Scalp Psoriasis: Symptoms, Causes and Early Signs
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Dandruff and Seborrhoeic Dermatitis: Symptoms, Causes and Treatment
What dandruff and seborrhoeic dermatitis are, what causes them, how to tell them from scalp psoriasis, which shampoos and treatments work, and when to see a GP.
Part of our dandruff and scalp health guides. Looking for scalp psoriasis? See scalp psoriasis: symptoms and causes.
Key fact: Dandruff and seborrhoeic dermatitis are linked to a yeast that lives on everyone's skin. They aren't caused by poor hygiene and aren't contagious, and most cases are controlled with the right medicated shampoo used regularly.
Get dandruff treatment online
Access Doctor provides medicated shampoos and prescription treatments for dandruff and seborrhoeic dermatitis following a GPhC-regulated online consultation with our pharmacist independent prescribers. For adults 18 and over.
See dandruff treatments →What is dandruff?
Dandruff (pityriasis capitis) is the most common scalp condition. Dead skin is shed from the scalp as white or grey flakes, which can be seen in the hair and on the shoulders, and the scalp may itch. It isn't caused by poor hygiene and isn't contagious.
It's linked to Malassezia, a yeast that lives on everyone's skin. In some people, the skin reacts to the yeast and to the oils it breaks down, which speeds up skin shedding and causes flaking. Dandruff tends to come and go, and is often worse in winter.
What is seborrhoeic dermatitis?
Seborrhoeic dermatitis is a more inflamed form of the same problem. As well as flaking, it causes red or darker patches with greasy, yellowish scale, and it can itch or sting. It affects the oily areas of skin, so as well as the scalp it often appears on the eyebrows, the sides of the nose, behind the ears, in the ears and on the chest.
In babies, seborrhoeic dermatitis on the scalp is known as cradle cap. It's harmless and usually clears on its own; ask a health visitor, pharmacist or GP if you're worried about it.
Symptoms
| Dandruff | Seborrhoeic dermatitis | |
|---|---|---|
| Flakes | Loose white or grey flakes through the hair | Greasy, yellowish scale that can stick to the skin |
| Skin | Little or no redness | Red, pink or darker patches; may sting or burn |
| Itch | Mild to moderate | Often itchy |
| Where | Scalp | Scalp, eyebrows, sides of the nose, ears, chest |
Causes and triggers
Malassezia yeast
A yeast that lives on everyone's skin. Some people's skin reacts to it, which causes flaking and inflammation.
Oily skin
The yeast feeds on skin oils, so the oiliest areas are affected most.
Weather and stress
Cold, dry weather and stress can make flaking and itching worse.
Hair products
Some products irritate the scalp; others leave residue that's mistaken for dandruff.
Seborrhoeic dermatitis is more common, and can be more severe, in people with some long-term conditions, such as Parkinson's disease or a weakened immune system. Washing your hair too rarely doesn't cause dandruff, but regular washing with the right shampoo helps control it.
Is it dandruff or scalp psoriasis?
Scalp psoriasis can look like bad dandruff, but it's an immune condition that needs different treatment. It causes raised, well-defined patches with thick, silvery-white scale that often spread past the hairline, behind the ears or onto the neck, and many people have psoriasis on their elbows, knees or nails too.
Why it matters: an antifungal shampoo controls dandruff and seborrhoeic dermatitis, but it won't clear scalp psoriasis on its own. If you think it might be psoriasis, see our scalp psoriasis symptoms and causes and our guide to scalp psoriasis vs dandruff.
Diagnosis
Dandruff and seborrhoeic dermatitis are diagnosed by how they look, and no tests are usually needed. A GP or pharmacist will look at where the flaking is, whether the scale is loose or greasy, and whether other areas such as the eyebrows or the sides of the nose are affected. They'll also check for signs of psoriasis or a fungal scalp infection, which is more common in children and causes broken hairs or bald patches.
Treatment options
NICE guidance on seborrhoeic dermatitis of the scalp starts with an antifungal shampoo and adds a short course of a steroid if the scalp is very itchy or inflamed.
| Severity | Treatment | Examples |
|---|---|---|
| Mild dandruff | Medicated shampoo used regularly: zinc pyrithione, selenium sulphide, coal tar or salicylic acid | Over-the-counter anti-dandruff shampoos |
| Persistent dandruff or seborrhoeic dermatitis | Ketoconazole 2% antifungal shampoo, usually twice a week for 2 to 4 weeks, then once every week or two to stop it coming back | Nizoral; ketoconazole 2% shampoo |
| Very itchy or inflamed scalp | A potent steroid scalp application for a short course, alongside the antifungal shampoo | Betacap, Betnovate Scalp, Elocon (prescription-only) |
| Thick, stuck-on scale | Soften and lift the scale first | Cocois; oils or emollients |
On the face, seborrhoeic dermatitis is usually treated with an antifungal cream, sometimes with a mild steroid cream for a short time. Ask a pharmacist or GP before using a steroid on your face.
