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Conditions that Can Be Confused with Dandruff

True dandruff is characterized by shedding of dry white flakes of dead skin from the scalp. It is confined to the head only and is not normally associated with redness, inflammation or itching. These symptoms are more likely to be caused by some other associated condition, such as seborrheic dermatitis or psoriasis.

The most common skin complaints that may occasionally be confused with dandruff include:

Seborrheic Dermatitis

This condition combines seborrhoea (oiliness of the skin) and dermatitis (an itchy red skin condition) and is characterised by redness and itching of the skin. Seborrheic dermatitis is sometimes considered to be a more severe form of dandruff.

A person with seborrheic dermatitis has a red, scaly, itchy rash affecting those parts of their body which have the highest number of sebaceous (oil-producing) glands. The areas most commonly affected are the scalp, the sides of the nose, the eyebrows, the eyelids, the skin behind the ears and across the middle of the chest. Other areas such as the breasts, armpits, groin, navel and buttocks can also become affected. In contrast, true dandruff is confined to the head only.

Treatment for mild forms of seborrheic dermatitis on the scalp is the same as for dandruff. Using a medicated shampoo regularly can treat it very effectively. A doctor can also prescribe a low-strength corticosteroid lotion or cream for use on affected areas. In some cases, seborrheic dermatitis is associated with a fungal infection. Treatment will then involve the use of an antifungal shampoo or cream.

Cradle Cap

Cradle cap is a special type of seborrheic dermatitis that affects babies. It usually clears up without treatment in eight to twelve months. Cradle cap can also occur in the nappy area and thus can be confused with nappy rash. On the scalp, it can be treated with a baby shampoo or with olive oil. Severe cases of cradle cap are treated with the use of prescription-strength shampoos or creams.

Eczema

Eczema is a skin condition in which the skin becomes red, itchy and inflamed. It is sometimes associated with loose dry scales of dead skin, thickening, cracking, weeping or blistering of the skin. Eczema can occur anywhere on the body, but usually affects a person’s scalp, face, ankles, wrists, the fronts of their elbows and/or the backs of their knees.

There are many different forms of eczema. Some occur for no obvious reason, while others are caused by immune system abnormalities including allergies or reactions to skin irritants such as detergents and solvents.

Eczema is usually treated by moisturising the skin and protecting it from irritants. Antihistamines can help reduce the itch, while careful use of steroid creams on affected areas or oral corticosteroids can help reduce the inflammation. In more severe cases, immunosuppressants can also be prescribed.

Psoriasis

Psoriasis is a skin condition usually associated with thick, dry, silvery-white, scaly patches of skin called plaques. The skin cells multiply at a very fast rate, which is similar to skin affected by dandruff. However, in psoriasis, the old dead skin cells are shed at normal speed, whereas, in dandruff, the old scalp cells are shed at a faster rate than normal. This causes thickening of the affected skin areas and build-up of scaly raised patches. These dead skin patches can be several centimetres wide.

Psoriasis can occur anywhere on the body and can have many different forms. The most common areas affected are the scalp, the buttocks, the backs of the knees, the lower back, the nails and/or the elbows.

Mild forms of scalp psoriasis can be treated by medicated shampoos. A moisturising cream called an emollient can also be used. In more severe cases, a doctor may prescribe a medicated lotion or cream. These preparations may contain coal tar and salicylic acid, similar to those used to treat dandruff or seborrheic dermatitis. Other treatments for scalp psoriasis can involve a retinoid cream (a vitamin D derivative), or anthralin, which affects the turnover of skin cells. In very severe cases, the patient may need to take oral medications, either alone or alongside phototherapy.

Fungal Infections

Fungal infections of the scalp can often look the same as dandruff. These can usually be treated with shampoos or creams bought over-the-counter or prescribed by a doctor.

Ringworm

Ringworm infection, which is also called tinea, is a particular type of fungal infection that can affect different parts of the body. When it infects the scalp, eyebrows or eyelashes, it is called tinea capitis and when it affects the feet, it is called tinea pedis, commonly known as athlete’s foot. This condition often forms ring-like areas of loose dry scales of dead skin and causes itching. Ringworm infection can often be treated with creams and lotions but sometimes oral anti-fungal medications are needed to get rid of it completely.

Skin Cancers

Rarely, the cause of itching and flaking skin on the scalp can be a skin cancer. However, a skin cancer on the scalp normally causes an isolated spot, a crusty irritated area or mole-like appearance. A doctor should be able to easily distinguish these spots from dandruff. Anyone who has a spot or mole on their scalp that changes shape and/or size, becomes itchy or otherwise bothering should see a doctor.