Dermatitis or Psoriasis on My Scalp?

Key Takeaways

Psoriasis and Folliculitis are two common skin conditions that give rise to patches of red, irritated skin, that can appear deceptively similar at the first glance. But if you take a closer look, these two conditions have unique characteristics that will help you easily identify which one it is.

Correct identification is very important as they have different causes and treatments. We bring you all the knowledge you need to make this demarcation accurately, and help you improve your skin health.

What is scalp psoriasis?

Thick scales and redness on the scalp and neck, a potential sign of scalp psoriasis

Psoriasis is a chronic skin condition that can appear anywhere on the body, including the scalp. When psoriasis affects the scalp, it is called scalp psoriasis. It can also extend beyond the hairline to areas like the forehead, the back of the neck, or behind the ears.

On the scalp, psoriasis may require different treatment approaches due to the thickness of the skin and the presence of hair, which can complicate the application of topical treatments.^[1] Psoriasis develops when the immune system sends faulty signals, causing skin cells to grow at an accelerated rate. Instead of shedding dead skin cells, they accumulate on the skin’s surface, forming the characteristic patches of thick, silvery scales.

What is scalp dermatitis?

Scalp dermatitis / seborrheic dermatitis on colored skin, presenting with scaling, inflammation, and flaking on the scalp.

Scalp dermatitis, specifically seborrheic dermatitis, is a common inflammatory skin condition that typically occurs on oily areas of the body, including the scalp. It causes a scaly rash that can sometimes be mistaken for other skin condition.^[2]

Seborrheic dermatitis is not contagious and dandruff is considered to be the mildest form of seborrheic dermatitis. Both condition causes white to yellowish scale, which may be dry or greasy or itchy. Unlike dandruff Seborrheic dermatitis can appear on eye brows, beard, or skin around the nostrils.

Sometimes they may overlap or coexist causing sebopsoriasis.

Sebopsoriasis on colored skin, presenting with an itchy, discolored scalp around the forehead, a combination of seborrheic dermatitis and scalp psoriasis.

Psoriasis vs. Dermatitis: Symptom Comparison

Both scalp psoriasis and seborrheic dermatitis cause scaling and itching, but there are some differences in how these conditions present:

Though these symptoms may overlap, the presentation and underlying causes of each condition are distinct, which makes an accurate diagnosis essential for effective treatment.

Causes and Risk Factors

What causes scalp psoriasis?

The underlying cause of psoriasis, regardless of where it appears, is linked to the immune system. In individuals with psoriasis, the immune system sends incorrect signals, causing skin cells to grow at an abnormally fast rate. Normally, skin cells shed and regenerate over several weeks, but in psoriasis, new skin cells form in days. This rapid build-up leads to the formation of thick, scaly patches on the skin’s surface

Who is at risk of developing scalp psoriasis?

Scalp psoriasis is a common manifestation of plaque psoriasis. Research indicates that around 50% of people who have plaque psoriasis will experience at least one flare-up on their scalp.^[1]

What causes seborrheic dermatitis?

While the exact cause of seborrheic dermatitis is still unknown, dermatologists believe it results from a combination of factors, particularly the following:

Malassezia yeast – This yeast is naturally present on everyone’s skin, but in individuals with seborrheic dermatitis, it may trigger an inflammatory response that leads to a rash.

Sebum production – Sebum, the oil produced by the skin, is also thought to play a role. The yeast thrives on oily skin, which could explain why seborrheic dermatitis often affects the scalp, face, and chest. Seborrheic dermatitis is neither caused by unclean skin nor is it an allergic reaction. It can affect individuals regardless of their hygiene habits^[2]

What are the Risk Factors for Development of Seborrheic Dermatitis (scalp dermatitis) ?

Though seborrheic dermatitis can develop in healthy individuals, certain medical conditions significantly increase the risk of developing it, including:

1. Neurological disorders like Parkinson’s disease and epilepsy
2. HIV infection
3. Brain or spinal cord injuries
4. Lymphoma
5. Mood disorders Including depression
6. Down syndrome
7. Anorexia nervosa: An eating disorder
8. Heavy alcohol consumption
9. Psoriasis or rosacea
10. Recent recovery from stroke or heart attack
11. Organ transplant recipients^[2]

How to Identify Scalp Psoriasis and Seborrheic Dermatitis

Identifying Scalp Psoriasis

 Scalp psoriasis can present in various ways, from small, easily hidden patches to widespread coverage of the entire scalp. Below are the most common signs to help identify scalp psoriasis:

• Reddish Patches – Some patches may be small and barely noticeable, while others can be thick, inflamed, and highly visible
• Dandruff-Like Flaking with Silvery Scales – While scalp psoriasis can resemble dandruff, it’s distinguished by a silvery sheen and dry scale
• Dry Scalp – Severe dryness can lead to cracking and even bleeding
• Itching – Itchiness is a common symptom that can range from mild to severe, sometimes disrupting daily life and sleep.
• Bleeding – Persistent scratching can lead to bleeding and exacerbate the psoriasis, causing larger and thicker patches.
• Burning or Soreness – Some individuals may feel a burning sensation or soreness on the scalp.
• Temporary Hair Loss – Scratching or forcefully removing scales can cause hair loss, but hair typically regrows once the psoriasis clears.

