process, it's kind of like why a wound, like if you get a scratch and it starts to heal, it's itchy. It's that same sort of process that happens with the psoriasis, but it just keeps going, so it just doesn't stop being itchy because it's never fully healed. And then the flaking will cause itchiness, and the immune system will cause itchiness, and it's just this repetitive cycle that goes on and on.
Jennifer Fugo (22:39)
That's what I was hearing, I was like, oh my gosh, this sounds like a vicious cycle. And trying to do different things to kind of break that cycle can be really tricky. I know that, like you shared, people go to all ends of the earth to try to just get itchiness to stop because it's so disruptive to normal daily life, to sleep, and whatnot.
And so we mentioned the urea cream as a scalp psoriasis cream, you touched on that, and I did want to talk about some scalp psoriasis treatment options and scalp psoriasis remedy, some things that you've seen in your clinic that work. I have heard, and I could be wrong, but since I've been to some of the derm conferences, I tend to hear the phrase that biologic drugs don't tend to work as well on scalp psoriasis, like it seems to be harder to treat. Do you agree with that? What's your take on it?
Dr. Jenny Bennett (23:32)
Yeah, the systemic biologics, so if you're using methotrexate or the TNF-alpha inhibitors, they don't work as well for scalp psoriasis as they do for things like the full body plaque psoriasis. I think that mostly has to do with just the vicinity and the area that they're in, that, I don't know, there's issues with the blood flow or it's just not as targeted as it necessarily could be, where the skin is so much thinner on the scalp that you the topicals work better because they can penetrate deeper. It's easier to go from the top down because of the thin area of the scalp than it is to go from the inside out because you have to get through a bigger area.
Jennifer Fugo (24:23)
So your feeling is that if you're going to go more of a biologic or systemic route, it's probably like, I know that they're working on these creams and foam, there's some foam products. For people who do have a fear or a nervousness of those type of scalp psoriasis meds, if you were to use a systemic, like a biologic or JAK inhibitor or something like that, that may be on the scalp that's a topical, do you think that that's as, is it impacting things as much taking like oral scalp psoriasis meds versus just using it topically in that limited area?
Dr. Jenny Bennett (25:09)
Okay, I think I understand your question.
Jennifer Fugo (25:11)
It's a tough question. There's a lot to this.
Dr. Jenny Bennett (25:32)
It's a tough question. Yeah, I would say that for most people, starting with the topicals and seeing what happens with them is the better option before moving to a systemic drug. And then if there's really no improvement, then trying some of the systemic options. And all this, too, is to say you should also be doing all the stuff we talked about with the psoriatic arthritis and the psoriatic nail changes. You have to reduce the systemic inflammation. And whether you do that through biologics, or you try to fix the gut microbiome, or you try to help with hormonal balance and things like that, improving the overall systemic inflammation will help sustain it over time. But if we need to get the inflammation down in the scalp, going with the topicals first is usually the most effective route.
Jennifer Fugo (26:14)
And in terms of the gut microbiome, do you find that there is a connection between what's going on within the gut microbiome and what happens in terms of the scalp, and maybe even impacting the severity of scalp psoriasis?
Dr. Jenny Bennett (26:30)
Absolutely, yes. The gut microbiome is always the first place that I look at for internal types of inflammatory control.
Jennifer Fugo (26:41)
Is there any interesting patterns or anything that you tend to see maybe, that might show up more often in scalp psoriasis versus someone who might have some other form of psoriasis on the body?
Dr. Jenny Bennett (26:59)
Well, you talked about the Pseudomonas on the scalp. I mean, we see that in the gut too. Like it can be in the gut causing inflammation internally and externally, and those two together can just skyrocket stuff.
Jennifer Fugo (27:02)
I find it so fascinating that we have this really internal, I like to think of it as let's work on the internal and the external at the same time. It's really a two-pronged approach because if you just try to do one, oftentimes the results tend to be a little bit more limited. And if someone is really, really suffering, it can make it hard to stick with the work that has to be done under the surface to really move the needle with the gut, because the gut microbiome work is not something you're going to get done in like three days or a week. It may take months for some. If somebody has had issues long-standing since they were a child and you're looking at decades of being ill, that's going to take time. You can't expect one month and you're like, back to good, right? Good as new.
Dr. Jenny Bennett (28:05)
I had someone tell me yesterday, she was like, this is gonna be like this for at least three more weeks? And I was like, this has been going on for three years, this is gonna take some time to backtrack some of this.
