Dandruff and Psoriasis: What’s the Difference?

The Difference Lies in the Root Cause

“Both dandruff and psoriasis can cause itchy, red, scaly areas in the scalp and sometimes on the face,” says Scott Paviol, M.D., a board-certified dermatologist at PHC Paviol Dermatology in Charlotte, North Carolina. While these conditions can sometimes be difficult to distinguish, they have a very different root cause.

“Psoriasis is an autoimmune condition that can involve not only the skin, but joints, and other internal organs,” says Paviol. Dandruff, on the other hand, happens when the skin overreacts to the normal yeasts that live on it, according to Susan Bard, M.D., a board-certified dermatologist at Vive Dermatology in Brooklyn, New York.

“Psoriasis is a chronic, long-lasting condition, where dandruff may come and go,” adds Paviol. Plus, psoriasis can appear on other areas of the body, not just the scalp. If you have scaly patches, on the elbows, knees, gluteal crease, or elsewhere, you’re likely dealing with psoriasis not dandruff.

Symptoms of Dandruff vs. Psoriasis

Both dandruff and psoriasis can cause itchy, red, scaly skin. The biggest difference is that psoriasis plaques often have a thicker, drier, silvery-white type of scale compared to dandruff.

Dandruff tends to be an oilier, greasier, more yellow flaking, according to Paviol. Bard adds that psoriasis tends to be itchier than dandruff, too.

But trying to make that distinction on your own isn’t something either dermatologist recommends. Psoriasis can also affect the joints and other internal organs and so it’s important to see a doctor who can help you manage your condition. “I always recommend seeing a physician so that you can be properly diagnosed,” Paviol says.

To complicate matters more, some people may have both conditions, which is termed sebopsoriasis. Treating the dandruff first can often reveal a person’s underlying scalp psoriasis.

Differences in Treatment

Treatments for mild scalp psoriasis and dandruff tend to be similar. “Usually shampoos and topical steroids,” says Bard. Anti-dandruff shampoos are available over the counter with ingredients such as pyrithione zinc (Head & Shoulders Classic Clean), salicylic acid (Neutrogena T/Sal), coal tar (Neutrogena T/Gel), and 1% ketoconazole 1 (Nizoral A-D). There are also prescription shampoos, such as 1% ciclopirox shampoo and 2% ketoconazole shampoo.

If you’re diagnosed with psoriasis, your doctor may prescribe a topical steroid to calm redness, itch, and inflammation. These include fluocinonide solution, fluocinolone oil, and clobetasol foam. You may also be given the option of systemic treatments, such as oral anti-inflammatories or biologic (injectable) medications, depending on your severity level.

Dealing with Flare-Ups

Both dandruff and psoriasis symptoms can keep coming back. Symptoms tend to flare with stress or changes in the environment, so you’ll want to have a plan in place for when you may flare again. That’s another area with which your doctor can assist.

“Once you have a diagnosis, you can have a treatment plan that is specific and tailored to your needs with appropriate follow-up,” says Paviol. “With a treatment plan, you know how to take care of yourself when you’re flaring and also when times are good and your scalp is calm.”

So, whether you think you have dandruff or psoriasis or aren’t sure, there’s no reason to go it alone. Chances are, you’ll waste time (and money) trying over-the-counter products that might not be the right fit. Under the care of a physician, you’ll have better odds of ridding yourself of those flakes, restoring your confidence and comfort.

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