To compare every option, see our scalp treatment options guide. Adults 18 and over can order dandruff treatment online after a consultation with one of our pharmacist prescribers. For children, including babies with cradle cap, speak to a pharmacist, health visitor or GP.
Looking after your scalp
- Massage medicated shampoo into the scalp and leave it on for 3 to 5 minutes before rinsing
- Keep using it regularly once the flaking settles, because dandruff usually comes back if you stop
- Try not to scratch, which damages the skin and makes itching worse
- Rinse out styling products well, and stop any product that seems to irritate your scalp
- Give a new shampoo at least 4 weeks before deciding it hasn't worked
Our guide to treating dandruff has more practical tips.
When to see a GP
See a GP if: medicated shampoos haven't helped after 4 weeks; your scalp is very red, sore, swollen, weeping or crusted; you have patches of hair loss or broken hairs; the rash is spreading to your face, ears or body; or you think it might be psoriasis. A child with a new scaly scalp and patchy hair loss should be checked for a fungal infection.
Get urgent help: call 999 or go to A&E if your skin quickly becomes red all over, or you feel very unwell with a spreading rash and fever. Call NHS 111 for urgent advice that isn't an emergency.
Dandruff guides
Nizoral dandruff shampoo
How ketoconazole 2% works for stubborn dandruff.
Ketoconazole shampoo for the scalp
Antifungal shampoo for dandruff and seborrhoeic dermatitis.
Dandruff treatment guide
From over-the-counter shampoos to prescription treatment.
How to treat dandruff
Step-by-step advice and prevention.
Stubborn dandruff and Betacap
When flaking won't shift with shampoo alone.
Betacap for an itchy scalp
When a prescription steroid helps scalp itch.
Betnovate for dandruff and scalp psoriasis
When a potent steroid scalp application helps.
Scalp treatment options
Every dandruff and scalp psoriasis treatment compared.
Frequently asked questions
What is the difference between dandruff and scalp psoriasis?
Dandruff causes loose, fine white or grey flakes through the hair with little redness, and is linked to Malassezia yeast. Scalp psoriasis is an immune condition that causes raised, well-defined patches of thick, silvery-white scale, often spreading past the hairline. A GP or pharmacist can usually tell them apart by looking.
Can dandruff turn into psoriasis?
No. Dandruff and scalp psoriasis are different conditions with different causes, and one doesn't turn into the other, though some people have both at the same time.
Is seborrhoeic dermatitis the same as dandruff?
They're closely related. Seborrhoeic dermatitis is a more inflamed form of dandruff, with redness and greasy, yellowish scale, and it can affect the face, ears and chest as well as the scalp. Both are linked to the same yeast and are treated with antifungal shampoos.
What is the best shampoo for dandruff?
For mild dandruff, an over-the-counter shampoo containing zinc pyrithione, selenium sulphide, coal tar or salicylic acid is a good start. For dandruff that keeps coming back, or seborrhoeic dermatitis, a ketoconazole 2% antifungal shampoo such as Nizoral is usually the most effective.
Is dandruff contagious?
No. Dandruff and seborrhoeic dermatitis are linked to a yeast that lives on everyone's skin, so you can't catch them or pass them on.
Can seborrhoeic dermatitis be cured?
It can't be cured, but it can be controlled. Most people keep it under control by using an antifungal shampoo regularly, and treat flares early when they happen.
Does washing your hair more often help dandruff?
Regular washing with the right medicated shampoo helps, because it removes flakes and reduces the yeast on the scalp. Leave the shampoo on for a few minutes before rinsing so it has time to work.
Can I get dandruff or scalp psoriasis treatment online in the UK?
Yes. Access Doctor provides treatments for dandruff, seborrhoeic dermatitis and scalp psoriasis to adults 18 and over, following a short online consultation with our GPhC-registered pharmacist independent prescribers. No GP appointment is needed.
Ready to treat your dandruff?
Complete a short online consultation. A GPhC-registered pharmacist prescriber checks your answers and, if treatment is suitable, we dispatch it from our UK pharmacy and let your GP know.
Start Dandruff Consultation →References
- NICE Clinical Knowledge Summaries. Seborrhoeic dermatitis. cks.nice.org.uk/topics/seborrhoeic-dermatitis
- NHS. Dandruff. nhs.uk/conditions/dandruff
- NHS. Seborrhoeic dermatitis. nhs.uk/conditions/seborrhoeic-dermatitis
- NHS. Cradle cap. nhs.uk/conditions/cradle-cap
- NICE Clinical Knowledge Summaries. Psoriasis. cks.nice.org.uk/topics/psoriasis
Medical disclaimer: This page is for information only and isn't a substitute for medical advice. Steroid scalp applications are prescription-only, so a clinical consultation is needed before they can be supplied. Always follow your prescriber's advice and the leaflet. In a medical emergency, call 999.
