Scalp Psoriasis vs Dandruff, Dry Scalp and Scalp Eczema
How to tell scalp psoriasis from dandruff, seborrhoeic dermatitis, dry scalp, scalp eczema and a fungal infection, and why the right diagnosis matters for treatment.
Part of our scalp psoriasis health guides.
Key fact: Scalp psoriasis, dandruff and scalp eczema can all cause an itchy, flaky scalp, but they need different treatment: antifungal shampoo won't clear psoriasis, and a steroid can make a fungal infection worse.
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See scalp psoriasis treatments →At a glance: which scalp condition is it?
| Condition | What you see | Where else | What treats it |
|---|---|---|---|
| Scalp psoriasis | Raised, well-defined patches with thick, silvery-white scale that sticks to the scalp | Past the hairline, behind the ears; elbows, knees, nails | Steroid scalp lotions, Dovobet gel, coal tar |
| Dandruff | Loose white or greyish flakes through the hair; little redness | Scalp only | Antifungal or medicated shampoo |
| Seborrhoeic dermatitis | Greasy, yellowish scale and redness | Eyebrows, sides of the nose, behind the ears, chest | Antifungal shampoo; a steroid for inflamed patches |
| Dry scalp | Small, dry white flakes; tight, itchy scalp; no greasy scale or raised patches | Often dry skin elsewhere | Gentle shampoo, less heat, moisturising |
| Scalp eczema | Red, itchy, sometimes weeping or crusted skin; may sting | Often other eczema; hairline and ears after hair dye | Avoiding triggers; emollients; a steroid |
| Fungal infection (tinea capitis) | Scaly patches with broken hairs or bald areas; sometimes swollen, pus-filled patches | Mainly children; can spread to others | Antifungal tablets from a GP |
Scalp psoriasis
Scalp psoriasis is an immune condition that causes raised, well-defined patches of thick, silvery scale. The scale sticks to the scalp and can bind to the hair, and the patches often spread just past the hairline or behind the ears. It can itch, feel sore or bleed when scratched. Many people have psoriasis elsewhere, or a family history of it.
See our guide to scalp psoriasis symptoms and causes.
Dandruff and seborrhoeic dermatitis
Dandruff causes loose flakes through the hair without raised patches. It's linked to a yeast that lives on everyone's skin, and it usually responds to an antifungal shampoo such as ketoconazole.
Seborrhoeic dermatitis is a more inflamed form, with greasy, yellowish scale and redness. It often affects the eyebrows, the sides of the nose and behind the ears too. It's treated with an antifungal shampoo, and sometimes a steroid scalp application to calm the inflammation.
The key differences from psoriasis: dandruff flakes are looser and finer, seborrhoeic dermatitis scale is greasy and yellowish, and neither usually forms the thick, raised, silvery patches of psoriasis. See our dandruff and seborrhoeic dermatitis treatments.
Dry scalp
A dry scalp produces small, dry, white flakes and feels tight or itchy, often in cold weather or after washing with hot water or harsh products. There are no raised patches or greasy scale. It usually improves with a gentle shampoo, cooler water, less heat styling and keeping your skin moisturised. If it doesn't, it may be dandruff, eczema or psoriasis.
Scalp eczema
Scalp eczema causes red, itchy, sometimes weeping or crusted skin. It can be part of atopic eczema, or it can be contact dermatitis, a reaction to something that touches the scalp. Hair dye (especially an ingredient called PPD), perfumes and preservatives in hair products are common causes, and the rash is often worst at the hairline, ears and neck.
Contact dermatitis gets better when you avoid the trigger. See our eczema and dermatitis treatments.
Fungal scalp infection
Tinea capitis is a fungal infection of the scalp, most common in children. It causes scaly patches with broken hairs or bald areas, and sometimes a swollen, tender, pus-filled patch. It's contagious and needs antifungal tablets from a GP. A steroid can make it worse, which is one reason a new scaly scalp in a child should be checked by a GP.
Can you have more than one?
Yes. Some people have features of both psoriasis and seborrhoeic dermatitis, sometimes called sebopsoriasis, and a prescriber may suggest treating both: for example an antifungal shampoo alongside a steroid scalp application. You can also have dandruff and psoriasis at the same time.
Why the difference matters
- An antifungal shampoo can clear dandruff, but it won't clear psoriasis on its own
- A steroid can calm psoriasis and eczema, but it can make a fungal infection worse
- Contact dermatitis keeps coming back until you stop using the product causing it
- Psoriasis-only medicines, such as Etrivex and Dovobet, are only supplied once a doctor has diagnosed psoriasis
Not sure? If you can't tell which it is, or a child has a new scaly scalp or patchy hair loss, see a GP or pharmacist. A GP can usually tell by looking, and sometimes takes a scraping to check for fungus.
Where to get treatment
Scalp psoriasis
Scalp psoriasis treatments
Steroid scalp lotions, medicated shampoos, Dovobet gel and coal tar, for adults.
See treatmentsDandruff
Dandruff and seborrhoeic dermatitis
Antifungal shampoos and treatments for inflamed seborrhoeic dermatitis.
See treatmentsFrequently asked questions
How can I tell if it's dandruff or scalp psoriasis?
Look at the flakes and the skin underneath. Dandruff causes loose, fine flakes through the hair with little redness. Scalp psoriasis causes raised, well-defined patches of thick, silvery scale that sticks to the scalp and often goes past the hairline or behind the ears. If you're not sure, a GP can usually tell by looking.
Is seborrhoeic dermatitis the same as scalp psoriasis?
No. Seborrhoeic dermatitis is an inflamed form of dandruff linked to a yeast on the skin, with greasy, yellowish scale. Scalp psoriasis is an immune condition with thick, silvery scale on raised patches. Some people have features of both.
Can you have dandruff and psoriasis at the same time?
Yes. Some people have both, or features of both psoriasis and seborrhoeic dermatitis (sometimes called sebopsoriasis). A prescriber may suggest treating both, for example with an antifungal shampoo alongside a steroid scalp treatment.
Is a dry scalp the same as dandruff?
No. A dry scalp gives small, dry flakes and a tight feeling, often from cold weather, hot water or harsh products, and it improves with gentle care. Dandruff is linked to a yeast on the skin, and its flakes can be larger or slightly greasy. It usually needs an antifungal shampoo.
Can hair dye cause scalp eczema?
Yes. Hair dye, especially an ingredient called PPD, is a common cause of contact dermatitis on the scalp, hairline, ears and neck. It can cause redness, itching, swelling and weeping. Stop using the dye and see a pharmacist or GP; a severe reaction with facial swelling needs urgent help.
Can a fungal infection look like scalp psoriasis?
Yes. A fungal scalp infection (tinea capitis) can cause scaly patches, but it usually also causes broken hairs or bald areas, and it's most common in children. It needs antifungal tablets from a GP, and a steroid can make it worse.
Ready to treat your scalp psoriasis?
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 Scalp Psoriasis Consultation →References
- NICE Clinical Knowledge Summaries. Psoriasis. cks.nice.org.uk/topics/psoriasis
- NHS. Psoriasis. nhs.uk/conditions/psoriasis
- NHS. Seborrhoeic dermatitis. nhs.uk/conditions/seborrhoeic-dermatitis
- NHS. Ringworm (including scalp ringworm). nhs.uk/conditions/ringworm
- NHS. Contact dermatitis. nhs.uk/conditions/contact-dermatitis
Medical disclaimer: This page is for information only and isn't a substitute for medical advice. Steroid scalp treatments, Etrivex and Dovobet 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.