Is It Dandruff or Psoriasis? Tips for Identification

With scalp psoriasis, you’ll notice silvery-red scales that may extend beyond the hairline. They’ll cause itching, flaking, and redness. In dermatitis, scales are white or yellowish and accompanied by dandruff.

What’s Causing My Scalp Psoriasis, and How Do I Treat It?

Psoriasis is a chronic skin condition that causes a buildup of skin cells in different parts of the body. These excess skin cells form silvery-red patches that can flake, itch, crack, and bleed.

Experts estimate that 125 million people, or 2 to 3 percent of people worldwide, have psoriasis.

When psoriasis affects the scalp, it’s simply known as scalp psoriasis. Scalp psoriasis is a relatively common condition.

Psoriasis treatment varies based on its severity and location. Generally, psoriasis treatments for the neck and face are gentler than treatments used on other parts of the body, such as the head.

There’s anecdotal evidence that some home remedies may help reduce scalp psoriasis symptoms. These are best used in conjunction with medical treatments that have been proven effective.

Scalp psoriasis is a form of plaque psoriasis, which causes silvery-red or purplish scaly patches (known as plaques). Plaque psoriasis is the most common psoriasis type. It can affect any part of the body.

Scalp psoriasis may also spread to — and cause plaques to appear on — the:

• hairline
• forehead
• back of the neck
• back of the ears

In addition to plaques, scalp psoriasis may also cause:

• fine white or yellow skin flakes on the scalp
• an itchy sensation
• a burning sensation
• dryness
• bleeding

Temporary hair loss is another common symptom and side effect. Hair usually grows back once scalp psoriasis is treated and clears up.

Researchers aren’t exactly sure what causes any kind of psoriasis. They think it occurs when a person’s immune system isn’t working properly. However, most people who develop psoriasis are likely to experience scalp-related symptoms.

According to two large 2016 studies, scalp psoriasis affects between 45 and 56 percent of people with psoriasis in the United States. A 2014 study conducted by the Asia Scalp Psoriasis Study Group concluded that psoriasis affects the scalp of 75 to 90 percent of people with psoriasis.

Someone with psoriasis may produce more of certain types of white blood cells called T cells and neutrophils. The job of T cells is to travel through the body, fighting off viruses and bacteria.

If a person has too many T cells, they may begin to attack healthy cells by mistake and produce more skin cells and white blood cells. In the case of scalp psoriasis, these excess skin cells may lead to inflammation, redness, patches, and flaking.

Genetics and lifestyle factors may also play a role in the development of psoriasis.

Family history

Having one parent with psoriasis increases your risk for the condition. You have an even greater risk for developing psoriasis if both your parents have it.

Obesity

People with obesity are also at an increased risk for psoriasis.

Smoking

Your risk for psoriasis increases if you smoke. Smoking also aggravates psoriasis symptoms, making them more severe.

Stress

High stress levels are linked to psoriasis. This is because stress affects the immune system.

Viral and bacterial infections

People with recurring infections and compromised immune systems, especially young children and those with HIV, have an increased risk for psoriasis.

Psoriasis triggers

People with psoriasis may notice that certain things worsen or trigger their condition. Common triggers include:

• a lack of vitamin D
• infections, such as strep throat or skin infection
• skin injuries
• certain medications, including lithium, beta-blockers, antimalarial drugs, and iodides
• an addiction to alcohol
• smoking
• stress

Treating scalp psoriasis can prevent severe symptoms, chronic inflammation, and hair loss. The types of treatments you need depends on the severity of your condition.

A doctor may combine or rotate several different options based on your needs. Here are some common treatments for scalp psoriasis:

Medical treatments

The following medical treatments have been proven to help treat scalp psoriasis:

Calcipotriene

Calcipotriene is available as a cream, a foam, an ointment, and a solution. It contains vitamin D, which can change how skin cells grow on parts of the body affected by psoriasis.

It’s sold in the United States under the brand names Dovonex (cream) and Sorilux (foam).

Betamethasone-calcipotriene

This combination of a corticosteroid (betamethasone) and vitamin D (calcipotriene) works to relieve scalp psoriasis symptoms such as redness and itching. It also changes how skin cells grow on affected areas.

It’s available as a cream, a foam, an ointment, and a suspension.

In the United States, this medication is sold as Wynzora (cream) and Enstilar (foam). The brand-name version Taclonex is available as an ointment and a suspension.

