Is Your Itchy, Flaky Scalp From Dandruff or Dryness?

Dandruff is caused by a combination of yeast overgrowth and too much sebum (oil) production, while dry scalp typically results from moisture loss in the outer layers of the skin. Because the causes are different, some people—such as those with stress—are more likely to have dandruff than others. Treatments also differ.

Causes

• Seborrheic dermatitis: This skin condition causes scaly, oily patches or rashes. When it appears on the scalp, it’s often referred to as dandruff.
• Dandruff: This condition develops from an overproduction of oil and an overgrowth of Malassezia yeast. This yeast sustains itself with the oil produced on your skin. The more oil you have, the more this yeast can multiply and grow, irritating and, ultimately, causing dandruff.
• Dry scalp: This condition isn’t related to yeast overgrowth or oil production. Like dry skin on other parts of the body, it occurs when the scalp loses too much moisture.

Duration

Some people experience dandruff only once or twice in their lives. However, others may experience chronic (long-term) dandruff and need to manage their symptoms regularly with medicated shampoos or other products.

Dry scalp isn’t typically chronic unless left untreated or related to an underlying health condition. Most people with dry scalp can restore the right balance of moisture with basic at-home strategies like cleansing with hypoallergenic products and protecting their skin from harsh elements.

Treatments

There is no permanent cure for seborrheic dermatitis, but treatment can relieve symptoms and sometimes prevent them from returning. Seborrheic dermatitis can also clear up on its own, so it isn’t always chronic.

Dandruff treatment involves using over-the-counter (OTC) or prescription products to reduce yeast on the skin and any resulting inflammation. Treatment options include shampoo containing antifungal ingredients like zinc pyrithione, salicylic acid, sulfur, coal tar, selenium sulfide, or ketoconazole.

It’s best to use a nonmedicated shampoo for dry scalp since medicated shampoos often contain harsh ingredients that decrease the natural oil on your skin and contribute to dryness. The best shampoos for dry scalp are ones labeled as gentle or hypoallergenic or that say they help strengthen your scalp’s natural barrier.

You may also benefit from protecting your scalp from the elements by wearing sun-protective hats in the summer and warm hats in the winter. You can also run a humidifier indoors if the air in your environment is dry.

Although the root causes of dandruff and dry scalp differ, you can get either condition due to many of the same factors, like your hair care products, the weather, your diet, hormones, and stress. Dandruff and dry scalp can also both be mistaken for other skin conditions, like psoriasis and ringworm.

Triggers

Some people are more prone to dandruff and dry scalp because of their skin’s makeup, but certain things can trigger a flare-up of either condition, especially if they’ve experienced one in the past.

Hair products that irritate the skin or disrupt the skin barrier can exacerbate dandruff or dry scalp. Cold or dry weather can also make the skin more vulnerable to dryness and dandruff.

Hormonal changes are another reason for dandruff or dry skin. Dandruff is common in children and adolescents due to fluctuating reproductive hormones like testosterone, while pregnancy and menopause can cause skin to become excessively dry.

Mistaken for Other Conditions

Dandruff and dry scalp often cause symptoms that make it hard to differentiate between them and other skin conditions. Some skin conditions that may present similarly to dandruff or dry scalp include:

• Psoriasis: This inflammatory skin condition can cause thick, scaly patches to appear on the skin, which can be itchy and inflamed. If psoriasis affects the scalp, it could look similar to seborrheic dermatitis. 
• Eczema: Eczema can cause dry, itchy skin that may look rashy, resembling some cases of seborrheic dermatitis and dry scalp. Seborrheic dermatitis may also occur more often in young kids and teens with eczema, making it hard to differentiate.
• Scalp ringworm: Ringworm is a fungal infection that commonly affects younger children. When it occurs on the scalp, it can cause scaly patches, itching, and inflammation, similar to fungal dandruff. 

Affected Ages

Dandruff is somewhat more common in children and younger adults. Seborrheic dermatitis on the scalps of babies is known as cradle cap. Dandruff may also occur when testosterone levels increase, such as during or after puberty. However, people of all ages can experience dandruff, including middle-aged and older adults.

The same is true for dry scalp, though aging causes the body to produce less sebum, which can result in dryness. It’s harder to pinpoint the exact number of people with dry scalp, but some researchers estimate that about 30% of adults have some kind of dry skin.

You can have both conditions simultaneously. An extremely dry scalp affects the skin’s protective barrier, causing the scalp to try to compensate for the lack of moisture. This can lead to dandruff and its characteristic oily, flaky patches of skin forming on the scalp.

This is one reason why dandruff is more common in the colder months—your skin is more likely to be drier, and your scalp is more vulnerable.

Dandruff won’t occur in everyone with a dry scalp because it also requires an overgrowth of yeast or a reaction to the yeast on your skin to trigger it.

Primary care providers can treat mild to moderate forms of dry scalp and dandruff, but if your symptoms are severe or persistent, you may want to ask your primary care provider about visiting a dermatologist.

Dermatologists are specialized in treating skin conditions, including dry scalp and dandruff. They may recommend certain prescription shampoos or medications to help manage your symptoms. You should see a healthcare provider like a dermatologist if you:

• Have tried treating your symptoms with OTC products for several weeks and haven’t seen any improvement
• Have successfully treated your symptoms with OTC products, but they return after you stop treatment
• Your symptoms are worsening or changing
• You think you may have a skin infection because your skin is red, swollen, hot to the touch, or has discharge
• You have a rash that spreads quickly, is widespread, and is accompanied by a fever or blisters
• Your symptoms are interfering with your quality of life, like if your scalp is so itchy you can’t sleep at night

Dandruff and dry scalp share several symptoms, including flaking, itching, and irritation. However, the causes differ, meaning their treatments involve different shampoos or topical treatments.

Other common skin conditions, like psoriasis and ringworm, can be mistaken for dandruff or dry scalp. If your symptoms are persistent or don’t respond to OTC treatments, see a healthcare provider for an evaluation.