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Roughly one in five Americans suffer from dandruff, making it an extremely common condition. Men are often diagnosed more often than women, and it’s believed this is because of the impact of male hormones, which increases sebum and natural oil production. There are also certain medical conditions that have increased association with dandruff, namely Parkinson’s disease, HIV, and other conditions that cause a weakened immune system. We all have organisms that normally live on our skin and bodies. For most people, they never cause any issues. But for the immunocompromised, the balance may get thrown off—leading to dandruff.
It’s easy to confuse dry scalp with dandruff since they can both present with white flakes, but there are some important distinctions. First and foremost, dandruff is a result of a build-up of natural oils on the scalp (though this can be due to several different causes), while dry scalp is a result of too little moisture, resulting in dry skin specifically on the scalp.
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Dry scalp vs. dandruff
All flakes are not alike, and once you learn to tell them apart, it’s relatively easy to distinguish between actual dandruff and a simple case of dry scalp. But their different symptoms are just a reflection of the fact that they have different root causes.
Dandruff can get a little confusing in terminology. Seborrheic dermatitis is the medical term for dandruff, but the term isn’t always used. The easiest way to think about this is that “dandruff” can be treated with over-the-counter anti-dandruff shampoos. If it needs a stronger treatment, like a prescription, we’ll then refer to it as “seborrheic dermatitis.”
Causes of dry scalp vs. dandruff
Dry scalp occurs when your skin has too little moisture. This often happens when the barrier function of the skin is interrupted, and moisture is not retained effectively in the outer skin layers. This can result from low humidity environments (dry air), genetics, skin conditions like atopic dermatitis, or even the results of overly harsh personal care or hair care products.
The causes of dandruff are more complicated. Some people believe that there’s a commensal yeast—one that gains benefits from us but doesn’t give us any benefits, though it does no harm—that lives on everyone’s skin called Malassezia. Normally, it doesn’t affect us, but some people theorize that it causes dandruff in susceptible individuals, like those who have an imbalance due to being immunocompromised. Nutritional deficiencies as a cause of dandruff are uncommon but possible. When they exist, it can be niacin, riboflavin, and pyridoxine (members of the vitamin B family) or zinc.
If you have a reaction to a hair care product, that’s something else entirely called allergic contact dermatitis. You can easily tell the difference because the symptom onset would be more acute, and you would likely experience more significant redness, burning, itch, and peeling.
We get really hung up generally on flaky scalps because they’re aesthetically displeasing, but the flakes actually reveal a lot about what’s going on if you take a closer look at them
Symptoms of dry scalp vs. dandruff
We get really hung up generally on flaky scalps because they’re aesthetically displeasing, but the flakes actually reveal a lot about what’s going on if you take a closer look at them. Dandruff is a result of too much oil on the scalp, and the main side effect is flaking that tends to be larger pieces of skin that are oily in nature. Dry scalp, on the other hand, is usually a fine, very dry scale that is much smaller in size—and, of course, it is not due to oil production since it’s characterized by dryness. The larger dandruff flakes can also be white or yellowish in color, while the smaller flakes associated with dry scalp are typically white.
Due to the excess oil involved with dandruff, you may also experience oily or greasy-feeling hair. This may also be accompanied by an itchy scalp, though a dry scalp may also cause persistent itching.
There is also sometimes confusion with psoriasis, which can mimic dandruff when confined to the scalp. Psoriasis is a type of atopic dermatitis that causes skin cells to multiply ten times faster than normal skin cells. This excess of skin cells builds up in red, bumpy patches on the body that are also scaly. Scalp psoriasis may mimic the look of flakes of skin associated with dandruff or dry scalp.
Treatment of dry scalp vs. dandruff
Since the causes of these conditions are different, the way we treat them needs to be as well. Dry scalp is treated in several ways, but these treatment options are aimed at getting to the root of the issue. If it’s a personal care product that’s stripping out too much moisture, it can be treated with gentle shampoos and hair products. Avoiding over-processing hair with chemicals and high heat dryers can help. Use a conditioner and apply a scalp oil as a moisturizer to hydrate the skin.
If you experience dry scalp due to the weather, a humidifier may help but not completely. Dry scalp is generally multifaceted, so there’s more than one cause of the issue. Some people, for example, are simply genetically predisposed to dry skin. But any intervention that helps hydrate the skin will help.
Dandruff can be treated with over-the-counter or prescription products. These include shampoos with zinc pyrithione (also called pyrithione zinc), coal tar, salicylic acid, selenium sulfide, and ketoconazole—ingredients that address multiple aspects of this condition. Some gently remove dead skin cells before they can flake off, while others combat the yeast-like fungus associated with dandruff. Everyone’s response to treatment is different, but you should see a significant improvement within two weeks of use. Over-the-counter and at-home remedies such as tea tree oil are sufficient to completely resolve symptoms for many. It is only when these are insufficient that one needs to see a specialist.
If you have tried and failed to improve your symptoms, schedule an appointment with a board-certified dermatologist. When these over-the-counter agents are not strong enough, there are prescription strength anti-dandruff shampoos as well as leave-in scalp treatments. These options tend to use anti-inflammatory ingredients and can be prescribed by a medical expert. First and foremost, it is critical for your dermatologist to confirm the diagnosis and rule out other causes of flaking and related symptoms. And second, it is important for them to design the correct treatment protocol. This may involve checking for an underlying skin condition if nothing else has helped with your symptoms.