Management of scalp psoriasis: Updated treatment recommendations from a Delphi consensus of 53 dermatologists from...

Scalp psoriasis affects approximately 80% of patients with psoriasis and presents therapeutic challenges related to treatment adherence, formulation selection, and quality of life. Updated management recommendations are needed.

A Delphi consensus study involving 53 dermatologists from the Psoriasis Working Group of the Spanish Academy of Dermatology and Venereology (AEDV) was conducted. Following a literature review, experts evaluated 47 recommendations using a 7-point Likert scale, with consensus defined as at least 75% agreement or disagreement. Preferences for topical vehicles and systemic treatments were also assessed.

Consensus was reached on 34 recommendations. Topical corticosteroids, particularly high-potency agents, were recommended as first-line treatment. Combinations with vitamin D analogues were supported for initial and maintenance therapy, while keratolytic agents combined with corticosteroids were considered appropriate for severe scaling. Scalp-compatible formulations, including lotions, solutions, shampoos, gels, and creams using Polyaphron Dispersion (PAD) technology, were favored. Systemic treatment was considered appropriate for severe symptoms or impaired quality of life, with IL-17 and IL-23 inhibitors receiving the highest preference scores (8.84 and 8.32, respectively).

This Delphi consensus provides updated, clinically applicable recommendations for scalp psoriasis management, emphasizing effective topical therapies, appropriate formulations, treatment adherence, and individualized systemic treatment selection.