What is the difference between Dandruff, Eczema and a dry scalp?

Patients suffering from scalp conditions regularly ask me about dandruff, dry scalp and psoriasis in the consulting room at the clinic. Dry scalp and dandruff are often used interchangeably by many of us. As a result, it’s not a surprise that there’s a misconception between these two scalp conditions and those present similar symptoms.

Difference Between Dandruff vs. Dry Scalp vs. Psoriasis

  • Patients describing these two conditions most commonly talk about Seborrheic Eczema. This symptom categorically is NOT dry scalp flakes. This scalp condition can vary in severity and cause an oily scalp with blotchy red patches, a light powder-like scale that looks like white flakes or just a severe itching feeling “as if something is moving,” as patients describe. It’s derived from increased yeast that the sebaceous glands produce, and stress and diet are the most significant contributing factors.
  • It could be Psoriasis, which causes larger thickened plaques or flakes of scale that can bleed when picked and, in severe cases, even become infected. An increased skin cell turnover causes this flaky condition; the scalp cannot shed the skin alone. This is where it is wrongly believed to be a dry scalp. I often suggest daily washing so that you can gently massage away this skin. Stress, lifestyle and diet can often be a trigger, but it can be treated well here with a non-steroidal approach using anti-inflammatory products.
  • The itching felt could be a form of Dermatitis; a contact form could be caused by an allergen such as tint or other styling aid that disagreed with the skin. Dandruff is the patient’s description, not the diagnosis, but irritating. The treatment for this would be to reduce the reaction and use a mild treatment base to help the reaction calm down. This most often appears like a rash under the skin, can be at the nape of the neck where the tint isn’t washed off properly, and when particularly bad, the scalp can become very tight and sticky to the touch where the skin is trying to dilute the chemical away from the skin. Not a dry scalp.
  • Other conditions are described this way; the often miss-diagnosed condition Frontal Fibrosing Alopecia in the early days could be mistaken for Dandruff. The inflammation associated with the active phase of this autoimmune disease presents with a perifollicular scale, which, unfortunately, can cause permanently scarred hair loss. For most patients with this, I can treat exceptionally well again with minimal steroid or hydrocortisone involvement.