If your scalp itches and flakes, your doctor can tell if it’s dandruff or a more serious problem like psoriasis, a disease that causes red, scaly patches on your skin. While there are several reasons you may have a flaky scalp, psoriasis will look slightly different than regular dandruff. Once you have the right diagnosis, you can treat the cause and get some relief.
What Is Dandruff?
Dandruff is a common skin problem. You may notice flakes that fall off your scalp and cling to your hair or land on your clothing. Your scalp may itch, too.
Several things can cause dandruff:
- Seborrheic dermatitis: This is oily, itchy, irritated skin that flakes off of your scalp. It also can happen with your eyebrows, groin, or chest hair.
- Contact dermatitis: Hair care products like shampoo, gel, or dye can irritate your scalp and cause redness, itchiness, and flakes.
- A fungus called malassezia is a yeast that thrives on the oil on your scalp.
- If you don’t shampoo your hair often enough, oily skin can flake off.
- Dry skin can lead to small flakes on your scalp. You’ll probably have dry skin all over your body.
- Male hormones: Men are more likely to get dandruff than women.
- People whose immune systems can’t fight off diseases, such as people who have HIV, may be more likely to get dandruff.
Dandruff usually isn’t serious. You can’t catch it from anyone else or pass it on. It can be uncomfortable or embarrassing, though. Dandruff can be treated at home without a prescription.
What Is Scalp Psoriasis?
Psoriasis can affect your scalp, and the red, scaly patches it causes can flake off the way dandruff does. There are a few differences, though:
- It’s chronic: Psoriasis is long-lasting, while dandruff may come and go.
- It’s more scaly than flaky. If it’s mild, scalp psoriasis looks like scaly, silvery, or powdery patches that may come off in tiny pieces. More serious outbreaks can be red and painful.
- It may spread. Psoriasis patches can creep past your hairline to your forehead, the back of your neck, or the skin around your ears. You may have psoriasis patches on other parts of your body, too, like your elbows, legs, feet, palms, or back.
- It’s an autoimmune disease. Psoriasis is caused by your body’s immune system: White blood cells that should fight off diseases attack your skin cells instead.
View a slideshow to see what scalp psoriasis looks like.
Diagnosis
Your doctor may figure out the reason your scalp flakes or itching just from your symptoms. To be sure, they may look at a small piece of skin from your scalp under a microscope or send it to a lab.
Treatments for Dandruff
If you have mild dandruff, the best thing you can do is to wash your hair every day or every other day with an over-the-counter dandruff shampoo. Look for ingredients on the label such as:
- Ketoconazole (Nizoral A-D)
- Salicylic acid (DCL Salicylic Acid Shampoo, Dermasolve, Neutrogena T/Sal, Selsun Blue Naturals Dandruff Shampoo)
- Selenium sulfide (Exsel, Head and Shoulders Intensive Treatment Dandruff Shampoo, Selsun Blue)
- Sulfur (Some shampoos have sulfur as an ingredient in combination with other active ingredients.)
- Tar (Denorex Therapeutic Protection Dandruff Shampoo, Pentrax, Neutrogena T-Gel)
- Zinc pyrithione (Everyday Clean Dandruff Shampoo, Head and Shoulders Dandruff Shampoo, Suave Anti-Dandruff Shampoo, Selsun Blue Salon Ultimate Daily Care 2 in 1 Shampoo)
Massage a small amount of dandruff shampoo into your scalp, beard, or other affected area. Don't scrub; you'll only irritate your skin more. Leave the shampoo in for 5 to 10 minutes (check the bottle label for exact instructions), then rinse.
Try different shampoos until you find one that works for you. Rotate your dandruff shampoo with a regular moisturizing one to avoid getting a dry scalp.
If you've tried over-the-counter dandruff shampoos and are still getting flakes, see a dermatologist. You may need a stronger, prescription-strength shampoo or another treatment.
Sometimes, even the best dandruff shampoo won't get rid of a stubborn case. Some things your dermatologist might try:
- They might prescribe a steroid cream, lotion, or solution that you rub onto the affected area once or twice daily.
- You may also need an antifungal medicine that you take by mouth or apply to your scalp or skin to get rid of the yeast.
- You may need to apply an oil-based medicine and leave it on your scalp overnight under a shower cap, if the problem is on your head.
Treatments for Scalp Psoriasis
There's no cure for scalp psoriasis. You might go through periods of flare-ups or remission (when your psoriasis goes away). But treatment can ease the symptoms you have.
Your symptoms might only get better after 8 weeks of treatment. For this reason, it's important to stay on top of your treatment routine and follow your doctors' instructions.
For mild cases, your doctor may prescribe an anti-inflammatory medication, coal tar, anthralin topical cream, or a salicylic acid lotion or shampoo.
There are also remedies you can try at home such as aloe vera, coconut oil, or olive oil. You could also try mixing 2 teaspoons of baking soda with water to form a paste and applying that paste to your psoriasis for 10 minutes. As with any treatment, you should check with your doctor to make sure it's a suitable option for you.
If you have severe psoriasis, you may need stronger drugs. These include methotrexate, which affects how certain cells grow; cyclosporine, which slows down your immune system; biologics, which target specific areas of your immune system; or oral retinoids, which are high doses of vitamin A.
You can also try ultraviolet or UV light treatments to control your psoriasis patches. You can part your hair in rows so UV light from a special lamp can reach your scalp or use a handheld UV comb that beams the light directly to your scalp.
To soothe and manage your symptoms at home, you can:
Use over-the-counter medications. Your doctor can help you find a medication to ease severe itching (like an antihistamine). You can also ask about prescription medications that may help.
Brush your hair gently. Go easy on your scalp while you comb. If you brush too hard, it'll cause irritation.
Shower or bathe in lukewarm water. Stay away from hot water and try to only stay in water for 15 minutes or less at a time.
Use conditioner. If you use conditioner each time you wash your hair, it'll keep your scalp and hair moisturized.
Moisturize your scalp. Keep you scalp moisturized throughout the day. Reapply with a cream or ointment multiple times a day and after you bathe or shower.
Topical creams, ointments, and foams like the following can slow psoriasis skin buildup and ease red, scaly patches on your scalp. They may have vitamins or steroids to calm the inflammation:
- Anthralin (Zithranol-RR)
- Calcipotriene (Dovonex)
- Calcipotriene and betamethasone dipropionate (Taclonex)
- Calcitriol (Vectical)
- Roflumilast (Zoryve)
- Tazarotene (Tazorac)
- Tapinarof (Vtama)
Your doctor can also put steroids (strong anti-inflammatory drugs) into the patches on your scalp if your psoriasis is milder or just in a few spots. If you have severe psoriasis, you may need stronger drugs. These include methotrexate, which affects how certain cells grow; cyclosporine, which slows down your immune system; biologics, which target specific areas of your immune system; or oral retinoids, which are high doses of vitamin A.
Some foods might cause psoriasis flare-ups. It might help to keep a journal of the foods that worsen your psoriasis. Some foods and drinks that worsen your condition might include:
- Alcohol
- Citrus fruits (lemons, oranges, and limes)
- Foods with gluten
- Some vegetables (like potatoes, tomatoes, and peppers)
- Dairy (like eggs and cow's milk)
An anti-inflammatory diet can help limit your flare-ups. You can eat foods like:
- Olive oil
- Oily fish (sardines, salmon, or mackerel)
- Leafy greens (spinach and kale)