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Is your dry scalp something more serious?

From dandruff to fungal infections, your scalp could be in need of some TLC

A dry, itchy scalp can prove distracting, painful and—when paired with scabbing or flaking—embarrassing. It may be tempting to take matters into your own hands by scratching or attempting to mask the issue with products, which may make matters worse.

If you are experiencing similar and sometimes overlapping symptoms, Deirdre Hooper, MD, FAAD, a board-certified dermatologist in private practice in New Orleans, says it’s important to differentiate mild dry skin or dandruff from other skin conditions so that you can get the treatment you need.

Dandruff and dry skin can show up on your scalp in similar ways, which can make it tricky to tell the difference without a dermatologist’s help. Dandruff shows up as small pieces of dry skin flaking off your scalp, and it may be itchy. Dandruff is a very common condition that often comes and goes. It is often associated with seborrheic dermatitis, which is a skin condition caused by the yeast that lives on skin, or by stress, cold, or overall health. On the other hand, dry skin happens when skin loses too much water. Some hair care products can dry and irritate the scalp by stripping the natural oils from your skin. Weather can also dry your scalp in low humidity and cold climates. When you have dry skin on your scalp, you’ll typically experience itchiness and flakes of skin, according to Dr. Hooper.

Dandruff can usually be improved by using dandruff shampoo, and a dry scalp by switching to a gentle, non-medicated shampoo.

Woman with natural hair scratching psoriasis on her scalp

Dr. Hooper says dandruff can usually be improved by using dandruff shampoo, and a dry scalp by switching to a gentle, non-medicated shampoo. "However, if over-the-counter products don’t do the trick, it’s time to see a board-certified dermatologist for a proper diagnosis and treatment plan."

Below, dermatologists speak to several common—and potentially serious—conditions that could be lurking behind your dry scalp.

The condition: Psoriasis

What it is: According to Danny Del Campo, MD, FAAD, a board-certified dermatologist in private practice in Chicago, psoriasis is a chronic skin condition that causes skin cells to grow too quickly, making them pile up on the surface of the skin in patches called plaques. "There are many genes that increase the risk of developing psoriasis. Hence, psoriasis is generally considered to be a genetic disease that is triggered by other factors," says Dr. Del Campo. Infections, skin injuries, some medications, and lifestyle factors such as drinking alcohol or smoking are common triggers for psoriasis.

What to look for: If you have scalp psoriasis, you may have it in small areas; however, it can also cover your entire scalp. You might have reddish or dark-reddish patches called plaques that can be elevated or inflamed; flakes of skin that seem like dandruff but have a silvery sheen, called scale; a dry, itchy, or burning scalp; or temporary hair loss.

How to treat it: Based on the severity of the condition and your medical history, Dr. Del Campo says a dermatologist will typically prescribe medicated ointments and creams you apply to the scalp; medicated shampoo; light therapy (phototherapy) to decrease inflammation; products that can soften the thick patches called scale softeners; or medications that work throughout the body.

The condition: Tinea capitis (scalp ringworm)

What it is: Tinea capitis is a fungal infection of the scalp skin, also called scalp ringworm, that can be transmitted through contact with others, says Julia Tzu, MD, FAAD, a double board-certified dermatologist in private practice in New York. "Sharing hats, combs, and other hair accessories can increase your risk. This condition also tends to be more common among children 5-14 years of age," she adds.

What to look for: According to Dr. Tzu, symptoms of tinea capitis include scaly patches on the scalp, usually combined with patches of hair loss (or broken hair shafts). "There can be inflammation (pink skin) or itchiness, as well."

How to treat it: You need prescription antifungal medicine to treat tinea capitis. Everyone you live with may also need to be seen by a dermatologist, as tinea capitis is very contagious. Dr. Tzu warns that tinea capitis can continue to spread across the scalp and cause additional hair loss if not stopped in its tracks.

The condition: Actinic keratoses (AKs)

What it is: Dr. Tzu describes AKs (also referred to as solar keratoses) as a form of precancerous sun damage that is caused by unprotected sun exposure. "While both men and women of any age can develop actinic keratoses, on the scalp I tend to see them more frequently in older men who have experienced hair loss, and therefore have had less protection against the sun. Genetic predisposition (such as fair skin, red or blond hair, and family history) can also factor in," she explains. While AKs often occur on the scalp, the condition can appear on any part of the body. AKs are most common in people who are 50 or older and have spent a lot of time outdoors without sun protection.

What to look for: Dr. Tzu says AKs often appear as dry, scaly, rough patches or bumps that can be skin-colored or pink. They might feel like sandpaper or be crusty. "Sometimes, actinic keratoses are easier to identify through touch, feeling like scaly, uneven skin that may not necessarily be itchy or painful, which some inflammatory skin conditions are," she adds.

How to treat it: If you find a scaly growth on your scalp, or anywhere on your body, that you think might be an AK, Dr. Tzu suggests seeing a board-certified dermatologist for a thorough skin exam. "Treatments for actinic keratoses include topical medications such as 5-fluorouracil (a chemotherapy agent) or imiquimod (an immune response modifier), or procedures such as minimally invasive cryosurgery (liquid nitrogen), which destroy precancerous cells," she says. AKs can also be treated using photodynamic laser therapy. Dr. Tzu also cautions that, if left untreated, some AKs turn into squamous cell carcinoma, the second-most-common form of skin cancer.

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Last updated: 5/26/21