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Dandruff is a scalp condition that causes flakes of skin to appear. There may also be itching.
Most people experience dandruff at some point in their lives, but it is more common from the teenage years up to midlife.
There are various possible causes, including seborrheic dermatitis, allergic reactions, psoriasis, and eczema. An overreaction to Malassezia, a yeast that occurs on the scalp, is among the causes of seborrheic dermatitis.
Various factors increase the risk of developing dandruff, including a person’s age, the weather, stress levels, medical conditions, and choice of hair products.
Poor hygiene is not a factor, but the flakes may be more visible if a person does not wash or brush their hair often.
People often feel self-conscious about dandruff, but help is available.
Some treatments will target an underlying condition, such as psoriasis. Others aim to exfoliate dead skin cells or counter the yeast production that can trigger dandruff.
The right strategy will depend on the person’s age, any underlying conditions, and how severe their dandruff is.
Here are some lifestyle changes and home remedies that may help:
- managing stress
- avoiding products that contain harsh detergents and chemicals
- brushing the hair often
- asking a dermatologist about a suitable scalp and hair-care strategy
If dandruff and itching are severe and persistent, or if symptoms worsen, it may be a good idea to see a doctor. They may identify an underlying problem that will respond to a specific treatment.
For mild dandruff without a specific cause, various over-the-counter products can help manage flaking and itchiness.
Before using an anti-dandruff shampoo, individuals should carefully try to remove as many scaly or crusty patches on the scalp as possible. This will make the shampoo more effective.
Gently use a comb or hairbrush to remove loose scales or flakes, and then wash with a medicated shampoo. Take care not to remove patches or plaques too aggressively, as this could irritate the condition.
Ingredients to look out for
Most anti-dandruff or antifungal shampoos contain at least one of the following active ingredients:
- Ketoconazole is an antifungal ingredient that is suitable for any age.
- Selenium sulfide helps manage dandruff by reducing scalp glands’ production of natural oils. It also has antifungal properties.
- Zinc pyrithione slows down the growth of yeast.
- Coal tar has a natural antifungal agent and can reduce excess skin cell production. During long-term use, coal tar may stain dyed or treated hair. It may increase the scalp’s sensitivity to sunlight, so users should wear a hat when outside. Coal tar may also be carcinogenic in high doses.
- Salicylic acid helps remove excess skin cells.
- Tea-tree oil is present in many shampoos. It has antifungal and antibacterial properties. One older study has suggested that shampoo containing 5% tea tree oil appeared to be safe and well-tolerated for treating dandruff. Do a patch test first, as some people experience a reaction.
How to use the shampoo
How often a person needs to use a medicated shampoo may depend to some extent on their hair type.
The American Academy of Dermatology offer the following advice:
For Black people: Shampoo once a week with a dandruff shampoo. Ask a dermatologist to recommend a suitable option.
For white and Asian people: Shampoo daily, and use a dandruff shampoo twice a week. If one shampoo does not help, try another one.
Some experts suggest using a shampoo for a month to see if it works.
A specific shampoo may become less effective over time. A person who feels their choice is losing its effectiveness may want to switch to a different shampoo with another ingredient.
The length of time a person should leave a product on their scalp will vary. Users should follow the instructions on the container.
Dandruff is a medical condition. A doctor will recommend suitable treatment for any of these underlying causes.
Often, it is not clear why dandruff occurs, but here are some possible factors:
People with seborrheic dermatitis have irritated, oily skin and are more likely to have dandruff. The skin will be red, greasy, and covered with flaky white or yellow scales.
It can affect the scalp, the backs of the ears, the eyebrows, the chest, and other parts of the body.
Medical conditions that commonly involve seborrheic dermatitis
Seborrheic dermatitis appears to be more common among people with:
- psoriasis or scalp psoriasis
- Parkinson’s disease
- alcohol dependency
- eating disorders
- recovery from a stroke or heart attack
- a weak immune system
A person with HIV who experiences severe scalp problems should see their doctor, who will recommend a suitable treatment.
Certain skin conditions
Apart from psoriasis, some conditions can cause flaking skin on the scalp, such as:
Dandruff often stems from Malassezia, a fungus that commonly lives on the scalp and feeds on the oils secreted by hair follicles.
Malassezia is not usually a problem, but in some people the immune system overreacts to it. This can cause the scalp to become irritated and produce extra skin cells.
As these extra skin cells die and fall off, they mix with the oil from the hair and scalp to form dandruff.
Shampooing and skin care products
Certain hair care products can irritate the scalp and may cause dandruff. If a person finds that a product is causing irritation, they should try switching to a gentle, non-medicated shampoo.
Some people say not shampooing enough can cause a buildup of oil and dead skin cells, leading to dandruff. Others say that too much washing will strip away the natural oils.
Evidence is lacking that either of these is true. The frequency with which a person needs to wash their hair will vary between individuals.
While specific products can trigger irritation and reaction in some people, frequent shampooing is usually helpful.
Other factors that may increase the risk of developing dandruff include:
- winter temperature extremes, and possibly a combination of cold weather and overheated rooms
- infrequent hair brushing, as brushing helps remove dead skin cells
- age, as dandruff is more likely to occur between the teenage years and midlife (though a type of dandruff known as cradle cap is also common with babies)
- hormonal factors, as it is more common in males
Dietary factors may play a role. Nutrients that may help include:
- zinc, if a person has a deficiency
- B vitamins, also if a person has a deficiency
- a type of omega-6 fat known as gamma linolenic acid, which is present in evening primrose oil
However, there is not enough research evidence to prove that these or other dietary measures can help resolve dandruff.
Complications rarely occur with dandruff, and most people do not need to consult a doctor. However, sometimes dandruff can indicate a more serious medical condition.
People should seek medical help if:
- There are signs of infection, such as redness, tenderness, or swelling.
- The dandruff is severe, and home treatment does not help.
- There are signs of eczema, psoriasis, or another skin condition.
- The scalp is very itchy.
Complications can sometimes result from treatment. If a shampoo or scalp treatment causes irritation, the individual should try another product.
Newborns and young infants often have a kind of dandruff known as cradle cap. There will be yellow, greasy, scaly patches on the scalp.
It often appears within the first 2 months after birth and lasts a few weeks or months.
Gently washing the scalp with baby shampoo and applying baby oil can help prevent the scales from building up.
If the following occur, the infant should see a doctor:
- skin cracking
- symptoms spreading to other parts of the body
Research into ways to help people with dandruff is ongoing.
Infusions of green, black, or white tea may help prevent dandruff and improve the condition of a person’s hair and scalp. Experts say this may be due to the antioxidants tea contains or other properties that offer protection from sunlight.
Another study has suggested that adding llama antibodies to shampoo could be a new strategy for fighting dandruff.
More research is needed to confirm whether these treatments work.