- Design
- Delphi consensus, 47 statements, 75% agreement threshold
- Population
- 53 dermatologists from the AEDV Psoriasis Working Group
- Primary outcome
- Consensus on scalp psoriasis management recommendations
- Effect
- Consensus on 34 of 47 statements
Fifty-three dermatologists from the Spanish Academy of Dermatology and Venereology psoriasis group rated 47 statements on scalp psoriasis in a Delphi process, with consensus set at 75% agreement. They agreed on 34.
High-potency topical corticosteroids were endorsed as first-line treatment, with vitamin D analogue combinations for starting and maintaining control. Keratolytics combined with a corticosteroid were favoured for heavy scale. Scalp-friendly vehicles, such as lotions, solutions, shampoos, gels and newer cream technologies, were preferred to ointments. Systemic therapy was considered appropriate for severe symptoms or poor quality of life, with IL-17 and IL-23 inhibitors scoring highest.
This is expert consensus, not trial evidence, and it reflects Spanish practice. But it lines up with what most clinicians already find: the vehicle decides whether treatment is used at all.
About four in five people with psoriasis have scalp involvement, and it carries a disproportionate effect on quality of life, so it merits being treated as a reason for escalation in its own right.
- Start a high-potency corticosteroid in a scalp-friendly vehicle.
- Use a vitamin D analogue combination for maintenance.
- Add a keratolytic when scale is thick.
- Consider systemic therapy when scalp disease severely affects quality of life, even if body surface area is small.
Why it matters
Scalp disease is often under-treated because body surface area understates its impact.
Don't overread it
A Delphi consensus records expert agreement; it does not compare treatments head to head.
The statistics, in plain English
Consensus here means at least 75% of the 53 experts agreed. Preference scores of 8.84 for IL-17 and 8.32 for IL-23 inhibitors reflect opinion, not measured efficacy.
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