Scalp psoriasis symptoms can be intermittent, with flare-ups triggered by factors such as stress, cold, or dry air

Identifying Seborrheic Dermatitis on Scalp

Seborrheic dermatitis can affect various parts of the body, including the scalp, face, and chest. Key signs and symptoms include

• Dry, Flaky Skin – This is especially noticeable on the scalp, face, or chest, where seborrheic dermatitis typically appears
• Rash on Scalp – The rash may be dry or greasy, appearing pink or lighter than the surrounding skin on darker skin tones, and red on lighter skin tones. In severe cases, it may be accompanied by white spots on darker skin
• Rash on Face -In darker skin tones, this can appear as darker patches or light spots, while on lighter skin tones, the rash is often red and oily in some areas, with dryness in others
• Burning or Itching – Itchiness is typically mild but can become intense on the scalp. Treatment usually alleviates the burning sensation and itching
• Rash on Eyelids (Blepharitis) – Seborrheic dermatitis can cause scaling, swelling, and discoloration of the eyelids, sometimes with yellowish scales between the eyelashes
• Rash Around Ears – Inflammation can occur around or inside the ears, causing flaking, crusting, and oozing
• Rash in Skin Folds – Maceration (skin breakdown due to moisture) often occurs in areas like the armpits or beneath the breasts, leading to pain, tenderness, and itchiness. If left untreated, the skin can split or become infected

Diagnosis of Scalp Psoriasis and Seborrheic Dermatitis

Diagnosing Scalp Psoriasis

To diagnose scalp psoriasis, a dermatologist will typically examine the scalp and may also take a small skin sample (biopsy) for analysis. The biopsy helps confirm the diagnosis by ruling out other conditions that can present with similar symptoms

Diagnosing Seborrheic Dermatitis

Diagnosing seborrheic dermatitis is usually straightforward. A dermatologist will,

• Ask about symptoms and medical history, including any allergies or other medical conditions
• Examine the affected skin closely

In cases where you have both seborrheic dermatitis and another skin condition, such as psoriasis, a biopsy may be performed. This helps differentiate between the two conditions, with overlapping symptoms. The sample is analysed by a dermatopathologist, who can identify multiple skin conditions.

Treatment Options: Dermatitis vs. Psoriasis

If psoriasis or folliculitis symptoms persist, worsen, or show signs of infection (like redness, swelling, or pus), seek medical advice without delay. A dermatologist can diagnose these conditions through close inspection or biopsies. In psoriasis, on successive removal of scales pinpoint bleeding points are seen. Your healthcare provider will use simple examination techniques like this to come to a correct decision. They will recommend appropriate treatments, helping you get rid of the symptoms faster.

Treatment of scalp psoriasis

There are many safe and effective treatments. Some people get relief from a medicated shampoo or solution. A few of these can be purchased without a prescription.
But scalp psoriasis can be stubborn. Many people see a dermatologist for treatment. A dermatologist can tell you what can help. The following types of treatment can help scalp psoriasis:
• Medicine applied to the scalp
• Medicated shampoos
• Scale softeners
• Injections
• Light treatments
• Biologics and other medicines that work throughout the body

Treatment of Seborrheic Dermatitis

The primary goals in treating seborrheic dermatitis are to reduce the rash, control scaling, relieve itching, and prevent future flare-ups. Treatment plans are tailored to the patient’s symptoms and may include a combination of skin care routines, medicated products, and prescription medications. The following treatments are commonly used

1. Skin Care Regimens

Using gentle, non-irritating products is essential for managing seborrheic dermatitis. Your dermatologist may recommend products such as a fragrance-free cleanser, zinc-based soap, or a moisturizer to soothe irritation and prevent flare-up^[2]

2. Medicated Shampoos

For those experiencing scalp symptoms, medicated shampoos are often the first line of treatment. These shampoos typically contain ingredients such as zinc pyrithione, selenium sulfide, or ketoconazole, which help control the overgrowth of yeast on the scalp. Your dermatologist will advise how often to use these shampoos, which may vary based on hair type (e.g., curly or coily hair may require less frequent use).

3. Topical Medications

Antifungal creams, gels, or foams may be prescribed to reduce scaling and itchiness on the skin. These are usually applied once or twice a week, depending on the severity of the condition.

