Dandruff

Dandruff is a condition of the scalp that causes flakes of skin to appear. It is often accompanied by itching.

The exact cause is unknown, but various factors increase the risk. It is not related to poor hygiene, but it may be more visible if a person does not wash or brush their hair often.

Dandruff can be embarrassing and hard to treat, but help is available.

Fast facts on dandruff

Here are some key points about dandruff. More detail is the main article.

  • Dandruff is a common condition, but it can be embarrassing and difficult to treat.
  • It is not related to hygiene, but washing and brushing the hair can help remove old skin flakes.
  • Risk factors include having certain skin or medical conditions and the use of inappropriate hair products.
  • Various treatments are available over the counter, but more severe cases should be seen by a doctor.

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The exact causes of dandruff are unknown.

One theory is that it is linked to hormone production, as it often begins around the time of puberty.

Here we look at 10 more possible factors.

1. Seborrheic dermatitis

People with seborrheic dermatitis have irritated, oily skin, and they are more likely to have dandruff.

Seborrheic dermatitis affects many areas of the skin, including the backs of the ears, the breastbone, eyebrows, and the sides of the nose.

The skin will be red, greasy, and covered with flaky white or yellow scales.

Seborrheic dermatitis is closely linked with Malassezia, a fungus that normally lives on the scalp and feeds on the oils that the hair follicles secrete.

It does not usually cause a problem, but in some people it becomes overactive, causing the scalp to become irritated and to produce extra skin cells.

As these extra skin cells die and fall off, they mix with the oil from the hair and scalp, forming dandruff.

2. Not enough hair brushing

Combing or brushing the hair regularly reduces the risk of dandruff, because it aids in the normal shedding of skin.

3. Yeast

People who are sensitive to yeast have a slightly higher chance of dandruff, so yeast may play a part. Dandruff is often worse during the winter months and better when the weather is warmer.

This may be because ultraviolet-A (UVA) light from the sun counteracts the yeast.

4. Dry skin

People with dry skin are more likely to have dandruff. Cold winter air combined with overheated rooms is a common cause of itchy, flaking skin. Dandruff that stems from dry skin tends to have smaller, non-oily flakes.

5. Shampooing and skin care products

Certain hair care products can trigger a red, itchy, scaling scalp. Frequent shampooing may cause dandruff, as it can irritate the scalp.

Some people say not shampooing enough can cause a build-up of oil and dead skin cells, leading to dandruff, but evidence is lacking that this is true.

6. Certain skin conditions

People with psoriasis, eczema, and some other skin disorders tend to get dandruff more frequently than others. Tinea capitis, a fungal infection also known as scalp ringworm, can cause dandruff.

7. Medical conditions

Adults with Parkinson's disease and some other neurological illnesses are more prone to dandruff and seborrheic dermatitis.

One study found that between 30 and 83 percent of people with HIV have seborrheic dermatitis, compared with 3 to 5 percent in the general population.

Patients who are recovering from a heart attack or a stroke and those with a weak immune system may be more prone to dandruff.

8. Diet

Not consuming enough foods that contain zinc, B vitamins, and some types of fats may increase the risk.

9. Mental stress

There may be a link between stress and many skin problems.

10. Age

Dandruff is more likely from adolescence through middle age, although it can be lifelong. It affects men more than women, possibly for reasons related to hormones.

Almost anyone can have dandruff, but certain factors can make you more susceptible:

  • Age. Dandruff usually begins in young adulthood and continues through middle age. That doesn't mean older adults don't get dandruff. For some people, the problem can be lifelong.
  • Being male. Because more men have dandruff, some researchers think male hormones may play a role.
  • Oily hair and scalp. Malassezia feeds on oils in your scalp. For that reason, having excessively oily skin and hair makes you more prone to dandruff.
  • Certain illnesses. For reasons that aren't clear, adults with neurological diseases, such as Parkinson's disease, are more likely to develop seborrheic dermatitis and dandruff. So are people with HIV infection, or those who have compromised immune systems from other conditions.

For most teens and adults, dandruff symptoms are easy to spot: white, oily-looking flakes of dead skin that dot your hair and shoulders, and a possibly itchy, scaly scalp. The condition may worsen during the fall and winter, when indoor heating can contribute to dry skin, and improve during the summer.

A type of dandruff called cradle cap can affect babies. This disorder, which causes a scaly, crusty scalp, is most common in newborns, but it can occur anytime during infancy. Although it can be alarming for parents, cradle cap isn't dangerous and usually clears up on its own.

Dandruff can often be a chronic condition, but it can be controlled with the proper treatment. First, try shampooing with a non-medicated shampoo, massaging the scalp firmly, and then rinsing well. Frequent shampooing removes flakes, reduces oiliness, and prevents dead skin cell build-up. If this fails to help, special antidandruff shampoos are usually helpful. Instructions for use depend on the specific shampoo used. Some are used on a daily basis, while other are used only once or twice weekly.

When selecting an over-the-counter shampoo, look for antidandruff ingredients such as ketoconazole*, selenium sulphide, salicylic acid, sulphur, coal tar, or zinc parathion. You may need to try a few products before you find the one that works for you.

