We’ve all be there – the itchy scalp, the white flakes. It must be dandruff, right?

But what if the dandruff shampoo doesn’t work? When the shampoos fail, we usually assume we have a bad case of a dry scalp. However, there may be something else going on. If you’re using a dandruff shampoo, yet the itching and flaking persists, it’s time to visit your dermatologist.

Two Possible Conditions

Dandruff is a widespread problem, but sometimes it takes the blame for other conditions.

If your scalp problems have progressed to the point that your head won’t stop itching or you can’t wear black because flakes show up on your clothing, you may have a different condition that needs special attention.

Related: How to Treat Dandruff

Seborrheic Dermatitis

Seborrheic dermatitis and psoriasis are two skin conditions often mistaken for dandruff. Seborrheic dermatitis, the most common cause persistent scalp peeling, feels a lot like dry skin. Much like dandruff, it produces tiny flakes, but it also affects the entire scalp with salmon-colored redness. It occurs because of yeast and oil on the scalp. The yeast lives on the skin and thrives on the oils our skin produces making it hard to eliminate.


Psoriasis does not affect the entire scalp but can be much more severe. Large red and black patches, referred to as plaques, often appear at the back of the head above the neck. Both unsightly and uncomfortable, these itchy plaques shed large scales. If you notice this type of skin flaking from your scalp, you’re experiencing more than a basic dandruff problem.

Related: Psoriasis: Causes, Appearance, and Treatments Options


Treatment Options

The first choice for any skin condition is to deal with the source of the issue. However, with seborrheic dermatitis, the yeast thrives on naturally occurring oils – oils that we can’t change.

The cure for psoriasis also eludes dermatologist. It occurs because of overactive skin cells, but what triggers this quick production of skin remains unknown. Both of these conditions remain incurable, yet the symptoms are treatable. There are several medications that lessen the severity of the problems.

Treatments are actually quite simple. For seborrheic dermatitis, we prescribe a mild, topical steroid solution to apply to the scalp after showering. Symptoms quickly diminish when treated consistently.

Psoriasis requires a stronger steroid to ease its symptoms, also available via prescription. Depending on the severity of the plaques, we may inject steroids directly into the affected area to bring about long-term relief.

Unless treated regularly, both of these conditions will return. But, with intentionality, you can keep the symptoms at bay. There’s no need to suffer from an itchy, flaky scalp. If your symptoms seem to be more than just dandruff, schedule an appointment right away .