Scalp Psoriasis Vs. Dandruff: What Are the Differences?

Reviewed on 7/26/2021

Scalp psoriasis and dandruff cause similar symptoms such as red, scaly, flaky patches on the scalp, but they are different conditions. Psoriasis is a chronic autoimmune condition, while dandruff is a mild form of seborrheic dermatitis.
Scalp psoriasis and dandruff cause similar symptoms such as red, scaly, flaky patches on the scalp, but they are different conditions. Psoriasis is a chronic autoimmune condition, while dandruff is a mild form of seborrheic dermatitis.

Both scalp psoriasis and dandruff can cause red, scaly, flaky patches of skin on the scalp, but they are different conditions. 

Psoriasis is a chronic autoimmune condition that causes red, scaly, thick, and flaky skin. Psoriasis commonly affects the scalp, as well as the elbows, knees, and other areas of the skin and nails.

Dandruff (seborrhea) is a mild form of seborrheic dermatitis. Seborrheic dermatitis is a skin condition that can cause redness, scaly or flaky patches, and itching. It typically affects areas of the skin that have many oil glands such as the scalp, face, upper chest, and back. 

What Are Symptoms of Scalp Psoriasis Vs. Dandruff?

Symptoms of scalp psoriasis and dandruff — their similarities and differences — are outlined in the table below.

Scalp Psoriasis Vs. Dandruff Symptoms Chart
Symptoms of scalp psoriasis and dandruff that are similar Additional symptoms of scalp psoriasis Additional symptoms of dandruff
White flakes or scales on the head or in the hair Thick, crusted plaques that cover the entire scalp

Itching

Dry scalp

Red and bumpy areas

Redness and greasy scales, usually on the scalp in infants (“cradle cap”)

Scalp redness

Cracked skin that itches or bleeds

Burning or soreness

Localized hair loss

Emotional effects

  • Embarrassment
  • Depression
  • Anxiety

Psoriatic arthritis

  • May also occur in some patients 
  • Causes stiff, swollen, painful joints

What Causes Scalp Psoriasis Vs. Dandruff?

All forms of psoriasis, including scalp psoriasis, are caused by an overactive immune system, but the reason for this immune system overactivity is not known. 

Risk factors for developing scalp psoriasis include:

Triggers for scalp psoriasis flares include:

The exact cause of dandruff (seborrhea) is believed to be due to an inflammatory reaction to a type of yeast (Malassezia globosa) that naturally lives on the skin. Most people have this microbe on their skin, and about half of all people are sensitive to it. 

Risk factors for developing dandruff include:

  • Dry skin
  • Sensitivity to hair products
  • Skin irritation
  • Skin conditions such as eczema or psoriasis 
  • Genetics 
  • Stress
  • Certain medications
  • Hormonal changes
  • Certain illnesses such as Parkinson’s disease and diseases that affect the immune system, such as HIV or AIDS
  • Dandruff is not caused by allergies or poor hygiene. 

How Are Scalp Psoriasis Vs. Dandruff Diagnosed?

Both scalp psoriasis and dandruff are usually diagnosed with a physical examination of the scalp. 

If the diagnosis is uncertain, a small sample of skin may be taken (a biopsy) may be taken to help confirm a diagnosis or to help rule out other conditions.


 

SLIDESHOW

Types of Psoriasis: Medical Pictures and Treatments See Slideshow

What Is the Treatment for Scalp Psoriasis Vs. Dandruff?

It is important to get a diagnosis for scalp psoriasis versus dandruff, because in some cases, scalp psoriasis may require prescription medications

Scalp psoriasis can be difficult to treat. The goal of treatment for scalp psoriasis is to relieve symptoms. 

Treatments to help get rid of psoriasis on the scalp include: 

  • Topical treatments, such as creams and ointments
    • Over-the-counter (OTC) topical treatments: The National Psoriasis Foundation (NPF) has a Seal of Recognition program that recognizes over-the-counter products intended to be non-irritating and safe for people with psoriasis
    • Look for products such as shampoos that contain:
      • Salicylic acid to help soften plaques and scales and remove scales from the skin
      • Coal tar or wood tar, to help slow skin cell growth and reduce inflammation, itching, and scaling
      • Scale lifters (keratolytics) with active ingredients such as salicylic acid, urea, lactic acid, or phenol to help loosen and remove scale, and allow medications to reach the psoriasis plaques
      • Aloe vera, jojoba, zinc pyrithione, and capsaicin to soothe, moisturize, remove scale, or relieve itching 
      • Anti-itch treatments such as calamine, hydrocortisone, camphor, benzocaine, diphenhydramine hydrochloride, and menthol (may increase irritation and dryness)
      • Coverings such as plastic wrap, cellophane, waterproof dressing, cotton socks, or a nylon suit may be applied over topical treatments to help increase effectiveness 
    • Prescription topical treatments
  • Systemic treatments
  • Phototherapy (light therapy)
    • Ultraviolet light B (UVB): broad band and narrow band
    • Psoralen + UVA (PUVA

Treatment of dandruff (seborrhea) includes:

  • Frequent shampooing or longer lathering
  • Avoiding use of hair spray or hair pomades
  • Dandruff hair care
    • Use of shampoos with antifungal or antiseptic properties containing salicylic acid, coal tar, sulfur, or zinc; selenium sulfide (2.5%), ketoconazole, and ciclopirox 
      • Follow instructions on the dandruff shampoo bottle because each type of active ingredient may require different application
      • Note that coal tar shampoos can discolor blonde, grey, or white hair, and can also make the scalp sensitive to sunlight so it is important to wear a hat if using this type of dandruff shampoo
    • Use of conditioner with zinc, 0.01% fluocinolone, and acetonide topical oil
    • Applying tar, bath oil, Baker’s P&S solution, or Derma-Smoothe F/S oil overnight to loosen scales may be helpful 

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Reviewed on 7/26/2021
References
https://www.uptodate.com/contents/psoriasis-the-basics?search=psoriasis&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1

https://www.psoriasis.org/

https://www.psoriasis.org/scalp/

http://emedicine.medscape.com/article/1108312-overview

https://www.headandshoulders.com/en-us/healthy-hair-and-scalp/dandruff

https://www.aad.org/public/everyday-care/hair-scalp-care/scalp/treat-dandruff