If non-prescription preparations are not successful in providing some improvement after 2 weeks, or if the condition worsens, you should consider seeing a doctor. A doctor may prescribe a corticosteroid lotion to be applied to the scalp. Never use corticosteroids for a long period of time without advice from a doctor. They can thin out the skin and cause other side effects.

For an infant with cradle cap, apply a small amount of mineral oil to the dry areas of the scalp to soften the scales. Then remove the scales by gentle brushing. You can then wash the infant's hair with mild baby shampoo. If these measures do not help, try applying a small amount of warmed mineral oil at bedtime and then shampooing it out in the morning. If this isn't effective, talk to your child's doctor about next steps.

In general, corticosteroid shampoos and lotions are not used on infants, as infants absorb them much more easily through the skin than adults do. The good news is that cradle cap usually disappears eventually without any treatment within the first year of a baby's life.

To help keep dandruff under control, shampoo frequently, reduce your stress levels, try reducing or stopping your use of hair products (e.g., gels and sprays), and eat a healthy diet.

Shampoos and scalp products are available over the counter at most stores and pharmacies. These can control seborrheic dermatitis, but they cannot cure it.

Shampoos and scalp preparations

Before using an anti-fungal shampoo, individuals should carefully try to remove any scaly or crusty patches on the scalp, as far as possible, This will make the shampoo more effective.

Dandruff shampoo is available to purchase online. Products are also available to treat dandruff in the beard.

Ingredients to look out for

Most anti-dandruff or anti-fungal shampoos contain at least one of the following active ingredients:

  • Ketoconazole: An effective anti-fungal. Shampoos containing this ingredient can be used at any age.
  • Selenium sulfide: This reduces the production of natural oils by glands in the scalp. It is effective at treating dandruff.
  • Zinc pyrithione: This slows down the growth of yeast.
  • Coal tar: This has a natural anti-fungal agent. Dyed or treated hair may become stained by long-term usage. Tar soaps may also make the scalp more sensitive to sunlight, so users should wear a hat when outside. Coal tar can also be carcinogenic in high doses.
  • Salicylic acids: These help the scalp get rid of skin cells. They do not slow down the reproduction of skin cells. Many "scalp scrubs" contain salicylic acids. Treatment can sometimes leave the scalp dry and make skin flaking worse.
  • Tea-tree oil: Derived from the Australian Tea Tree (Melaleuca alternifolia), many shampoos now include this ingredient. It has long been used as an anti-fungal, an antibiotic, and an antiseptic. Some people are allergic to it.

The best strategy is to select a shampoo containing one of these ingredients and shampoo the hair every day until the dandruff is under control.

After this, they can be used less frequently.

Alternating dandruff shampoo with regular shampoo may help. A specific shampoo may stop being as effective after some time. At this point, it may be a good idea to switch to one with another ingredient.

Some shampoos should be left on the scalp for around 5 minutes, as rinsing too quickly will not give the ingredient time to work. Others should be rinsed at once. Users should follow the instructions on the container.

In adults, dandruff and seborrheic dermatitis may return at any time.

There is not much you can do to prevent dandruff and seborrheic dermatitis from reoccurring. However, using an antidandruff or antifungal shampoo once a week (or as prescribed on the bottle) after the scalp is clear may help to prevent dandruff and seborrheic dermatitis of the scalp.

Self-care advice

The following steps can help prevent dandruff:

  • Try not to scratch your scalp when using shampoo. Gently massage your scalp without scratching as this will not damage your scalp or your hair.
  • Brush your hair daily and wash it at least three times a week. After washing your hair, rinse it thoroughly to get all the shampoo out. Using a shampoo that contains tea tree oil daily may help reduce dandruff. It contains an antifungal and antiseptic and can be bought in health shops.
  • Avoid using chemicals on your scalp, such as those used in hair colouring products. The chemicals reduce the number of bacteria on the scalp that are needed to fight against yeasts.
  • Using hair products, such as hair gels and hair sprays, can build up oils and can irritate the scalp in some people. You may want to stop using a product for a while to see if your dandruff improves, or change products completely.
  • Spending time outdoors can help reduce dandruff. However, ultraviolet (UV) light from the sun can damage your skin, as well as increasing your risk of developing skin cancer. Make sure you protect yourself from the sun by using a sun screen with the appropriate skin protection factor (SPF) for your skin type.
  • Managing stress can reduce your risk of getting dandruff. Stress can have an adverse effect on your overall health and can increase your risk of becoming ill. Stress can also trigger dandruff or make existing dandruff worse. If you feel stressed or under pressure, your GP can recommend a variety of different ways to help treat your stress. See the Health A-Z topic on Stress for more detailed information.

See your GP if you are concerned about the location, amount and size of any flakes of dandruff. Your GP may test for other conditions, such as psoriasis (a skin condition that causes red, flaky, crusty patches of skin and silvery scales).

Anti fungal

Anti fungal medicine is used to treat fungal infections. Examples include clotrimazole and ketoconazole.

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