If you’re picking flakes off your shoulders that instinctively escape your black shirt, you may think you have a particularly stubborn case of dandruff. But there’s a possibility that you may actually have scalp psoriasis, a form of chronic skin condition that spreads to the scalp, hairline, and ears.
Scalp psoriasis has a lot in common with dandruff, also known as seborrheic dermatitis; Both conditions involve scaly or dry patches as well as layers on the scalp. In fact, they’re so similar that “we sometimes even use the term ‘sebo-psoriasis’ to describe the overlap between seborrheic dermatitis and psoriasis,” she says. Joseph Merola, MDA board-certified dermatologist at UT Southwestern Medical Center. But that misdiagnosis can prevent you from getting the right treatment and getting some relief. With that said, here’s how to tell them apart.
Why do psoriasis and dandruff get confused?
Itching, flaking, inflammation: these are typical symptoms of both psoriasis and dandruff. But you can find subtle clues to tell them apart, as they can vary in their appearance, location, and severity. Let’s start with the causes: Scalp psoriasis is an autoimmune condition that leads to overproduction of skin cells, which overgrow and form telltale plaques on the skin. Dandruff, on the other hand, results from the overgrowth of a yeast (which naturally lives on the scalp) that triggers inflammation.
First, take out the flakes. You may see fine, loose scabs with dandruff, whereas psoriasis scabs are coarser. And if you (or the doctor) are able to see beyond your hair follicles, Dr. Merola says, “Scalp psoriasis typically causes a thicker, more stubborn layer that sticks to the scalp and settles in clearly defined red spots.” There may be signs beyond your dome, too: Scalp psoriasis often involves the eyebrows and nasolabial folds (aka smile lines), while dandruff is usually confined to the scalp. “Psoriasis can also involve other areas such as the elbows, knees, nails or skin folds, and a family history is often present,” says Dr. Merola.
And then there’s the intensity. Dandruff can be embarrassing and uncomfortable in itself, but scalp psoriasis has the potential to be debilitating, such as: Mark Lebwohl, MDA board-certified dermatologist at Mount Sinai says so. “In some patients, scalp psoriasis will be so bad that it will be like having their head in a hard hat all day,” he says. Instead of just being itchy, it is extremely painful. And some people experience scalp psoriasis so severe and inflamed that they even lose their hair as a result.
How to Solve Your Scalp Concerns
If you use over-the-counter treatments – namely medicated shampoos – available at the drugstore, both dandruff and mild cases of scalp psoriasis may improve. “Products containing ingredients like zinc pyrithione are generally safe, and may even help patients who have an overlap between dandruff and psoriasis,” says Dr. Merola.
However, “if it’s not going away with simple, easy over-the-counter treatments like shampoo, you should see a dermatologist,” says Dr. Lebwohl, who adds that if you wash your hair daily, you should expect some improvement in a week. If your symptoms persist after this, or they are very painful, disrupt your sleep, or are accompanied by ejaculation, make an appointment. A dermatologist may prescribe topical corticosteroids (which are the first-line treatment). And for severe cases, Dr. Merola says, “We now also have highly effective oral and injectable drugs that can help patients clear or nearly clear the disease when topical therapy is not enough.”
Why is it important to know the difference?
If you are taking the wrong treatment, you will never get relief. “Psoriasis is often in remission, meaning it will persist unless it is actively treated,” says Dr. Lebwohl. “It doesn’t just fluctuate.” Seborrheic dermatitis, on the other hand, can be completely cured with the right shampoo.