Dandruff and scalp psoriasis can look very similar, as both produce flakes of skin in and underneath the hair. However, there are significant differences between the two conditions that may help a person get a prompt diagnosis and treatment.

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Psoriasis is a chronic inflammatory condition that affects multiple systems across the body, including the skin, the immune system, and the musculoskeletal system. It often presents as thick, itchy scales and plaques.

Psoriasis often develops on the scalp. Unlike dandruff, the plaques of scalp psoriasis often have a silvery sheen and can look like dry scales on the scalp.

Dandruff is a less severe chronic condition that affects the scalp. A dry or greasy scale may present on the scalp, and flakes from the scalp may fall onto a person’s shoulders and clothes.

This article explains the difference between dandruff and scalp psoriasis.

Although people often find it difficult to distinguish between psoriasis of the scalp and dandruff, these conditions do produce different symptoms.

Dandruff

Dandruff is a common scalp condition that causes small pieces of dry skin to flake from the scalp. These flakes can be noticeable and may cause a person to feel embarrassed if they fall onto the person’s shoulders. However, the condition is not contagious or harmful to overall health.

Sometimes, what seems to be dandruff might indicate another underlying skin condition, such as seborrheic dermatitis, eczema, psoriasis, or fungal infection.

A person should seek medical treatment for dandruff if symptoms are severe or do not resolve with over-the-counter (OTC) shampoos and ointments.

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This image shows dandruff affecting a person with dark skin.
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This image shows dandruff on the scalp.
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Psoriasis

Psoriasis can affect any area of the scalp and will typically appear as thick, inflamed, and reddish patches or silvery-white scaling patches.

Scalp psoriasis can cause extreme itching, and the skin might become so dry that it cracks and bleeds. Scalp psoriasis can also spread from the scalp onto the face.

Other symptoms of scalp psoriasis include:

  • dandruff-like flaking
  • silvery-white scale on the scalp
  • temporary hair loss
  • burning sensation

People should seek medical attention if they find any cracking or bleeding underneath what they believe to be dandruff.

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Psoriasis is a skin condition that causes an overproduction of skin cells on the scalp, leading to scaly and flaky patches. WARAPORN.IN/Shutterstock
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Psoriasis on the scalp is associated with overlying silvery scale.
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Other conditions

A flaky scalp might develop as a symptom of several other health conditions, including:

  • Seborrheic dermatitis: This condition occurs due to an inflammatory response to yeast on the skin. Seborrheic dermatitis can cause the scalp to become itchy, scaly, and red. It may have similar symptoms to dandruff, but it can develop in other places of the body. Also, seborrheic dermatitis is more common in babies and adolescents, while dandruff is more common in adults.
  • Tinea capitis: This fungal infection is also known as “scalp ringworm” and can cause flaking.
  • Eczema: This is a common skin condition that results in dry, red, and flaky skin in different areas of the body.
  • Contact dermatitis: Contact dermatitis on the scalp can also display as flaking skin and may result from the use of certain cosmetic products, shampoos, conditioners, or other products.
  • Cradle cap: This is a type of seborrheic dermatitis. It causes yellow, greasy, and scaly dandruff that often affects babies, peaking at about 3 months of life. Symptoms usually only last for a few weeks or months. Gently washing the hair with baby shampoo can help prevent a buildup of scales on a baby’s head.
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Seborrheic dermatitis is a common skin condition similar to dandruff that causes flaky areas of skin with a red, greasy base.
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Tinea capitis is a fungal infection on the scalp.
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Both psoriasis and dandruff may be due to an inflammatory response in the body, but researchers do not fully understand all the causes.

Psoriasis causes

About half of all people with plaque psoriasis will experience symptoms on their scalp. Scalp psoriasis has the same underlying cause as other forms of psoriasis.

When a person has psoriasis, their immune system becomes overactive and instructs the skin cells to grow too quickly. This causes skin cells to build upon the surface of the skin in the form of thick plaques.

Stress, extreme temperatures, and infectious illnesses can all trigger flares of scalp psoriasis.

In the United States, more than 8 million people are living with psoriasis. Psoriasis frequently begins in individuals aged 15–25 years, although it can develop at any age.

Dandruff causes

Dandruff is a common scalp condition that affects around 1 in 2 adults globally.

Contrary to some people’s belief, poor hygiene does not cause dandruff, although infrequent shampooing can make it more obvious.

Scientists do not completely understand its root causes.

A person with scalp psoriasis may wish to consult a dermatologist. This is a doctor who specializes in skin conditions and can recommend appropriate treatments.

Dermatologists also have more experience in differentiating between and diagnosing various skin conditions.

