If you’ve noticed itching or flaking skin on the scalp, you may be wondering if you’re dealing with dandruff or the more serious skin condition, scalp psoriasis. In this blog, Dr. Seena Monjazeb of U.S. Dermatology Partners Houston Clear Lake will take a closer look at how to tell the difference between these two skin conditions. According to Dr. Monjazeb, “Scalp psoriasis and dandruff have some similar symptoms, but they are very different conditions that require unique treatments. If you’re not sure whether you’re dealing with dandruff or scalp psoriasis, it’s time to talk to your dermatologist.”
What Is Scalp Psoriasis?
Scalp psoriasis is a specific form of the chronic skin and inflammatory condition – psoriasis. All types of psoriasis, including scalp psoriasis, occur when improper immune function causes skin cells to grow too quickly. This rapid development causes thick patches of skin that are typically referred to as plaques. Comparing scalp psoriasis to other forms of psoriasis, Dr. Monjazeb says, “If you have psoriasis on other parts of the body, and you see thickening, flaking skin on the scalp, you are likely dealing with scalp psoriasis rather than other skin conditions that cause flaky skin on the scalp. Psoriasis on the scalp, like psoriasis on other parts of the body, can range in severity from mild to very severe. If you begin addressing the symptoms of scalp psoriasis early, it is much more likely to respond to the treatment.”
Psoriasis may develop on any part of the body, but to be specifically considered scalp psoriasis, the condition needs to affect the head, hairline, forehead, ears, and neck. Those who are diagnosed with scalp psoriasis are significantly more likely to develop psoriatic arthritis. This is an inflammatory condition that impacts the function of the joints. Because of the increased risk for psoriatic arthritis, it’s very important to work with a dermatologist to create a treatment plan to manage the effects of scalp psoriasis in its earliest stages.
What Causes Scalp Psoriasis?
According to Dr. Monjazeb, “Psoriasis is an immune mediated inflammatory disease that results in a characteristic rash when the skin cells replicate too quickly. While we know that scalp psoriasis occurs due to a dysfunctional immune system, we don’t really know why people develop this condition. It does seem to run in families, and psoriasis is more common among people with lighter skin.”
In addition to lighter skin tone and genetic predisposition, other risk factors for developing scalp psoriasis include:
- Smoking and excessive alcohol consumption
- High levels of stress
- Immune function issues related to other health concerns
- Taking certain medications like indomethacin, quinidine, beta-blockers, lithium, antimalarials, and iodides
- Being severely overweight or obese
- Having certain viral or bacterial infections
- Vitamin D deficiency
- Skin injuries
What Is Dandruff?
Dandruff is a common skin condition that occurs when flakes of skin are shed from the scalp. When people suffer from dandruff, the skin may be itchy and oily, and they are likely to see the telltale white flakes that dandruff is known for.
What Causes Dandruff?
There are two main causes of dandruff. The first is a skin condition called seborrheic dermatitis, which impacts the oil-producing parts of the body, including the scalp. Seborrheic dermatitis causes the skin to be oily, itchy, and flaky. This condition is very common in infants, and it’s often referred to as cradle cap. Dandruff can also occur due to a fungal infection, causing itchy and flaky skin.
Is it Scalp Psoriasis or Dandruff?
When it comes to determining whether you’re suffering from scalp psoriasis or dandruff, Dr. Monjazeb says, “If patients have never been diagnosed with psoriasis on other parts of the body and their scalp psoriasis is mild, it’s almost impossible to tell the difference between dandruff and scalp psoriasis. If you notice flaky skin on the scalp that doesn’t improve with treatment for dandruff or that lasts for one or more weeks without getting better, you should contact a dermatologist to ensure your condition isn’t scalp psoriasis.” Another telltale sign that you’re struggling with scalp psoriasis is the color of the skin. Scalp psoriasis causes the skin to appear purple, pink, or red.
What Treatments Are Available?
The recommended treatment will depend on whether you’re diagnosed with scalp psoriasis or dandruff. Below, we will outline the most common treatment options for both conditions.
At-Home Scalp Psoriasis Treatments
Scalp psoriasis can’t be cured, but many treatments offer effective solutions to manage flare-ups and reduce the impact of scalp psoriasis. In the early stages, scalp psoriasis symptoms may be easily managed with topical medications that contain ingredients like salicylic acid and coal tar. There are over-the-counter and prescription-strength psoriasis treatments available. Additionally, topical medications may be prescribed containing anthralin, corticosteroids, antimicrobials, or vitamin D. It can be difficult to manage the symptoms of scalp psoriasis entirely with topical treatments because the hair makes it challenging to reach the affected area. For this reason, you may also need to take oral medications to help manage symptoms, including oral retinoids, corticosteroids, methotrexate, cyclosporine, or apremilast.
