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Psoriasis affects one to three percent of the United States population. Symptoms include itchy, red, scaly patches of skin that are often localized, but may become generalized, covering several body parts. Self-treatment is appropriate for mild cases of psoriasis. Ketoconazole is a safe choice for some patients, though its effectiveness in psoriasis is limited.


Psoriasis is a chronic autoimmune disorder. Plaque psoriasis is the most common type of psoriasis and is characterized by raised, thick, red patches that are covered with a silvery layer of dead skin cells. Psoriasis lesions tend to appear on the scalp, elbows, fingernails, and lower back. Psoriasis may cause severe itching in some cases, leading to skin breakage and bleeding.
Some cases of psoriasis may clear spontaneously, while others may require prolonged treatment. Also, remissions and recurrences of psoriasis are unpredictable. Psoriasis is not contagious.


Mild cases of psoriasis may be safely self-treated with over-the-counter products. Patients with moderate to severe cases of psoriasis, or psoriasis that involves more than ten percent of the body surface should be under the care of a physician for the treatment of psoriasis. The severity of psoriasis is determined by how much of the body surface is covered with lesions, and also by how the condition impacts a patient’s daily life. The goal of psoriasis treatment is to control or eliminate the signs and symptoms of the disorder and prevent or minimize its recurrence.

Many over-the-counter products are available to treat psoriasis, including tar-based and salicylic acid-based treatments for scalp psoriasis and hydrocortisone creams and ointments for facial lesions or small, isolated patches of psoriasis. Ketoconazole-containing shampoos are available without a prescription and may be used in scalp psoriasis, but ketoconazole’s effectiveness is superior in treating the related conditions of seborrheic dermatitis of the scalp and scaly dermatoses compared to psoriasis. Ketoconazole is not used to treat other types of psoriasis, or to treat psoriasis plaques on other body parts.

If ketoconazole is chosen as a treatment plan for psoriasis of the scalp, patients should first shampoo their hair with a nonmedicated, nonresidue shampoo to remove dirt and oil from the hair and scalp. The medicated shampoo containing ketoconazole should then be thoroughly massaged into the scalp and left on the head for one to three minutes. The hair and scalp should be rinsed thoroughly, and the process repeated. Ketoconazole shampoo can safely be used twice weekly for four weeks, with at least three days in between treatments. Ketoconazole-containing shampoos are well-tolerated by most patients and produce few adverse effects, but may cause hair loss, a change in hair texture, skin irritation or dry skin in rare instances.

Psoriasis is usually a persistent condition and may be difficult to self-treat, particularly with ketoconazole. If treatment with ketoconazole does not control the signs and symptoms of scalp psoriasis, several other over-the-counter treatment options might be considered, including tar- and salicylic acid-containing products, corticosteroids, Vitamin D preparations or oil-based topical treatments. In recurrent, hard-to-treat cases of psoriasis, oral medications may be prescribed by a physician. If a patient experiences worsening psoriasis or adverse effects while using ketoconazole shampoo, contact the physician immediately.