Treatments may include the following:

Topical treatments

Severe cases of scalp psoriasis may require topical therapies, such as:

  • Corticosteroids: These are the most effective topical treatment for scalp psoriasis. A dermatologist might prescribe another medication alongside steroids to reduce side effects.
  • Medicated shampoos: These usually accompany a stronger treatment as part of an overall treatment regimen. Shampoos containing clobetasol propionate are among the most effective shampoos for scalp psoriasis. People can safely use them every day for 4 weeks or less.
  • Scale-softening agents: Ointments, creams, and lotions containing salicylic acid and urea can help soften scales, which makes removing them easier.
  • Calcipotriene: This is a synthetic type of vitamin D3 that individuals with scalp psoriasis often apply before bed. People sometimes combine this with a steroid to boost the effects of treatment.
  • Tazarotene (Tazorac): A person with psoriasis can apply a thin layer of tazarotene before bed. They can shower off the layer when they wake up. A treatment plan might include this medication alongside a steroid.

In addition, a person may find success with in-office treatments, such as excimer laser or other light therapies. Excimer lasers allow a dermatologist to treat only the affected areas of the skin. However, it often requires several sessions per week that last about 10 minutes each.

Medications

Systemic medications target specific parts of the immune system to reduce the frequency of flares and the severity of symptoms.

For scalp psoriasis, however, doctors do not usually prescribe systemic drugs unless symptoms are severe or do not respond to other medications.

Some systemic medications a doctor may prescribe for scalp psoriasis include:

  • Injected corticosteroids: A dermatologist can inject steroids directly into the psoriatic lesions. However, they will only be able to carry this out for a limited number of injections.
  • Biologic medications: These come from living cells and target specific parts of the immune system. They can help reduce the frequency and level of skin responses to flares.
  • Cyclosporine (Gengraf, Neoral, SandIMMUNE): Individuals living with severe plaque psoriasis can use cyclosporine, a drug that suppresses the immune system. People normally use it to prevent the body from rejecting an organ after a transplant, but it may be useful for people with psoriasis as well.
  • Acitretin (Soriatane): This is an oral retinoid, which is a form of vitamin A. It can slow cell growth and bring down swelling and redness.
  • Apremilast: This medication inhibits an enzyme within the skin cells that is responsible for inflammation.

People with more severe scalp psoriasis may need to try and combine several treatments before they find one that works for them.

After repeated use, a person’s psoriasis may become less responsive to some medications. If this happens, they should speak with a doctor about their concerns. The doctor can help determine the next steps in treatment.

There are many different OTC shampoos for dandruff.

Some of these shampoos have slightly different instructions on how long people should lather or leave on the scalp before rinsing the hair. For maximum effect, a person should follow the label instructions closely.

People can try using shampoos that have different active ingredients if their first choice is not effective. Active ingredients can include:

  • zinc pyrithione
  • salicylic acid
  • coal tar

It is of note that coal tar may cause discoloration to hair that is not already black and make the scalp more sensitive to sun exposure.

If a person’s symptoms improve, then they may be able to use the shampoo less often. However, if they stop using the shampoo altogether, dandruff will likely come back.

If symptoms have not improved after a person has tried dandruff shampoos for longer than 1 month, they may wish to seek guidance from a healthcare professional.

There are many ways that people who have scalp psoriasis or dandruff can care for their scalp. Certain steps can help manage each condition and provide some relief from symptoms.

Scalp care for psoriasis

The following are some self-care tips for dealing with psoriasis:

  • Avoid picking or scratching at the plaques.
  • Gently apply products such as shampoo.
  • Avoid stressful situations or look for ways to help manage stress — for example, through yoga or meditation — as this can also help people with this condition.

Scalp care for dandruff

Although each individual may require different treatment depending on the severity of their symptoms or the specific recommendations from a doctor, some care tips for dandruff may include the following:

  • Use caution when using coal tar, as this can cause staining.
  • Follow all instructions on shampoo and conditioner containers.
  • People of African American descent should use dandruff shampoo only once per week.
  • People of Asian descent and white people should use dandruff shampoo only twice per week.

A person living with dandruff may not need to consult a doctor. OTC shampoos and conditioners may be enough. If dandruff does not get better, however, a person should speak with a healthcare professional about other options.

Individuals living with psoriasis should be monitored by a doctor. If treatment is no longer effective or if scalp involvement occurs, the doctor can help determine the best course of treatment going forward.

If a person develops red, itchy patches on their scalp, they should seek medical attention as soon as possible. This could be a sign that psoriasis has developed.

Scalp psoriasis and dandruff are different conditions that affect the scalp. Both can cause dryness and flakes to appear. However, psoriasis often presents with more severe symptoms, such as plaques, bleeding, and itchy or burning skin.

A person can often treat dandruff with medicated OTC shampoos or conditioners. By contrast, psoriasis typically requires more extensive treatments to prevent flares and reduce the severity of symptoms.

In either case, a person should seek guidance from a doctor if their treatment no longer works. The doctor can help determine the next best course of action.

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