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At first glance, symptoms of scalp psoriasis and dandruff may seem almost the same. Both scalp conditions can cause itchy, flaky skin. But beyond their most apparent symptoms, the two have distinctly different definitions, causes, and treatment options.
If you’ve started noticing changes to your scalp health, you may wonder if you have dandruff or scalp psoriasis. Here’s a rundown of the major differences between the two conditions.
Scalp psoriasis is a long-term skin condition that causes inflammation on the scalp. It leads to symptoms like flaking, dryness, itching, and changes in skin color. Although it usually shows up along the hairline, it can also spread to the forehead, the back of the neck, or behind the ears. Scalp psoriasis happens when the body makes skin cells too quickly. Instead of shedding as they should, these extra cells pile up and form thick, silvery-white scaly patches that can flake off.
Psoriasis on the head and scalp is relatively common for those with the skin condition: Between 45 percent and 56 percent of people living with psoriasis experience symptoms on their scalp.
Dandruff is considered a mild form of seborrheic dermatitis, a type of eczema. It’s a common chronic condition that causes skin flaking, itching, and crusting of the scalp when it affects babies.
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. Dandruff flakes also tend to be yellow or white, rather than the silvery color characteristic of psoriasis flakes on the scalp or skin.
There are notable differences between the symptoms of scalp psoriasis and dandruff, beyond the color, shape, and texture of their respective flakes. A dermatologist or other healthcare provider can help distinguish these symptoms.
Not all people experience psoriasis in the same way. According to the American Academy of Dermatology, symptoms can vary. Some people experience scaling (fine skin flaking) that resembles mild dandruff while others develop thick, crusted skin plaques that span the entire scalp.
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.
Itchiness on the scalp led a member of MyPsoriasisTeam 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.”
Fortunately, these patches of hair loss are usually temporary, and hair will often regrow when the inflammation of the psoriasis resolves.
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.
Researchers do not fully understand the exact causes of either psoriasis or dandruff, but there are differences in what’s known.
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 skin plaques.
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.
In people with psoriasis, factors that may trigger a flare include:
Work with your healthcare provider to determine what might trigger your flare-ups.
The cause of dandruff isn’t entirely clear either. Research has suggested that several different factors work together to cause dandruff and seborrheic dermatitis, including an overgrowth of Malassezia yeast — a yeast present on everyone’s skin, but people with seborrheic dermatitis may have a reaction to the yeast. Sebum, an oil produced by the skin, may also play a role in the development of seborrheic dermatitis.
According to Cleveland Clinic, certain environmental and lifestyle factors can also make existing dandruff cases worse. These include:
The diagnostic process for scalp psoriasis and dandruff is 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. The rest of the body should be examined for other areas of psoriasis.
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.
Addressing psoriasis on the scalp can be difficult due to its location.
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 (those applied directly to the skin) 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 systemic (whole-body) treatments like biologics.
Topical corticosteroids (anti-inflammatory drugs) are commonly prescribed to treat scalp psoriasis. These medications are available as over-the-counter or prescription ointments, oils, gels, foams, soaps, shampoos, and creams.
Topicals with salicylic acid may be recommended. These come in concentrations of 5 percent to 10 percent and offer a keratolytic (scale-softening) effect. Coal tar and coal tar shampoo can offer anti-inflammatory and anti-itch benefits. Shampoos containing clobetasol propionate may also be recommended by your healthcare provider.
A dermatologist may prescribe phototherapy, which involves regularly exposing the skin to ultraviolet light under medical supervision.
Phototherapy can help:
This treatment may be more difficult to apply to the scalp due to hair coverage.
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.
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 a medicated shampoo.
There are many anti-dandruff shampoos available over the counter (without a prescription), including:
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 options before finding one that works 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 to seek immediate medical attention if you experience signs of an allergic reaction, such as a rash, hives, or difficulty breathing.
Although having both psoriasis and dandruff isn’t common, it is possible to have sebopsoriasis — a condition that causes signs of both psoriasis and seborrheic dermatitis. You may see white and silver flakes and have itchiness and scaliness.
That said, if you think you may have one or both conditions, check with your doctor or a dermatology provider to get the right diagnosis and develop a tailored treatment plan.
On MyPsoriasisTeam, people share their experiences with psoriasis, get advice, and find support from others who understand.
Have you found new ways to manage your scalp psoriasis? Let others know in the comments below.
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