Scalp Psoriasis vs. Dandruff: Understanding Scalp Flakes | MyPsoriasisTeam

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Scalp Psoriasis vs. Dandruff: Understanding Scalp Flakes

Medically reviewed by Kevin Berman, M.D., Ph.D.
Written by Sage Salvo
Updated on January 5, 2024

At first glance, the symptoms of scalp psoriasis and dandruff may seem almost the same. Both scalp conditions can cause itchy, flaky skin. But beyond their most apparent effects, the two have distinctly different definitions, symptoms, and treatment options.

If you’ve started noticing changes to your scalp health, you may wonder which of the two conditions you have. Here’s a rundown of the major differences between scalp psoriasis and dandruff.

What Is Scalp Psoriasis?

Scalp psoriasis is a chronic (ongoing) inflammatory skin condition that occurs on the scalp. It causes symptoms such as flaking, dry skin, redness, and itching. While symptoms most commonly appear under the hairline, they can extend onto the forehead, the back of the neck, or behind the ears.

As its name suggests, scalp psoriasis is a particular type of psoriasis — a chronic condition in which symptoms occur when the body produces skin cells too quickly. Rather than shedding, these skin cells adhere to the top of the skin, building up into silvery-white, scaly patches that flake off.

Head-specific psoriasis is relatively common for those with the skin condition: Between 45 percent and 56 percent of people with psoriasis experience symptoms on their scalp.

What Is Dandruff?

Dandruff is a form of seborrheic dermatitis — a subtype of eczema — and a common chronic condition that causes rashes, crusting, and a reddish color on the skin.

Dandruff is significantly more common than scalp psoriasis, as it affects roughly half of the general population.

From far away, dandruff flakes may look similar to a mild case of scalp psoriasis. However, the two are distinct when viewed up close. Dandruff flakes are typically thinner, with less-defined edges than psoriasis scales. They also tend to be yellow or white, rather than the silvery color characteristic of psoriasis flakes.

Scalp Psoriasis and Dandruff Symptoms

There are notable differences between the symptoms of scalp psoriasis and dandruff, beyond the color, shape, and texture of their respective flakes.

Symptoms of Scalp Psoriasis

Not all people experience psoriasis in the same way. According to the American Academy of Dermatology, symptoms can vary from scaling (fine skin flaking) that resembles mild dandruff to thick, crusted skin plaques that span the entire scalp.

Scalp psoriasis can affect the areas behind the ears. Scalp psoriasis is common – around half of people with psoriasis have scalp symptoms. (CC BY-NC-ND 3.0 NZ/DermNet)

Scalp psoriasis can be quite uncomfortable. In a 2014 survey of nearly 3,500 people with psoriasis, 43 percent of respondents reported that itchiness was “the most bothersome symptom of their psoriasis.” As one member of MyPsoriasisTeam described, “It feels good to scratch, but you end up with a dandruff-looking pile on your clothes.”

Scratching can have another frustrating impact: temporary hair loss. If a person scratches their dry scalp or forcibly removes itchy scales, they may inadvertently lose hair in the affected areas.

This very experience led another MyPsoriasisTeam member to learn of their diagnosis: “I just found out I have psoriasis because I have a huge round spot on the back of my scalp, and it’s so itchy!” they shared. “My dermatologist told me what I was already pretty sure of.”

Harshly scratching or rubbing psoriasis scales on your scalp can lead to temporary hair loss. (CC BY-NC-ND 3.0 NZ/DermNet)

Fortunately, these patches are usually temporary, and hair will often regrow when the inflammation of the psoriasis resolves.

Symptoms of Dandruff

Dandruff causes skin flakes and an itchy scalp. The signs and symptoms of dandruff may worsen during times of stress and in cold, dry weather.

Although you may immediately associate dandruff with the scalp, it can occur on other areas of the upper body, including the eyebrows, beard, mustache, and central chest. These locations are affected for a reason. Generally, seborrheic dermatitis tends to affect oily areas, and oil can accumulate in the parts of the body mentioned above.

What Causes Scalp Psoriasis and Dandruff?

Researchers do not fully understand the exact causes of either psoriasis or dandruff, but there are differences in what’s known.

Causes of Scalp Psoriasis

Doctors know that psoriasis is an immune-related disease. As with other forms of psoriasis, scalp psoriasis occurs when dysfunction in the immune system causes inflammation, resulting in scaly plaques and, in some instances, psoriatic arthritis.

Normally, the body produces new skin cells in the deepest layer of skin. These cells then rise to the surface of the skin over the course of three to four weeks. For people with psoriasis, this time frame is shortened to around three to seven days. The rapid turnaround causes immature cells to accumulate on the skin’s surface, creating the flaky, itchy patches covered with silvery scales characteristic of psoriasis.

