Are Those Flakes Dandruff — or Scalp Psoriasis?

Psoriasis has received a lot of attention within the past few years. Kim Kardashian was among the first of many celebrities to share her experience with the skin condition; she did so on "Keeping Up With the Kardashians" in 2011, which prompted a bigger conversation around the various side effects that come with psoriasis, which can occur all over your body, including your scalp.

Psoriasis is an immune-mediated disease that causes inflammation in the body, board-certified physician assistant Bari Genoa, PA-C, MPAS, tells PS. "An overactive immune system speeds up skin cell growth, which then leads to a buildup of skin cells without shedding, otherwise known as plaques."

When psoriasis is on your scalp, it comes with the same side effects as if it was on your arms, legs, and stomach. However, because of its location, it can be easily mistaken for another itchy irritation that occurs on your scalp: dandruff. Here, experts explain the differences between scalp psoriasis and dandruff.

Bari Genoa, PA-C, MPAS, is a board-certified physician assistant specializing in the field of dermatology at Infinity Dermatology.

Morgan Rabach, MD, is a board-certified dermatologist based in NYC.

Elizabeth Bahar Houshmand, MD, is a double board-certified dermatologist based in Dallas.

"Psoriasis is an autoimmune disease that causes red, thick, flaky skin on the scalp, behind the ears, [on the] neck, forehead, but can also present anywhere on the body," board-certified dermatologist Morgan Rabach, MD, says. "It is noncontagious, and the inflammation can also be inside the joints."

The condition comes with a handful of symptoms that can vary from mild to moderate or severe. Dermatologist Elizabeth Bahar Houshmand, MD, says those with scalp psoriasis may experience:

"Scalp psoriasis can be hereditary, and the scalp may be itchy, one of the most common symptoms. Patients may also see temporary hair loss," Dr. Houshmand says.

The exact cause of scalp psoriasis is unknown. "It is thought that it is due to a combination of an overactive immune system, genetics, and environmental factors," Genoa says. A study from the National Library of Medicine found that certain drugs like chloroquine, lithium, beta-blockers, steroids, and NSAIDs can exacerbate the condition. Those with psoriasis on their scalp may notice that the summertime improves their symptoms while winter worsen them.

With scalp psoriasis, you will notice itchy patches of skin that often appear red on the scalp, neck, hairline, and forehead and behind the ears. Scalp psoriasis can run in families, and our experts explain that anyone can be affected by scalp psoriasis, especially if you drink alcohol, experience stress or depression, are obese, smoke, or have another autoimmune disease, like rheumatoid arthritis and celiac disease.

There are some similarities between seborrheic dermatitis, also known as dandruff, and scalp psoriasis, such as flaking of the skin and their chronic nature, but they occur for different reasons. "People with dandruff have a genetic predisposition to scalp itching and flaking due to demodex mites that live on the skin," Dr. Rabach says.

Dandruff is caused by a naturally occurring yeast called malassezia, "which causes flakes in hair-bearing areas like the scalp, eyebrows, and beard," Dr. Houshmand says. "Malassezia is a yeast that thrives from the oil on the scalp, so if you have buildup on the scalp, dandruff will occur. Dandruff is also more commonly seen in extremes of temperature in the hot months and in the middle of winter from extreme dryness of the scalp."

Because of how similar dandruff and scalp psoriasis appear, it's easy to confuse them. However, they are not one and the same. "Unlike dandruff, scalp psoriasis causes a silvery sheen and dry scale on the scalp, is long-lasting, and involves other areas of the body, while dandruff may come and go," Dr. Houshmand says.

It's important to remember that these signs and symptoms for dandruff can come and go and scalp psoriasis flare-ups can be associated with many triggers, like increased stress and extreme temperatures.

Many people want to know how to cure scalp psoriasis permanently. Unfortunately, as of right now, there is no cure. Flare-ups may occur even after effectively treating scalp psoriasis. "Psoriasis can flare from stress, certain medications, too much sunlight, so it's important to establish a relationship with a dermatologist that specializes in psoriasis," Dr. Rabach says.

"Scalp psoriasis is a chronic and stubborn condition, but the good news is that we have many different treatments with differing degrees of intensity," Dr. Rabach says. "Prescription topical treatments are usually foams, sprays, gels, and shampoos that contain different types of steroids." The most common ingredients to look out for, she adds, include clobetasol, betamethasone, and fluocinonide, which all treat itching and redness. "Another medication, calcipotriene, is sometimes added to the steroid to help reduce inflammation."

In-office treatments are also an option. This might include steroid solutions that are injected into stubborn plaques, Dr. Rabach explains. "Systematic oral medications of injectable medications are sometimes indicated in people with scalp psoriasis, especially if other topical therapy doesn't work, and if they have psoriasis on their body, and if they also have psoriatic arthritis."

Doctors might also recommend excimer laser therapy, which uses a "narrowband UVB laser that can be used in the dermatology office to treat scalp psoriasis," Dr. Rabach says. Natural light can also help treat scalp psoriasis. This method is "one of the few times a board-certified dermatologist will tell a patient to get a little sun on their body and scalp," she says.

Dr. Rabach adds, "We use UVB light boxes in the office to treat psoriasis, but if that isn't readily available, natural sunlight will help the psoriasis get better. A few minutes a day is all that would be required for natural sunlight."

Overall, experiencing scalp psoriasis and any of the side effects that come with it is a little scary, especially when you begin experiencing hair loss. "The good news is this type of hair loss is temporary, and once scalp psoriasis clears, the hair usually regrows."

One of the least invasive ways to treat scalp psoriasis is by using over-the-counter shampoos. These might include exfoliating ingredients like salicylic acid, "which helps break down the extra skin and scale on the scalp," Dr. Rabach says. She notes that Neutrogena's T/Sal ($7) and T/Gel ($43) shampoos are great options as they can help reduce the inflammation on the scalp.

Our experts also recommend Head & Shoulders Clinical Strength Dandruff Defense Shampoo ($20) for itch relief because of its cooling effect and Nizoral Scalp Psoriasis Shampoo & Conditioner ($18) for its ability to relieve the scalp from redness, irritation, and flaking thanks to three percent salicylic acid.

Sydney Wingfield has been a freelance writer in the beauty and wellness space for six years. She has written for Women's Health, Marie Claire, Glamour, and other publications and loves to cover all things skin care, makeup, and hair.