The calibre of the hair shafts growing in plaques of psoriasis is also greatly reduced. A familial history of the condition or lesions elsewhere on the body, together with pitting of the fingernails, are among the most useful diagnostic findings. Often there is a continuous history of scalp psoriasis extending over many years and it is not unusual to find this both extensive and neglected through frustration. A good trichologist can keep the condition under control and improve the cosmetic appearance beyond belief. However, there is no single topical treatment that will achieve these results.
Management is as important as medication.
Pharmacists should be aware that lithium, used in manic depression, is a powerful trigger of psoriasis in susceptible individuals. One is more likely to see cases in our larger inner cities today than in the country as was formerly the case. There is a marked movement towards infection by Trichophyton tonsurans, a fungal infection transmitted from person to person. Dermatologists no longer consider topical medications effective in treating dermatophyte infections of the scalp. Certainly, home application of topical treatment without the closest supervision throughout is simply not going to work.