Therapeutic update of biologics and small molecules for scalp psoriasis: a systematic review

Scalp psoriasis represents the most common difficult-to-treat area in psoriasis patients. Its presence is linked to severe discomfort and impairment of quality of life given the associated symptoms (most of all, scaling and pruritus) and the location in a highly visible area, thus a prompt treatment is required. Its management may be challenging as the scalp is quite sensitive to long-term treatment with topical corticosteroids and usually resistant to topical and systemic agents. Likely, the currently available therapeutic armamentarium has been enriched with biologicals and small molecules that revolutionized psoriasis treatment and that of scalp psoriasis. Nevertheless, the lack of international dedicated guidelines pushed us to perform a comprehensive review on the efficacy and safety of biologics and small molecules on scalp psoriasis with the aim to put the basis for a therapeutic algorithm. After reviewing all the available evidence on the short-term and long-term efficacy of biologics and small molecules on scalp psoriasis the use of the newest biologics (anti-IL-17 and anti-IL-23) seems to be linked to the highest clinical performances in controlling scalp psoriasis. However, head-to-head comparisons between different biologics or biologics and small molecules are lacking. Hence, treatment selection should always be individualized.

Automated summary

Scalp psoriasis, commonly found in psoriasis patients, requires prompt treatment due to its discomfort and impairment of quality of life. Biologics and small molecules have shown potential in revolutionizing the treatment of scalp psoriasis, with the newest biologics like anti-IL-17 and anti-IL-23 demonstrating high clinical performances in controlling the condition. However, individualized treatment selection is important due to a lack of direct comparisons between different treatment options.