Tazarotene

Tazarotene comes as a foam, cream, gel, or lotion. It helps with increasing cell turnover, which helps reduce the number of plaques and keeps them under control.

It’s sold under the brand names Fabior (foam), Avage (cream), and Arazlo (lotion). The brand-name version Tazorac is available as a cream and gel.

Oral retinoids

Retinoids are medications made from vitamin A. They’re designed to reduce inflammation and cell growth. They can take anywhere from 2 to 12 weeks to work.

Acitretin (Soriatane) is one oral retinoid available for use in the United States. Learn more about oral medications for psoriasis.

Methotrexate

Methotrexate is a medication that can stop skin cells from overgrowing. It must be taken on a fixed schedule as determined by a doctor. It’s available in many different forms, and the oral tablet is often used to treat psoriasis.

In the United States, the oral tablet is also sold under the brand name Trexall.

Cyclosporine

Cyclosporine works by calming the immune system and slowing the growth of specific types of immune cells. It’s administered orally and taken once a day at the same time each day.

It’s intended for people with severe psoriasis. However, more research is needed to better understand how effective it is over a long period of time.

Cyclosporine is also sold as Gengraf, Neoral, and Sandimmune in the United States.

Biologics

Biologics are injectable medications made from natural substances. They reduce the body’s immune response, which can decrease the inflammation and redness caused by psoriasis.

Examples of biologics used to treat psoriasis include adalimumab (Humira) and etanercept (Enbrel).

Ultraviolet (UV) light therapy

In phototherapy, the affected skin is exposed to ultraviolet (UV) light. Ultraviolet B (UVB) is effective in treating psoriasis. Laser treatments are especially effective for scalp psoriasis.

Regular sunlight emits broadband UVA and UVB light. The artificial light most often used in phototherapy is narrowband UVB.

Tanning beds aren’t recommended because they emit UVA light, not UVB. According to the American Academy of Dermatology, using tanning beds before you turn 35 years old also raises your risk for melanoma by 59 percent.

Home remedies

Most home remedies haven’t been proven to alleviate scalp psoriasis symptoms. However, anecdotal evidence suggests that they can help reduce symptoms when used along with medical treatment.

Here are some popular home remedies for scalp psoriasis:

• aloe vera cream or gel, applied three times a day to the scalp and other affected areas
• apple cider vinegar solution, to be washed over the affected areas
• a paste of baking soda and water to reduce scalp itchiness
• capsaicin cream to reduce flaking, redness, and inflammation
• coconut or avocado oil to moisturize the affected areas
• pureed garlic that’s been mixed with aloe vera cream or gel, applied daily before being rinsed off
• Mahonia aquifolium (Oregon grape) cream, an herbal treatment that can reduce the body’s immune response
• an oatmeal bath to reduce itchiness, flaking, and inflammation
• omega-3 fatty acid supplements to reduce inflammation
• a sea salt bath or an Epsom salt bath to cut down on redness and inflammation
• tea tree oil to reduce inflammation
• turmeric to reduce inflammation
• vitamin D to cut down on redness and inflammation

Psoriasis shampoos

Psoriasis shampoos are another popular home treatment. While you can get medicated shampoos from a doctor, there are many over-the-counter products that can reduce your symptoms too.

Look for versions that contain at least one of the following ingredients:

Should you peel your flakes?

Avoid peeling your flakes, as that may result in hair loss. Experts suggest combing your flakes out gently if you want to improve the appearance of your scalp psoriasis.

Dermatitis is a term used to describe various types of skin inflammation. This includes contact dermatitis (a reaction to a chemical product) as well as seborrheic dermatitis (a form of eczema).

Like psoriasis, dermatitis can also affect the scalp. While some of the treatments for these conditions may overlap, the conditions themselves have different causes.

Scalp psoriasis is likely caused by immune dysfunction. Dermatitis is caused by various skin irritants, such as allergens.

With scalp psoriasis, you’ll notice silvery-red scales that may extend beyond the hairline. They’ll cause itching, flaking, and redness. In dermatitis, scales are white or yellowish and accompanied by dandruff.

A doctor can usually tell the difference between scalp psoriasis and dermatitis by taking a look at the affected area. In other cases, it might be trickier to tell the difference.

They might perform a skin scrape or take a biopsy. An overgrowth of skin cells will be present in cases of scalp psoriasis. In dermatitis cases, there will be irritated skin and sometimes bacteria or fungi.

