Brief Answer:
Increase steroid dose/percentage with Vitamin D cream

Detailed Answer:
Hi there,

Psoriasis is a chronic, multisystem inflammatory disorder most commonly characterized by long-standing, discrete, red, plaques with silvery-white scales. It is a complex genetic and immune mediated disorder with flares related to systemic, psychological, infectious, and environmental factors. Environmental factors such as stress and medications can exacerbate symptoms. Psoriasis most commonly affects the scalp, ears, elbows, knees, nails, and umbilicus. Generally, psoriasis will appear in spots following injury of the skin, which is called the Koebner phenomenon. Therefore, you want to avoid scraping off the lesions as it will worsen the disease. Also, avoid triggers, including trauma, sunburns, smoking, and exposure to certain medications, alcohol, and stress; weight loss helps if obese. There is a higher rate of heart disease in people with psoriasis, as well as obesity and inflammatory bowel disease.

Scalp psoriasis is very difficult, especially if there is hair present. You need to keep the skin hydrated and minimize itching and scaling to help decrease the risk of the Koebner phenomenon. Topical steroids help with acute flares and diseased areas that are itching, scaling, and progressively worsening. They are not a good long term medication due to the risk of skin atrophy, hypopigmentation, and risk of infection in the area. If your current triamcinolone and clobetasol creams/shampoos are not effect, then you might need to increase the dose/precent concentration. Vitamin D analogues such as calcipotriene limits psoriasis proliferation; it is highly effective for short-term control in combination with a superpotent corticosteroid. However, some people will get worsening itching and burning. Topical retinoids such as tazarotene has similar effects to vitamin D analogues with the itching and burning. Vitamin D analogues have slower onset of action than topical corticosteroids, but longer disease-free periods. Combination of superpotent steroids and vitamin D analogs has better efficacy than either as monotherapy. If the vitamin D and superpotent steroid combination are not effective, you will need systemic therapy which your doctor can help prescribe.

---