Corticosteroids – If antifungal shampoos or creams fail to alleviate symptoms, topical corticosteroids such as hydrocortisone may be added to the treatment plan. These medications help reduce inflammation and control flare-ups.

Roflumilast foam – This FDA-approved treatment works to clear the rash, reduce discoloration, and relieve itching. It is suitable for adults and children over 9 years old, and can be applied to areas such as the nose, eyebrows, ears, and scalp. Studies show that roflumilast provides significant improvement within 8 weeks.^[2]

4. In cases where topical treatments fail or the condition is widespread, systemic treatments may be considered, including oral antifungals, Light Therapy (UVB Therapy).

Note:
It is important to follow a tailored treatment plan based on a healthcare provider’s recommendations. Overuse of medicated products, particularly topical corticosteroids, can lead to adverse effects. Always consult with a dermatologist before starting or changing any treatment to avoid complications and manage symptoms effectively.

Prevention and Management Tips

Managing Scalp Psoriasis

Scalp psoriasis can be persistent, but with proper care, flare-ups can be minimized. Here are some dermatologist-recommended tips for preventing and managing scalp psoriasis effectively

• Avoid Scratching – While itching is a common symptom, scratching worsens psoriasis and can lead to bleeding or hair loss. Using medication to manage the underlying psoriasis will relieve the itch
• Shampoo Gently – Rubbing or scrubbing the scalp too hard can exacerbate the condition. Instead, apply shampoo gently and allow it to sit before rinsing
• Carefully Remove Scales – Removing psoriasis scales is essential but must be done gently. Use a scale softener containing salicylic acid to soften thick patches, allowing medications to penetrate better. Avoid picking at scales to prevent flare-ups and hair loss
• Reduce Stress – Stress can trigger psoriasis and hair loss. Practicing stress management techniques such as relaxation exercises, meditation, or yoga can help reduce flare-ups.
• Be Gentle with Hair Care – Comb and brush gently to avoid pulling out hair along with the scales. After shampooing, use a conditioner to reduce dryness and protect the scalp from further irritation
• Alternate Shampoos – Using a medicated shampoo daily can dry out your scalp. Alternate between a medicated and a gentle, non-medicated shampoo to prevent dryness and hair breakage.
• Test Hair Products – Hair sprays, dyes, and straightening products can irritate the scalp. Test products on a small area before using them extensively, and avoid products that cause irritation.
• Air Dry Your Hair – Blow drying can further dry out your scalp, so allowing your hair to air dry can help reduce irritation and dryness.
• Consult a Dermatologist – If your scalp psoriasis treatment feels too harsh, or if nothing seems to work, consult a dermatologist to modify your treatment plan

Managing Seborrheic Dermatitis

Seborrheic dermatitis can flare when the skin is irritated, especially on sensitive areas like the scalp and face. Follow these tips to reduce flare-ups and manage the condition effectively,

• Be Gentle When Washing – Use a medicated soap or fragrance-free cleanser to wash affected areas twice a day. Avoid deodorant soaps and harsh cleansers that can irritate the skin
• Use Medicated Shampoos – Seborrheic dermatitis often affects the scalp. Your dermatologist may recommend a shampoo containing ingredients like ketoconazole or zinc pyrithione. Use it as directed to control flaking and itchiness
• Use Alcohol-Free Products
• Manage Stress – Stress is a known trigger for flare-ups. Incorporate stress-relieving activities into your routine, such as exercise, meditation, or relaxation techniques
• Protect Skin in Cold Weather – Cold, dry air can lead to flare-ups. Protect your skin by wearing appropriate clothing, including hats, and keeping your skin moisturized
• Know Your Triggers – Triggers for seborrheic dermatitis vary. Common ones include stress, cold weather, hot showers, sweat, harsh chemicals, and infections. Keep a journal to track what triggers your flare-ups, and avoid those triggers when possible
• Treat Flare-ups Early – Early treatment prevents flare-ups from worsening. A dermatologist can help create a personalized treatment plan that suits your skin type, age, and specific symptoms

When to Seek Medical Help

If scalp psoriasis or seborrheic dermatitis proves difficult to manage, or if home treatments are not effective, make an appointment with a board-certified dermatologist. A dermatologist can offer more advanced treatments, such as biologics for psoriasis or antifungal medications for seborrheic dermatitis, tailored to your specific condition.

Common Myths and FAQs

1. Can scalp psoriasis be contagious?

No, scalp psoriasis is not contagious. It is an autoimmune condition that cannot be spread from person to person

2. Can I treat scalp dermatitis with dandruff shampoo?

While dandruff shampoo might help with mild cases of seborrheic dermatitis, it may not be enough for more severe cases. It’s best to consult a dermatologist for a proper diagnosis and treatment plan.