Dermatitis (and seborrheic dermatitis in particular) can cause dandruff. Scalp psoriasis and dandruff share many of the same symptoms, such as:

• white or yellow skin flakes on the scalp
• mild redness
• itchiness
• dryness
• temporary hair loss

In addition, dandruff may also cause:

• dry skin on other parts of the face, such as the eyebrows or ears
• a greasy or oily scalp

However, dandruff won’t cause the thick plaques that are typical of psoriasis. Dandruff doesn’t usually have well-defined borders either, while psoriasis plaques tend to have a well-defined red border.

Dandruff is also a lot easier to treat than psoriasis and can typically be managed with the right shampoo or home remedy.

Speak with a doctor about any changes to your skin that don’t resolve on their own or with home treatment. A doctor will be able to design a treatment plan appropriate for you.

Home treatments may be most helpful in reducing symptoms when used in combination with doctor-recommended medical treatments.

Last medically reviewed on August 4, 2021

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Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available.

Is It Dandruff or Psoriasis? Tips for Identification

Both dandruff and psoriasis can cause flakes to appear on the scalp. However, flakes caused by psoriasis may also cause dead skin to build up on the surface of your skin.

Dry, flaky skin on your scalp can be uncomfortable. Those flakes can be caused by dandruff or psoriasis, which are two very different conditions:

• Dandruff (also known as seborrhea) can usually be treated relatively easily and is seldom a serious medical problem.
• Psoriasis, on the other hand, is a chronic condition without a current cure. It can cause a great deal of discomfort.

Dandruff is a condition marked by flakes of dry skin on the scalp. The flakes can often fall from your hair and land on your shoulders.

Dandruff is usually due to the body’s overreaction to the presence of typical yeast on the skin. This inflammation leads to the overproduction of skin cells, leading to flaking. If this is the cause, the flakes are typically small and you may also have dry skin on other parts of your body.

Washing your hair with a harsh shampoo or using a lot of chemicals on your hair can sometimes irritate your scalp and lead to flakes.

A fairly common condition called seborrheic dermatitis is the cause of many dandruff cases. Experts consider it a type of eczema that affects areas of the skin with oil-producing sebaceous glands. It’s characterized by patches of red and oily skin that leave yellowish flakes on the scalp. These flakes are often larger than the dandruff flakes that can arise from dry skin.

Seborrheic dermatitis can also cause flaky, irritated patches elsewhere on your face and body, which may lead you to think you have psoriasis.

In Black people and People of Color, seborrheic dermatitis can appear as:

• hypopigmentation, or lightening of the skin
• curved or petal-like lesions along the hairline
• flaking or hypopigmentation on the scalp in infants

Unlike dandruff, psoriasis is rooted in your immune system. It’s considered an autoimmune disease, which means proteins called autoantibodies mistakenly attack healthy tissue.

This attack causes skin cell production to speed up, creating an unhealthy and abnormal growth of new skin that collects in dry, flaky patches on your body, including the scalp.

Typically, dead skin is shed in tiny, thin fragments from the outermost layer of skin. Neither you nor anyone else can usually tell when you lose dead skin. New, healthy skin cells form beneath the surface of your skin and, in a matter of weeks, rise to the surface to replace the dead skin.

If you have psoriasis, that process speeds up in various spots on your body and there’s no time for the dead skin to go through its natural cycle of shedding. That causes dead skin cells to build up on the surface. This usually occurs on the:

Psoriasis can take different forms. Sometimes your skin may look cracked and dry. Other times it may be discolored and dotted with small silvery patches. Psoriasis can appear salmon-colored with silvery-white scales on medium skin tones. Darker skin tones could look violet with gray scales.

Share on Pinterest With most cases of dandruff, people notice white flakes on their scalps or shoulders and mild itching. Unlike psoriasis, there are no thickened plaques. Photography courtesy of AndreyPopov/Getty Images

Share on Pinterest Dandruff on the scalp can look like flakes. Photography courtesy of powerofforever/Getty Images

Share on Pinterest Severe cases of dandruff can be hard to distinguish from scalp psoriasis. Both conditions can cause pink, irregular plaques with scaling and flakes. A doctor can help diagnose which condition is present and the best treatment options. Photography Courtesy of rob_lan/Getty Images

Share on Pinterest Even with mild cases of scalp psoriasis, very itchy, thickened plaques on the scalp can develop. The plaques can become very irritated and bleed with scratching. Photography courtesy of Ternavskaia Olga Alibec/Shutterstock

