What is the cause of red, scaly lesions on the scalp, possibly indicative of a condition such as seborrheic dermatitis or psoriasis?

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Last updated: May 19, 2025View editorial policy

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Differential Diagnosis for Red Scaly Scalp

  • Single most likely diagnosis
    • Seborrheic dermatitis: This is the most common cause of a red, scaly scalp, characterized by inflammation and a flaky, itchy scalp. It is often associated with oily skin and can be triggered by stress, cold weather, or certain hair products.
  • Other Likely diagnoses
    • Psoriasis: An autoimmune condition that causes red, scaly patches on the scalp, often accompanied by itching and flaking. It can be triggered by stress, trauma, or certain medications.
    • Dandruff: A mild form of seborrheic dermatitis, characterized by a flaky, itchy scalp, often caused by a fungal infection or sensitivity to hair products.
    • Eczema (atopic dermatitis): A chronic skin condition that can cause red, scaly patches on the scalp, often accompanied by itching and dryness.
    • Contact dermatitis: An allergic reaction to hair products, dyes, or other substances that can cause redness, itching, and scaling on the scalp.
  • Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
    • Lupus: A chronic autoimmune disease that can cause a red, scaly scalp, as well as other systemic symptoms such as fever, fatigue, and joint pain. If left untreated, lupus can lead to serious complications, including kidney damage and seizures.
    • Sarcoidosis: A rare disease that can cause granulomas to form on the scalp, leading to redness, scaling, and hair loss. If left untreated, sarcoidosis can lead to serious complications, including lung damage and blindness.
    • Cutaneous T-cell lymphoma: A rare type of cancer that can cause red, scaly patches on the scalp, often accompanied by itching and hair loss. If left untreated, cutaneous T-cell lymphoma can lead to serious complications, including disfigurement and death.
  • Rare diagnoses
    • Pityriasis amiantacea: A rare skin condition that causes a thick, scaly crust to form on the scalp, often accompanied by redness and itching.
    • Keratosis pilaris: A rare skin condition that causes small, rough patches to form on the scalp, often accompanied by redness and itching.
    • Lichen planus: A rare skin condition that causes flat, itchy patches to form on the scalp, often accompanied by hair loss and scarring.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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