A 49-year-old white woman presented with a 20-year history of scalp psoriasis. Over the years, she had tried numerous topical treatments, such as 0.05% clobetasol propionate solution with 0.005% calcipotriene solution for 3 months, as well as various tar- and salicylic acid– based shampoos, with no success. She stated that the itching associated with her scalp psoriasis had worsened over the past year, often keeping her awake at night. She had abandoned medical treatment for 6 months. She was otherwise in good health and was not taking any medications. There was no family history of skin disease. Physical examination revealed thick, hyperkeratotic, scaly, erythematous, confluent plaques almost completely covering the scalp, including the postauricular area, clinically consistent with scalp psoriasis.