Managing Chronic Scalp Psoriasis in Young Adults: A 24-Year-Old Male Case Study in Katy & Houston, TX
Psoriasis is a chronic autoimmune condition that often affects the scalp, causing itching, redness, and thick scaling that can significantly impact quality of life. At Village Dermatology, we frequently treat patients in Katy and Houston, Texas, who have been living with psoriasis for years and are seeking lasting solutions. This case features a 24-year-old male with moderate scalp psoriasis who had previously tried multiple systemic and topical treatments without long-term success.
Patient Presentation
The patient reported:
An 8-year history of scalp psoriasis
Ongoing itching and redness, moderate in severity
No family history of psoriasis
Despite long-standing efforts, his psoriasis had been difficult to control:
Otezla was discontinued due to elevated liver enzymes
Skyrizi provided good clearance but had to be stopped for the same reason
He had also tried various topical steroids and medicated shampoos with limited results
Physical Examination
A detailed scalp and facial exam using a dermatoscope revealed:
Red, scaly plaques located on the right superior forehead, consistent with psoriasis
No signs of acute distress
Patient was alert, healthy, and well-nourished
Diagnosis: Chronic Scalp Psoriasis
Scalp psoriasis is a common manifestation of chronic plaque psoriasis. It presents as:
Well-demarcated red plaques
Covered in silvery-white scale
Located along the hairline, scalp, or behind the ears
Associated with itching, burning, and social discomfort
Updated Treatment Plan
After a full review of his medical history, failed treatments, and lab results, we developed a new, tailored management strategy:
Topical Prescriptions:
Ketoconazole 2% Shampoo –
Lather on scalp for 5–10 minutes, use 3x per week.
Helps reduce inflammation and yeast that may aggravate psoriasis.Fluocinonide 0.05% Topical Solution –
Apply to scalp twice daily for 2 weeks, then PRN for flares.
A potent steroid to calm active inflammation.Hydrocortisone 2.5% Ointment –
Apply to facial areas twice daily for 2 weeks, then as needed.
A lower-potency steroid for sensitive areas like the face.
Initiating Tremfya® (Guselkumab)
Given his systemic treatment failures, we recommended starting Tremfya, a biologic injection indicated for moderate-to-severe plaque psoriasis.
Tremfya Plan:
Dosing: 100 mg subcutaneous at weeks 0 and 4, then every 8 weeks
Monitoring:
Baseline TB test (PPD)
Annual TB re-screening
Liver enzyme monitoring
We discussed the risks and benefits, including rare risks such as infection, immunosuppression, and posterior leukoencephalopathy syndrome. The patient verbalized understanding and opted to begin Tremfya immediately.
Counseling Highlights
We educated the patient on:
Chronic nature of psoriasis: flare-ups and remissions are expected
Trigger management: stress, alcohol, strep infections, and certain medications may worsen symptoms
Importance of ongoing monitoring during biologic therapy
The patient received a handout with his treatment regimen and will follow up in 2 months.
Why This Case Matters for Katy & Houston Residents
Scalp psoriasis can be physically uncomfortable and emotionally taxing, especially when resistant to treatment. At Village Dermatology, we offer advanced therapeutic options and personalized care plans for young adults and others suffering from chronic psoriasis. If you're located in Katy or Houston, TX, our expert team is ready to help you regain comfort and confidence in your skin.
