A Dermatologist Told Us Your Flaky Scalp May Not Be Dandruff

If you’re embarrassed by a flaky scalp, you’re not alone. Flaky scalps are a widespread problem. But is dandruffl aways to blame for your flaky scalp? There are many causes of scalp flaking, some more serious than others. It’s important to know what’s causing your scalp to flake, as treatments for the condition are not all the same.

We spoke to dermatologist Dr Cara McDonald to understand the different causes behind scalp flaking, the signs you should be looking for to distinguish them, and how best to treat them.

The 4 Conditions That Cause a Flaky Scalp

Eczema

Dr McDonald says eczema, known as atopic dermatitis, is an itchy, scaly skin rash with a strong genetic predisposition. It presents as very dry skin on the scalp rather than particularly scaly skin and will pop up on other areas of the body, particularly creases like elbows and knees.

Tinea

Tinea is a fungal infection that can affect the scalp. It typically causes red, scaly, itchy, inflamed and even pussy circular patches – and can cause hair loss. It is most commonly caught from domestic animals like cats and dogs.

Psoriasis

Like eczema, psoriasis is also a genetic condition. As opposed to eczema, psoriasis on the body more typically affects the outer arms and legs but can appear elsewhere. It is not generally as itchy as eczema but is flakier with thick white scale and well-circumscribed red scaly patches.

Seborrhoeic Dermatitis

Seborrhoeic Dermatitis is the most common cause of garden-variety dandruff. Appearing as cradle cap in babies with thick yellow scale and more commonly dandruff with fine white scale in adults. Seborrhoeic dermatitis is associated with overgrowth or sensitivity to be yeast, Malassezia which lives in our hair follicles and thrives in an oily environment.

Pityriasis Aminantacea

 Pityriasis Aminantacea is a scalp condition characterised by thick yellow plaque and scale, which sticks tightly to the hair and scalp. The exact cause of this condition is unknown.

With these four flaky scalp-causing conditions in mind, we spoke to Dr McDonald about how to identify them and treat them.

POPSUGAR: Is it possible to distinguish these conditions without seeing a specialist? 

Dr Cara McDonald: Often, the family history and presence on other areas of the body help confirm the diagnosis. For example, psoriasis often causes skin changes where eczema is associated with widespread dry skin and a family history of atopy – eczema, asthma or hay fever. 

However, the diagnosis can be challenging in some cases, and a specialist opinion is helpful. It is worth noting that although these conditions described are the most common causes of itch and scale in the scalp, there are, in fact, dozens of other rare and wonderful diagnoses seen by dermatologists that can sometimes all look similar. In the more complex cases, a skin biopsy is required to provide further information about what type of inflammation is going on in the skin and assist in making a diagnosis. 

Are over-the-counter hair serums and scrubs helpful in treating the scalp? 

If you are prone to dry skin, such as those who suffer from eczema, it is important to hydrate and moisturise the skin, including the scalp.

Avoiding excessive irritation with overwashing or fragrance products is also essential. I would recommend that those with dry, sensitive or eczema-prone skin treat their scalp the same way they treat their body with regular bland moisturising products and avoid any scrubbing or irritation where possible.

In general, scrubs are not helpful, even for those with scaly skin. It is preferable to use gentle exfoliating products like salicylic acid and tar to remove excess scale. If you are struggling with a medical scalp condition, it is probably worth getting some professional medical advice regarding treatment rather than trying many over-the-counter options.

What course of treatment would a specialist recommend for conditions like tinea or eczema?

This is a tricky question because every case is a bit different, and treatment is usually personalised. For eczema and psoriasis, the mainstay of gentle treatment would be prescription corticosteroid lotions to reduce the itch and inflammation and products to break down the dead skin cells and scale or provide skin hydration. For tinea, oral prescription medication is usually required. To address the scale, we would typically recommend anti-yeast shampoo and medicated scalp treatment for regular dandruff or seborrheic dermatitis. 

Does having an oily or dry scalp impact the likelihood you’ll experience flakiness or other scalp conditions at all?

Having an oily scalp can predispose to seborrheic dermatitis, or where is a dry scalp is more likely to result in eczema.

Are there any retail products you like and recommend for common dandruff, oiliness or particularly dry scalps? 

For scaly scalp conditions, specifically psoriasis and seborrheic dermatitis (dandruff), scalp oils and shampoos containing salicylic acid (which breaks down scale) and tar (which reduces inflammation) are helpful. Good products include Coco Scalp Ointment, Neutrogena T-gel shampoo ($13.50), and Sebitar shampoo ($18.49).

Dandruff also responds well to medicated anti-yeast shampoo, such as Nizoral. 

For eczema, I’d recommend using a gentle shampoo designed for dry/eczema-prone skin and avoiding fragrance where possible. If you’re still struggling, it is best to seek personal medical advice from a general practitioner or dermatologist.

For more practical skin care advice, you can follow Dr Cara Mconald on Instagram at @drcara_dermatologist