At-Home Dandruff Treatments
For mild cases of dandruff, washing hair more often to decrease oiliness and cutting out styling products that can irritate the skin may be adequate to address the symptoms. For more severe or chronic dandruff, over-the-counter or prescription-strength topical shampoos may be necessary. Dandruff can stem from a few different sources, and you may need to determine the cause before you choose your treatment. Each ingredient in topical dandruff treatments is used to address a specific cause of dandruff. Salicylic acid products are usually effective for addressing dandruff caused by seborrheic dermatitis since they remove excess oil and help remove excess scale. Coal tar and selenium sulfide prevent the rapid production of skin cells, so they’re best to address fungal dandruff. Ketoconazole was created to address fungal growth on the skin, and it may also be used to address dandruff caused by fungus. Finally, pyrithione zinc may be used daily to prevent dandruff flare-ups related to fungal growth or seborrheic dermatitis. It’s also beneficial in addressing a current flare-up in fungal dandruff.
Dermatologic Scalp Psoriasis Treatments
In addition to the available at-home treatments, a dermatologist may recommend patients with scalp psoriasis receive more advanced dermatologic treatments. According to Dr. Monjazeb, “Long-term management of psoriasis on any part of the body typically requires a combination of both in-office and at-home treatments. Specifically, biologics are often recommended for individuals with scalp psoriasis due to the common link between scalp psoriasis and psoriatic arthritis. Biologics can help address the symptoms of both forms of psoriasis.”
Additionally, patients may visit their dermatologist to receive treatments like phototherapy. This in-office procedure uses UV rays to treat the scalp, reducing itching and inflammation related to psoriasis flare-ups. Similarly, laser therapy may be recommended to decrease redness and itching and reduce the length of the scalp psoriasis flare-up.
Dermatologic Dandruff Treatments
Dandruff is almost always responsive to treatments that are readily available over the counter. If your dandruff doesn’t clear up or show noted improvement after a week, you may want to consult with a dermatologist about stronger dandruff treatments available by prescription. They can also ensure that the dandruff isn’t something more serious like scalp psoriasis.
Preventing Scalp Psoriasis & Dandruff
As is the case with other forms of psoriasis, prevention is an essential part of any treatment plan to manage scalp psoriasis symptoms. According to Dr. Monjazeb, “Most patients will begin treatment for scalp psoriasis by taking time to identify their triggers. These are the things that commonly lead to psoriasis flare-ups. While they are often similar, people who struggle with psoriasis on any part of the body have their own unique set of triggers, and avoiding these triggers is the best way to minimize the risk for flare-ups.” To determine scalp psoriasis triggers, patients should take a few minutes each day to describe their current skin condition and any side effects of psoriasis. Then, they should quickly note details about their day, including the weather, foods and drinks they’ve consumed, skincare products used, activities, and any other factors that might contribute to flare-ups. By tracking this for several weeks or months, patients typically start to see patterns emerge that can help them identify and avoid triggers to minimize risk for scalp psoriasis flare-ups.
In addition to learning flare-up triggers, patients with scalp psoriasis can also take steps to prevent more severe symptoms during a flare-up, including:
- Avoid scratching or picking at the scalp. This can cause more inflammation and irritation. Picking at plaques can also increase the risk for infection and scalp psoriasis-related hair loss.
- Use a gentle shampoo or one that is specifically formulated for psoriasis.
- Massage the scalp while cleaning to gently remove plaques and relieve itch.
- Use a deep moisturizing conditioner, a leave-in conditioner, or topical treatments with shea butter or aloe to relieve itch, keep skin hydrated, and promote healing.
- If your scalp is very itchy, try a colloidal oatmeal soak. This is recommended to help with itching on any part of the body, and it can help alleviate irritation on the scalp as well.
The easiest way to prevent dandruff is to wash hair more frequently. This helps to reduce excess oil buildup that causes dandruff, and it can diminish fungal growth on the skin that leads to dandruff. Additionally, those who struggle with chronic dandruff may want to use a gentle anti-dandruff shampoo regularly. For severe and frequent flare-ups, a daily use product may be necessary. Others manage symptoms by using an anti-dandruff shampoo a few times a week.
Interested in Learning More?
If you’re not sure whether you’re dealing with dandruff or scalp psoriasis, a visit to the dermatologist’s office is the easiest way to find out. When you’re ready to get started working with one of the knowledgeable dermatologists at U.S. Dermatology Partners, simply take a few minutes to complete our online scheduling request form.
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