Jennifer Fugo (28:17)
Yeah. So some of the other things that you had shared with me were about using maybe, can you talk a little bit about steroids? I know my audience is pretty well versed on steroids, and obviously some individuals definitely have some concerns about using them long term and the potential of the more like, I would say kind of addictive quality to steroids, but they can serve a time and a place. What are your thoughts on using them on the scalp?
Dr. Jenny Bennett (28:49)
The most common steroid used for scalp psoriasis is the topical clobetasol shampoo, and that in and of itself tends to be pretty well tolerated. It's got a lower profile for skin atrophy, the side effects are much less than some of the other stronger dexamethasones and stuff like that. I am never a fan of using steroids long-term. My goal is always to try to get people off the steroids. My biggest concern, even with the clobetasol, is topical steroid withdrawal syndrome, where people try to get off the steroid and their body just freaks out and it causes an even bigger reaction than it did before.
But I do believe they have a place, especially with really recalcitrant psoriasis, like if we're doing all the right stuff and it's just not letting go, like to use the steroids as an option to just kind of get it over the edge. And then we switch back over to some of the more natural over-the-counter stuff to continue it back to its normal state.
Jennifer Fugo (29:57)
Yeah. And then you shared with me a little bit about ultrasound on the scalp. Can you talk a little bit about that?
Dr. Jenny Bennett (30:04)
Yeah, we've been doing this more, this is so cool. Okay, so there's a lot of new studies that have come out recently around a scalp psoriasis treatment called transepidermal drug delivery, which is using ultrasound, which is just sound waves, to penetrate the skin or mostly the scalp, where you can apply the ultrasound gel and then you put topicals into it. And you could put anything into it. You could put the steroids into it, which is used sometimes when it's used for psoriasis. You could put, we use like melatonin and peptides and sometimes we use minoxidil, and we put that into the ultrasound gel and then we ultrasound the scalp.
And what that does, as opposed to putting a topical just directly on the skin where it's only going to get maybe like one to three millimeters of penetration, you can take the ultrasound and it will drive that topical deeper down into the scalp. So maybe you get five to ten millimeters of penetration as opposed to three millimeters. So you're getting it deeper into the follicle, deeper down into the area where the inflammation is happening, and it makes those topicals much more effective because you can get them closer to the area that the inflammation is.
Jennifer Fugo (31:29)
Wow, that's really cool.
Dr. Jenny Bennett (31:31)
Yeah, it's really cool, and it's safe. You know, we were kind of taught in school to be careful about using ultrasound on the scalp, but more research lately shows that it's safe. It's completely safe if used in moderation, and that maybe it helps with depression and anxiety because it's improving blood flow to the area.
Jennifer Fugo (31:53)
Interesting. And does it matter if you have long hair, like if you're not with a short haircut?
Dr. Jenny Bennett (32:00)
Yeah, we do it with people of all different hair lengths. I mean, we have to like part the hair and then we kind of, I mean, people walk out of here goopy.
Jennifer Fugo (32:10)
Okay, so we're not going to the beauty salon. You're gonna walk out of the office, okay, got it.
Dr. Jenny Bennett (32:15)
No, this is not a spa service. This is a medical treatment. So we always tell people, because you don't want to rinse it out right away, so we always tell people don't plan anything right afterwards, prepare to get goopy. And we kind of rinse it out. It always kind of feels like you're in the 90s because people walk out of here with their hair all crispy and gelled sort of. And they leave it on there for several hours after the treatment and then they can wash it out, and it's much more effective.
Jennifer Fugo (32:46)
Wow, that is cool. And then you also mentioned to me about UV light treatments, which people are always like, well, is it UVA or UVB? And then also, I guess, how do you do that if you have hair?
Dr. Jenny Bennett (33:02)
Yeah, so, we know that UV radiation is very good for psoriasis because people will be like, stand out in the sun and it'll be helpful. But you have hair on your head and that's going to protect you to a certain degree from the sun. It's UVB that you want, you always want UVB. That is the most effective for psoriasis. And there are many different ones that you can get off the internet that do UVB treatment. The biggest thing is you can burn yourself, absolutely burn yourself, with the UVB wands. So you have to be very, very, very careful with that.