Causes of Dandruff

The cause of dandruff isn’t entirely clear either. Research has suggested that several different factors work together to cause dandruff, including:

  • Dryness
  • Irritated and oily skin
  • Overgrowth of Malassezia (a normally occurring yeastlike fungus)
  • Not shampooing enough
  • Sensitivity to hair care products (known as contact dermatitis)
  • Other skin conditions, including psoriasis and eczema

According to Cleveland Clinic, certain environmental and lifestyle factors can also make existing dandruff cases worse. These include:

  • Stress
  • Cold weather
  • Dry climates
  • Alcohol-based lotions

How Are Scalp Psoriasis and Dandruff Diagnosed?

The diagnostic processes for scalp psoriasis and dandruff are relatively similar. In both cases, a doctor will ask questions and examine the hair and scalp for telltale signs of a certain condition.

If a doctor suspects scalp psoriasis, they may also perform a biopsy (take a small skin sample for analysis) on the affected area to rule out other skin conditions and confirm their diagnosis. If scalp psoriasis is suspected, the rest of the body should be examined for other areas of psoriasis.

How Are Scalp Psoriasis and Dandruff Treated?

Although some medications for scalp psoriasis and dandruff may overlap, treatment plans for each condition are distinct. Always talk to your doctor to determine which medications are best for you.

Treatments for Scalp Psoriasis

Addressing scalp psoriasis can be somewhat difficult, due to its location on the body.

Hair can complicate treatment for scalp psoriasis. Hair not only affects the application and penetration of medications to affected areas — it also affects the likelihood a person will stick to their treatment plan.

Topical treatments are currently used as first-line treatment in many people with scalp psoriasis. Those with more moderate to severe cases may also need phototherapy (light treatment) or a type of medication known as biologics. An oral biologic called apremilast (Otezla) is approved by the U.S. Food and Drug Administration (FDA) to treat mild to moderate plaque psoriasis, especially scalp psoriasis.

Topical Treatments

Topical corticosteroids (anti-inflammatory drugs) are commonly prescribed to treat scalp psoriasis. These medications are available as over-the-counter or prescription lotions, oils, gels, foams, soaps, shampoos, and creams.

Other common topical treatments for scalp psoriasis include salicylic acid in 5 percent to 10 percent concentrations, which offers a keratolytic (scale-softening) effect. Coal tar and coal tar shampoo can offer anti-inflammatory and anti-itch benefits. Shampoos containing ketoconazole and selenium sulfide can also be helpful.

Phototherapy

A dermatologist may prescribe phototherapy, which involves regularly exposing the skin to ultraviolet light under medical supervision.

Phototherapy can help:

  • Slow down the growth of skin cells
  • Suppress immune system overactivity
  • Reduce inflammation and allow the skin to heal
  • Reduce or eliminate itchiness

This treatment is more difficult to apply to the scalp, due to hair coverage.

Systemic Treatments

Systemic treatments address how psoriasis affects the entire body. Your dermatologist may recommend a systemic treatment if your symptoms are particularly severe or haven’t responded to other forms of treatment.

Biologics have been found to improve the symptoms of scalp psoriasis in clinical trials. In addition to apremilast, biologics that may be prescribed include:

Treatments for Dandruff

For mild cases of dandruff, clearing up flakes may be as simple as doing a daily wash with a gentle shampoo to remove excess oil and skin cell accumulation. If that doesn’t do the trick, you may want to try medicated shampoo.

There are many anti-dandruff shampoos available, including:

  • Pyrithione zinc shampoos — Offer antibacterial and antifungal effects
  • Tar-based shampoos — Soften scaling and slow the flaking process
  • Selenium sulfide shampoos — Provide antifungal benefits
  • Ketoconazole shampoos — Kill dandruff-causing fungi

If you aren’t sure which shampoo is best for you, or if the shampoos you’ve used don’t appear to be working, talk to your doctor. Keep in mind that shampooing won’t be an instant fix, and you may need to try a variety of shampoos before finding one that works well for you.

Be careful, as some shampoos may have a harsher impact on your skin. Mayo Clinic advises that you stop using a product if you develop itching, stinging, discoloration, or burning and that you seek immediate medical attention if you experience an allergic reaction, such as a rash, hives, or difficulty breathing.

Is It Possible To Have Both Scalp Psoriasis and Dandruff?

In short, yes. Although having both psoriasis and dandruff is relatively rare, it is possible to have sebopsoriasis — a condition in which psoriasis and seborrheic dermatitis occur simultaneously. If you have sebopsoriasis, you will experience the symptoms of both conditions. You may see white and silver flakes and experience itchiness and scaliness. That said, if you think you may have both conditions, check with your doctor to get the right diagnosis and develop a tailored treatment plan.

Find Your Team

MyPsoriasisTeam is the social network for people with psoriasis and psoriatic arthritis and their loved ones. Here, more than 123,000 members come together to ask questions, share advice, and connect with others who understand life with psoriasis.

Have you found new ways to manage your scalp psoriasis? Let us know in the comments below or start a conversation by posting on your Activities page.

Updated on January 5, 2024
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Kevin Berman, M.D., Ph.D. is a dermatologist at the Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Learn more about him here.
Sage Salvo is a content creator who specializes in developing savvy, SEO-aware content strategies and top notch ghostwritten articles for a wide variety of industry niches. Learn more about her here.

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