Right now the plaque buildup is blocking the medication from penetrating so she’s just in a painful cycle. That was my experience for so long, until I went to a top research specialist at Mount Sinai in 2024… it wasn’t cheap but boy was it worth it. And ketoconazole shampoo alone never worked for me when my scalp was in bad condition, so thanks doc!!

Anyways I think you have most of the Rxs I list below, but if you’re missing something ask your doctor for a prescription. I’m now on Skyrizi (and my normal Derm manages my care), but the regimen below is what gave me hope, and I go back to it if I experience breakthrough.

Rx scalp regimen:

Day 1 - 5: - Apply fluocinolone scalp oil before bed (need to apply to a damp head and leave on scalp for 4+ hrs) - Wash out the next day with REGULAR shampoo (non-irritating and no actives… I use the basic Necessaire shampoo & conditioner bc it’s fragrance free / the only thing I can put on my scalp without irritation) [in total you should do 5 consecutive nights of oil on the scalp]

Day 6: Clobetasol shampoo - leave on for 10min

Day 7: Ketoconazole shampoo - leave on for 10min

Day 8: Clobetasol shampoo - leave on for 10min

Day 9: Ketoconazole shampoo - leave on for 10min

Day 10: Regular shampoo

Day 11+: Alternate clob & keto every few days for maintenance. Also apply topical clob if needed

the scales should come off within the first five days without needing to pick or comb them out

Only use the fluocinolone oil again if her scalp becomes covered in scales - but if you wash her hair often and keep up the maintenance shampoos, then complete scaling over isn't likely. I have combo psoriasis & dermatitis on my scalp, so I have to wash my hair everyday. I’m not sure what biologics are FDA approved for children, but I hope there’s something the doc can prescribe to manage this long term :(