And you want someone to walk you through it, if you can, but it's usually starting at really low increments, like doing it for a minute and seeing how you get, and then doing it for two minutes. The goal is always to get it kind of, you want it to be just barely pink. It's kind of like if you've been out in the sun and you feel kind of rosy, but not burned. So if you can get it to that kind of, it feels warm and there's blood flow here, that's perfect. Any farther than that will likely burn you. So you've got to get close to that point, but not over it. And then people can do that daily if they want. Usually we recommend several days in between just to give your body time to rest. But if you get used to it, you can do it on a daily basis for short intervals.
Jennifer Fugo (34:25)
Would you use a comb to kind of part the hair if you have longer hair and you have the plaques under the hair?
Dr. Jenny Bennett (34:34)
Yeah, you always want to try to get it as close to the skin as you can, so you can part the hair and then pin it, like bobby pin it, down so you can get that area. But also a lot of the UVB ones do have comb attachments to them. So you can use it, some people will take the comb attachment and they'll just kind of move it across their scalp and it will move some of the hair out of the way to get closer to the scalp area.
Jennifer Fugo (35:03)
Any thoughts, too, on just red light therapy? Do you think red light therapy can be helpful for scalp psoriasis or not as much as the UVB light?
Dr. Jenny Bennett (35:12)
Yeah, I don't know that the red light therapy is as effective for scalp psoriasis. I have found that the red light therapy is actually really beneficial for the itching, but it's not as good for getting rid of the flaking and the inflammatory piece. But I have had people use the red light therapy and they feel like it really reduces the itchy part of it.
Jennifer Fugo (35:16)
Awesome. That is great to know. And then I guess too, if they have questions about how to use the comb, they could also ask their derm or their doctor just for some guidance. I mean, I would imagine a derm would have had experience if they're not working with like someone like yourself or somebody who has experience with it.
Dr. Jenny Bennett (35:55)
Yeah, I mean most dermatology offices have UV treatments in their office so they should know how to use them and what to look for.
Jennifer Fugo (36:03)
Cool. I'm so glad we had this conversation because I get so many messages about psoriasis, and scalp psoriasis specifically, because it is so difficult. I feel like other areas of the body respond faster and scalp psoriasis is harder, trickier. I don't know if you feel that way, but that's kind of always been my experience, is the scalp is more stubborn.
Dr. Jenny Bennett (36:32)
It is, like it's in a weird spot, the blood flow is different, there's a lot of factors playing a role that make it much more difficult to treat. And it's like you can't, if you're putting topicals on there, it's hard to get it in, you can really rub something into the arm, but you can't really rub something into a hairline if you have a fair amount of hair.
Jennifer Fugo (36:40)
Yeah. Well, I just want to thank you so much for coming and sharing about this. I feel like we're rounding out a beautiful cluster of episodes that all actually support one another, which is so, so neat. So I'll put all of the other links to our episodes in the show notes for this so that people can check them out if they haven't seen those yet. And you actively see patients, correct?
Dr. Jenny Bennett (36:56)
Perfect. I do, yes, I do. So I'm here in Seattle, my clinic is Aria Integrative Medicine. We do telemedicine, but we always prefer to see derm and patients in person so we can like, so I can, I like to touch the scalp and make sure it's not oily. So that sort of thing. And then I am here with Dr. Anastasia Stocker, and she and I work together very closely with all sorts of autoimmune diseases and skin and GI conditions all the time.
Jennifer Fugo (37:36)
Yeah, and you also have a really fantastic TikTok channel, Dr. Jenny Bennett. So people can go check you out there.
Dr. Jenny Bennett (37:46)
Yep, yeah, I am on the internets.
Jennifer Fugo (37:47)
Yes, you are, you're doing it. You're sharing the information that people are looking for, which I was so impressed when I found your channel. I was like, oh my gosh, this is so great. I love it.
Dr. Jenny Bennett (37:59)
Well, that's good. It's hard to do, but I appreciate that. Thank you.
Jennifer Fugo (38:10)
You're welcome. But we'll put all of your show notes, you know, we obviously have different links, we'll put all of your links into the show notes so that way it's easy for people to find you. And I hope we can have you back sometime to talk more, I don't know if it'll be more on psoriasis. We have so much to talk about on this more rheumatoid side of things.
Dr. Jenny Bennett (38:28)
There's rheumatoid, we also brought up the hair. We do a lot of alopecia, like tons of alopecia. So we could talk about that. There's lots of stuff.
Jennifer Fugo (38:38)
We should talk. We should talk more about hair. All right. You always have more ideas. I love it. Well, thank you so much for joining us, Dr. Bennet. I really appreciate you.
Dr. Jenny Bennett (38:48)
Yeah, thank you so much for having me.
