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Why Psoriasis In Only One Place?
from Swarup

Dear Ed:  I have had psoriasis since 1997 (I am 30 now). It is restricted to my scalp. The weird thing is that I fell down from a bicycle when I was small (around 10), and got hurt at the elbows. I have never developed psoriasis from the accident. But I have it in my scalp and sometimes it flakes pretty badly. I had an embarrassing incident at the hair salon where I was flaking so much, the whole sheet was covered. The proclivity of one area of the body to develop psoriasis, whereas the other is unaffected even with an accident trigger seems to confound me. -Swarup


Ed’s Response:  It confounds me, too, Swarup.  I haven’t read anything significant about the “mechanism” that determines where P lesions are going to occur.  I do know that many of us have lived with P in one or only a few areas — the scalp is common, even as a single area — while others have started small and watched (with horror) the P spread; and yet others have had a manageable number of lesions sprout in various different areas and sometimes watch these wax and wane as though they had minds of their own.

Lots of us would have Koebnerized the elbow wounds from your bike fall, as you more-or-less expected to do.  The “Koebner phenomenon” has been well documented.  Why didn’t it happen to you?  Perhaps the immune system malfunction was not triggered at the time of the accident and the wound healed BEFORE that trigger “woke up” the P.  (Consider yourself lucky!)  Or perhaps whatever triggers your scalp P is unique to your scalp — in other words, a location-specific trigger.

Another possibility — though you may have ruled this out long ago — is that your flakes aren’t really from psoriasis.  Eczema often affects the scalp and may be a highly localized condition.....

Wishing you the best, -Ed

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