Recommendations for a patient-centered approach to the assessment and treatment of scalp psoriasis: a consensus statement from the Asia Scalp Psoriasis Study Group

Background: International consensus statements on the management of scalp psoriasis are available, but no such recommendations exist for Asia. Methods: The Asia Scalp Psoriasis Study Group (ASPSG) met in May 2011 to review the epidemiologic pattern of scalp psoriasis in Southeast Asia and to develop Asia-specific recommendations for its management. Results: The overall prevalence of psoriasis in Asia is <0.3%, but 75-90% have scalp involvement, whether isolated or with lesions elsewhere, which can negatively impact quality of life (QoL). Treatment decisions should be based primarily on objective disease severity, but should also take account of patient QoL. Psychosocial support and more aggressive treatment should be offered to all patients with moderate to severe QoL impairment. Topical therapy is indicated first-line in all patients, with combination therapy (corticosteroid + calcipotriol), more occlusive formulations, keratolytics, and very potent corticosteroids for patients needing greater or faster efficacy. Systemic therapies, light or laser treatments should be reserved for patients with severe and recalcitrant disease. Conclusions: The ASPSG recommends a patient-centered approach to scalp psoriasis management, consistent with the international consensus statements. Asian physicians should also consider patient QoL, prior treatment response, formulation preferences, likely adherence, cost, time available for self-management, and potential adverse events