Share on Pinterest Psoriasis on the scalp may look darker than the surrounding skin. In people with light skin tones, scalp psoriasis can look red with silvery scales. Photography by Ratchapon Supprasert/Getty Images

Share on Pinterest Psoriasis on the scalp may look darker than the surrounding skin. In people with dark skin tones, it can look purple with silvery scales. Photography courtesy of Leanne Almario et al./CC BY 4.0

Share on Pinterest Severe cases of scalp psoriasis can become very inflamed and red, with silvery flakes on a thickened plaque that extends beyond the scalp area. Photography courtesy of Christine Langer-Püschel/Getty Images

Share on Pinterest Psoriasis can affect other areas of the head, including the ears and neck. Photography courtesy of Pitchaporn Kaengluang/Shutterstock

Dandruff can often be prevented, while psoriasis can’t.

Dandruff

Dandruff can usually be prevented. Using a dandruff shampoo is often enough to keep dandruff from forming. Keeping your hair clean, in general, and washing your hair at least 2 to 3 times a week is ideal.

Oil and dirt can build up on your scalp and cause your scalp to dry. Brushing your hair away from the scalp also helps keep oil from accumulating on your scalp.

Psoriasis

There’s no way to prevent psoriasis.

According to the National Psoriasis Foundation, it’s less common in children and often appears between the ages of 15 and 35, but it can develop at any age.

The organization notes that in the United States, psoriasis affects 3% of adults — as many as 7.5 million people. Psoriasis can develop in people of all ages and skin colors.

Its prevalence by race and ethnicity is as follows:

• 3.6% of white people
• 1.9% of Black/African American people
• 1.6% of Hispanic people

But these numbers may not tell the entire story as the condition may be disproportionately undertreated and misdiagnosed in People of Color because it isn’t always recognized on darker skin tones.

Treatment exists for both dandruff and psoriasis.

Dandruff

Dandruff can usually be treated with medicated shampoo. It’s also important that you follow the directions of any shampoo you use. Some can be used a couple of times per week, while others can only be used once per week. You may have to switch shampoos too, as one may become less effective over time.

The American Academy of Dermatology Association (AAD) recommends that Black people use dandruff shampoo once per week and that white people and people of Asian descent use dandruff shampoo twice per week.

They also note that shampoo containing coal tar can discolor lighter hair, including blond, white, or gray hair.

Psoriasis

Psoriasis can be treated with topical, oral, and injectable medications. Many of these medications are steroids. They help to make the symptoms somewhat milder.

But there’s no cure for psoriasis.

Experts may recommend topical treatments for mild to moderate psoriasis. They may prescribe other types of treatment if topical treatments don’t work or for more severe psoriasis.

These may include:

• Disease-modifying antirheumatic drugs (DMARDs): These drugs are given to people with moderate to severe psoriasis.
• Light therapy:Light therapy, which targets psoriasis trouble spots with specially directed ultraviolet (UV) light, can also help treat the symptoms of psoriasis.
• Biologics:Biologics can be used to treat various forms of moderate to severe psoriasis. These injectable drugs work by blocking inflammatory proteins.

Often dandruff can be self-diagnosed at home just by observing flakes on your hair and scalp. If you’re concerned it could be something more, a doctor can help identify it as dandruff or psoriasis.

If the doctor believes it may be psoriasis, they’ll ask you if you’re experiencing other symptoms like joint pain or itchy skin elsewhere on your body.

Joint pain and inflammation may be a symptom of psoriatic arthritis. As many as one in three people with psoriasis may develop psoriatic arthritis.

If your dandruff doesn’t go away or doesn’t get better using antidandruff shampoo, you may want to consult a dermatologist. Prescription dandruff shampoos may have the strength you need to overcome the problem. You may also require a medicated topical.

If all signs point to psoriasis, you may want to be evaluated by a dermatologist. If stiff or swollen joints accompany your psoriasis, you may have psoriatic arthritis. A rheumatologist can treat this condition. A primary care physician should be able to help coordinate your care and your various specialists.

Dandruff and psoriasis can both cause flakes of skin on the scalp. But they’re separate conditions.

Dandruff can occur as the body’s overreaction to yeast on the skin or seborrheic dermatitis, a type of eczema.

Psoriasis is a chronic autoimmune condition. It can cause dead skin to build up on the surface of the skin. It may affect the scalp and may also affect other areas of the body.

Last medically reviewed on November 1, 2022