How to tell the difference between scalp eczema vs. psoriasis

There are some key symptoms that distinguish scalp eczema from psoriasis.

Scalp eczema symptoms

Symptoms of scalp eczema can include a dry, flaky, itchy scalp. A person may also experience inflammation, pain, and weeping of the scalp.

There are several forms of eczema that can affect the scalp, each with different symptoms. These include:

• Seborrheic dermatitis: This causes a scaly, red, or gray scalp with possible dandruff.
• Atopic eczema: This causes a dry, itchy scalp with inflammation.
• Allergic contact dermatitis: This causes an itchy, crusting, or scaly scalp with possible lesions and blisters.
• Irritant contact dermatitis: This causes a dry, itchy scalp with inflammation.

Learn more about the symptoms of scalp eczema here.

Scalp psoriasis symptoms

Symptoms of scalp psoriasis may include fine scaling that resembles dandruff or thick, crust-like plaques that affect the entire scalp.

Psoriasis typically has a powder-like texture and appears to have a silvery sheen.

Learn more about the symptoms of scalp psoriasis here.

Scalp eczema and scalp psoriasis are very different conditions. However, they share several similarities, including:

• neither is contagious
• both involve the immune system but are not strictly autoimmune diseases
• stress, weather, certain medical conditions, some medications, and skin irritants can trigger both conditions
• both conditions typically cause a dry, itchy skin rash
• there is no cure for either scalp eczema or scalp psoriasis

There are several ways to differentiate between scalp eczema and scalp psoriasis, including:

• Prevalence: Scalp eczema is approximately four times more common than psoriasis.
• Age of onset: Scalp eczema typically first occurs in infants and children, whereas psoriasis typically first occurs in people between the ages of 15 and 35.
• Appearance: Scalp eczema typically presents as dry, scaly skin with red patches on lighter skin or gray patches on darker skin. Psoriasis typically presents as thick layers with much clearer edges than scalp eczema. A person with psoriasis may experience scaly patches that can be silvery, white, or red. A person may experience more inflammation with psoriasis than with scalp eczema.
• Itching sensation: Scalp eczema typically presents an intense itch, whereas psoriasis typically presents a milder itch alongside a stinging or burning sensation.

Experts think that scalp eczema and scalp psoriasis both result from issues with a person’s immune system.

We explore these causes in further detail below.

Scalp eczema causes

Scalp eczema usually occurs when a person has an overreactive immune system that responds to certain external or internal triggers.

Research suggests that a person with scalp eczema may have a gene mutation that leaves the skin more susceptible to dryness, irritants, and allergens.

There are a variety of triggers that can lead to a scalp eczema flare, including:

• stress
• hormonal changes
• changes in the weather
• certain medications
• medical conditions such as HIV and Parkinson’s disease
• allergens such as hay fever, asthma, or food allergies
• environmental factors such as pollution, tobacco smoke, cold, and damp
• perfumes, detergents, and skin care products
• materials such as nickel and latex
• harsh chemicals
• genetic factors such as family history

Scalp psoriasis causes

Scalp psoriasis usually occurs when the cells in the immune system behave abnormally, causing skin cells to overproduce. The body cannot shed these excess cells, and they pile up on the surface of the scalp.

The triggers of psoriasis include:

• infections such as streptococcal (strep) and HIV infections
• certain medications
• stress
• cold or dry weather
• smoking
• being overweight
• genetic factors such as family history
• alcohol

To diagnose scalp psoriasis, a healthcare professional may:

• examine the scalp
• ask a person a series of questions about the rash
• take a full medical history
• perform a skin sample test

When diagnosing scalp eczema, a healthcare professional may follow similar steps. They may also test for the presence of a fungal infection and any allergies.

There is currently no known cure for either scalp eczema or psoriasis. However, there are several treatments available for the symptoms of both conditions.

Although some of the treatments may be similar, what works to treat scalp eczema may not work to treat scalp psoriasis.

The treatments for scalp eczema include:

• emollient cream or coconut oil
• salicylic acid and tar treatments
• topical steroids
• oral antibiotics if scalp eczema becomes infected
• soothing or medicated shampoos

The treatments for psoriasis include:

• medicated shampoo
• topical steroids
• tar products
• scale softeners
• injections
• phototherapy
• medications such as biologics and immunosuppressants

There are also lifestyle changes a person can make to help manage the symptoms of scalp eczema and psoriasis, including:

• managing stress
• maintaining a healthy weight
• keeping the scalp well moisturized
• following a healthy diet
• avoiding known triggers

While scalp eczema and scalp psoriasis can look alike and share some similarities, they are very different conditions. A healthcare professional will need to diagnose each condition accurately in order to prescribe the correct treatments.

Key differences between scalp eczema and scalp psoriasis include appearance, age of onset, and itching sensation.

Neither scalp eczema nor scalp psoriasis is curable. However, there are several treatments available that can help alleviate symptoms. Making lifestyle changes may also help a person manage the symptoms of both conditions.