Dandruff is a common skin condition that affects about 5% of the population. Many once believed it was related to poor hygiene, which is incorrect. Though it is an annoying and embarrassing problem, it is not dangerous or life-threatening. Unfortunately, it can be a life-long issue, requiring daily treatment for some.
Dandruff causes scalp redness, itchiness, and skin flakes.
The exact cause is unknown, but it is related to excess oil production, scalp irritation, and overgrowth of Malassezia yeast.
If you have dandruff, it is important to reduce stress, keep your body and immune system functioning properly, use the right products for your scalp, and practice good hygiene and hair care routines.
Over-the-counter shampoos can be effective in mild cases and contain ingredients such as zinc pyrithione, selenium sulfide, coal tar, salicylic acid, ketoconazole, and tea tree oil.
Prescription medications are needed for severe cases of dandruff.
What is dandruff?
Dandruff, also referred to as seborrheic dermatitis of the scalp, is a skin condition that can come and go throughout one's lifetime. It presents with white-yellow oily flakes on the scalp that can fluff off or stick to your hair, creating crusty areas on your scalp. Your scalp may also become red and inflamed, causing an itching or burning sensation.
Causes of dandruff
While the exact cause is unknown, some factors have been discovered that contribute to causing dandruff. For example, an overgrowth of the yeast Malassezia has been found colonizing the scalps of dandruff patients. This yeast gorges itself off the oils produced on the scalp. People who genetically overproduce oils are prone to developing dandruff.
Other causes include sensitive skin, stress, and the weather. Often, products can irritate the scalp, especially those with sensitive skin, and lead to dandruff. Patients with sensitivity already have impaired skin barrier function, making them prone to dandruff conditions. Without a functioning barrier, their skin gets easily irritated, infected, and dehydrated. Stress has been linked to flares in many skin conditions, such as dandruff. It lowers the immune system, probably allowing for the overgrowth of yeast. Finally, cold, dry weather can irritate the scalp, likely leading to excess oil production and a subsequent overgrowth of yeast.
Who is at risk for developing dandruff?
Certain patients are at risk for developing dandruff. Many are likely related to a dysfunctional immune system. The exact mechanisms are not completely elucidated yet, but may include:
- Neurological disorders, such as epilepsy and Parkinson's disease
- Compromised immune system, such as HIV, chemotherapy, and transplant patients
- Psychological conditions such as alcohol dependency, depression, and eating disorders
- Skin conditions such as rosacea, psoriasis, and eczema
- Age (from teen to midlife)
Ways to prevent dandruff
If you are prone to developing dandruff, there may be some things you can do at home to prevent or lessen the disease in some cases.
- Reduce stress by exercising, doing yoga, or meditating.
- Be sure to use gentle products on your scalp to prevent irritation.
- Brush daily to remove loose flakes.
- Limit friction and irritation to your scalp by gently washing your hair and not scrubbing.
- Practice good hygiene and hair care routines.
- Keep your body healthy by eating a good diet rich in antioxidants and lean proteins, getting eight hours of sleep a night, and drinking plenty of water.
OTC treatments for dandruff
Fortunately, there are several good, over-the-counter shampoos for treating dandruff. These can be used three times a week to get it under control. You may be able to cut down on usage during maintenance. However, researchers recommend rotating your shampoos monthly to prevent your scalp from growing accustomed to the ingredients, potentially making them less effective. Additionally, it is very important to leave the shampoo on your scalp for as long as directed. This is because the ingredients need time to penetrate the scalp to work effectively.
What ingredients to look for?
There are certain effective ingredients to look for in over-the-counter dandruff shampoos. These are effective for mild to moderate cases of dandruff.
- Zinc pyrithione. This has antibacterial and antifungal properties.
- Selenium sulfide. It contains antifungal properties and can also decrease oil production. If you have light-colored hair, it could discolor it.
- Ketoconazole. This has antifungal properties.
- Salicylic acid. It can get rid of dead skin cells/flakes on the hair and scalp.
- Coal tar. This has antifungal properties and can slow down the production of skin flakes. It can make your scalp sensitive to sunlight, so you must protect it with a hat. It can also discolor light-colored hair.
- Tea tree oil. It has antifungal and antibacterial properties.
Available prescription treatments
There are prescription medications for the treatment of moderate to severe cases of dandruff.
- Ketoconazole. This is the same ingredient in over-the-counter shampoos, but stronger.
- Steroids. Topical steroid shampoos, solutions, or lotions can decrease the inflammation in the scalp caused by dandruff. This will soothe the scalp and ultimately stop the flakes. Usually, steroid pills are not required. However, long-term use of steroids can cause many medical problems, so be sure to discuss the proper usage of steroids with your doctor.
When should I see my dermatologist?
While many cases of dandruff can be treated at home with over-the-counter products, severe cases usually require the help of a board-certified dermatologist. Even if you have a mild case, but the treatments are not working, or your scalp is worse, you need to see your doctor. You may not have dandruff, but other similar-looking skin conditions, such as psoriasis, contact dermatitis, or fungal infection. If you notice swelling, pain, or pus, see your doctor right away. You may have a bacterial infection that requires prescription antibiotics. Finally, if you notice hair loss, immediately see your doctor to prevent worsening.
Dandruff is a common skin condition that can significantly impact your self-esteem. Therefore, it is best to treat it right away to prevent worsening. Most mild cases can be treated with over-the-counter medicated shampoos. However, if your case is severe or you are unsure which medicated shampoo is right for you, always consult a board-certified dermatologist. The quicker you treat your dandruff, the faster you will be back to your old self.
- American Family Physician. Seborrheic dermatitis: an overview.
- Clinical Microbiology Reviews. The Malassezia genus in skin and systemic diseases.
- International Journal of Cosmetic Science. Stratum corneum dysfunction in dandruff.
- International Journal of Dermatology. Malassezia species in healthy skin and in dermatological conditions.
- Experimental Dermatology. Ketoconazole beyond antifungal activity: Bioinformatics-based hypothesis on lipid metabolism in dandruff and seborrheic dermatitis.
- Journal of the American Academy of Dermatology. Treatment of dandruff with 5% tea tree oil shampoo.