Hairdressers' section

• The most common type is plaque psoriasis (present in 80% of sufferers).
• Raised and thickened patches of pink/red skin called ‘plaques', which are covered with silvery scales.
• Plaques vary in size and can appear in distinct patches or join together to cover a large area.
• Plaques usually appear on the elbows, knees, scalp, chest and lower back. However they can appear anywhere on the body.
• The skin is often dry and may be painful. Skin can itch, burn, bleed and crack. In severe cases, the discomfort can make it difficult to sleep or focus on everyday activities.

• Small extensive round red dots that usually appear on the arms and legs and occasionally form on the scalp, face and ears.
• Widespread coverage of the ‘dots' - rain drop like in distribution with little scaling.
• Appears quickly, usually a few days after an infection such as a cold, tonsillitis, chicken pox, skin injury or after taking certain medications.

• Red and inflamed plaques that occur in skin folds such as armpits, in the genital area, between the buttocks, and under the breasts.
• Wounds are very red, shiny and smooth, with little scaling.
• Skin very tender and easily irritated, especially by rubbing and perspiration.
• More prevalent in people who are elderly or overweight.

• Psoriasis confined to certain areas, usually the palms and soles of feet.
• Skin red, swollen, and dotted with yellow and brown, occasionally pus-filled sores.
• Affected areas tender and sore. Using hands or walking are often painful.
• More common in middle aged women who smoke.

These are regarded as the most serious types of the condition and require hospital admission.

Pustular

• Red, swollen skin covered with raised bumps and small, white, pus-filled blisters.
• Can be confined to certain areas - commonly to the hands and feet; or can be widespread patches occurring randomly.

Erythrodermic

• Widespread inflammation and shedding of the skin that covers a large portion of the body.
• Covers most of the body surface.
• May be accompanied with severe itching, swelling and pain.

Communication is key

It may not be an easy subject to start talking about, especially if you are not fully familiar with the condition. A discussion about psoriasis is a highly personal one that may make you feel awkward, uncomfortable, or even afraid. At the same time, addressing the situation directly can help and may create an opportunity to:

• Correct misconceptions
• Transform your workplace into a more open environment for everyone
• Put your customer at ease

Don't put it off - The sooner you understand what symptoms of psoriasis your customer is experiencing the more support and advice you can offer on haircare. Most likely, they'll appreciate your concern - and you being upfront. You can then openly discuss the best style and hair-care plan for them.

Others will take their cue from you - Most people will be eager for you – as their hairdresser - to feel comfortable, just as you would be if the situation were reversed. The more you can communicate that you're at ease with psoriasis, the more relaxed your customer will be and you can both work to achieve the best outcome for them.

Be upbeat and casual; take the lead - Psoriasis isn't contagious, however it often carries a stigma and can provoke negative reactions from others. As such, hair is often a great way to disguise the symptoms - talk with your customer about the best hair styles for them, that can be both practical for treatment purposes but still give your customer confidence.

Be informed - Check out our hairdressers' guide, so you're familiar with the latest developments in psoriasis treatment and care, and so you're able to discuss your customers' symptoms from an informed stand point.

Ordinary shampoos, soaps and shower gels tend to dry out the skin which can make the condition worse. There are various medicated shampoos which can treat psoriasis as well as clean hair. Direct customers to their GP for more information and advice on the most appropriate product.

When you have washed your customer's hair, don't cause more irritation by rubbing it hard with a towel; just pat it dry. If they have long hair, try wrapping it round in the towel like a turban and let it dry for a few minutes. It's a good idea to comb and brush the hair as long as you don't scratch the scalp.

Scalp psoriasis shouldn't prevent perming or colouring hair as long as gentle products are used. However, please do check which treatment your customer is currently using as some treatments are known to tint or strip hair colour. These are predominately coal tar based treatments which have been known to tint light, blonde or grey hair and some synthetic vitamin D3 products can strip colour from the hair. Direct customers to their treatments patient information leaflet for more information. If alternative products are available for perming or colouring hair, these are worth considering.

When scheduling any cosmetic treatments with a customer, try to choose a time when there's no broken skin on the scalp because the chemicals could irritate the skin further. If your customer is self-conscious about an area of scalp psoriasis around the hairline, suggest a style that will help to hide it.

Where there are plaques, the scalp hair may appear flat. The hair can be dry and tends to break easily and there is often an increased shedding of hairs and a decreased hair density.

Treatment of scalp psoriasis often involves two stages. Firstly, thick scale should be softened by olive, coconut or almond oil, ideally applied under a shower cap or cling film. The oil should be left on for an hour, then some of the loosened scales can be picked or combed out followed by shampooing the hair with a detergent/disinfectant shampoo.

The second stage involves active treatment with applications of coal tar, dithranol, a topical corticosteroid or vitamin D treatment. The cosmetic acceptability of many of these preparations is poor as many have a strong smell and are messy to apply.