Is it just dandruff or scalp psoriasis? How to identify symptoms early, keep your hair healthy

Dandruff is a common problem caused by excess yeast-like fungus (Malassezia), which grows on the scalp, causing mild inflammation of the scalp and shedding of skin (Image: Pexels)

At some point in your life, you will likely suffer from a scaly scalp. Most of the time these flakes are completely harmless and usually happens due to dandruff which can be managed relatively easily with an over-the-counter medicated shampoo or home remedy.

But, when flaking persists along with redness, irritation, and itching, it may mean something worse — scalp psoriasis. While dandruff is a common and relatively benign skin condition, scalp psoriasis is a chronic skin disease requiring medical diagnosis and treatment.

Recognizing the difference

Dandruff is a common problem caused by excess yeast-like fungus (Malassezia), which grows on the scalp, causing mild inflammation of the scalp and shedding of skin. The condition usually reacts favourably to anti-dandruff shampoos and generally worsens when colder.

Also read | Scalp care tips: How to combat dandruff beyond flake control

Scalp psoriasis is an autoimmune disorder where the immune system exponentially quickens the production of skin cells that produce thick, silvery-white scales and red patches on the scalp. This may also extend to the forehead, ears or neck. Scalp psoriasis can last for months or years, unless treated accordingly.

Dr Priyanka Kuri, Consultant - Dermatology, Aster Whitefield Hospital, Bengaluru, explains that it is critical to identify symptoms of scalp psoriasis early to avoid complications.

• Thicker scales: Unlike dandruff, which has light and powdery flakes, psoriasis leads to the accumulation of dead skin cells which creates thick membranes that may feel hard to the touch. The scales may be silvery-white or yellowish in appearance and are sometimes tightly adhered to the scalp requiring more effort to remove. Thickness may also result in some tightness or tenderness in the areas involved.

• Persistent redness: The redness associated with psoriasis is deeper and has a more inflammatory quality, and is generally seen more along the hairline, temples or neck. The redness/pink is longer lasting than a typical easy-scalp irritation associated with dandruff. Sometimes it is accompanied by some swelling, or warmth, signaling continuing inflammation under the skin. There can even be times where some flakes can be rubbed off and some of the redness remains visible.

• Itching with burning or pain: Psoriasis can have a significant amount of itching that is sometimes accompanied by burning or soreness. Excessive scratching will also result in minor injuries, bleeding, or loss of temporary hair on the affected area. It can even become difficult to carry out normal functions with this itchiness. This irritation can even make it difficult to function.

• Flakes beyond the scalp: Scaling can occur on the forehead, behind ears or on the neck. This happens because as in other areas of the body, psoriasis does not stay localised to the scalp, rather it tends to affect adjacent skin areas. There can also be patches at the hairlines of the scalp and sideburn areas in the more advanced cases.

• Nail or skin changes: Pitting, thickening, or discoloured nails, or scaly patches on elbows and knees, could mean psoriasis is affecting other parts of the body. The fact that nails are involved is an indicator that this disease is more systemic in nature.

Psoriasis is a lifelong management condition with flare-ups and remissions. If left untreated, psoriasis gets worse and leads to hair loss from scratching and increases your chances of developing related health problems, including heart disease and arthritis. A dermatologist may usually diagnose psoriasis based on how your skin looks and perhaps a skin biopsy.

How to manage scalp psoriasis

There is no cure for scalp psoriasis, but treatment can help manage the symptoms it presents:

• Medicated shampoos that contain coal tar, salicylic acid or ketoconazole to help reduce the scaling.
• Topical treatments: Using topical corticosteroids and vitamin D analogue creams will help soothe the inflammation.
• Use mild hair care to prevent further irritation; avoid vigorous brushing and hairstyling with lots of chemicals.
• Using oils for moisturising (e.g. coconut oil) can soften the scales which will then help when you wash them off.