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Signs of dandruff: Dandruff – Symptoms and causes

by alexxlab

Dandruff – NHS

Dandruff is a common skin condition. It’s not harmful and you cannot catch it.

Check if it’s dandruff

Dandruff causes white or grey flakes of skin to appear on the scalp and in the hair.

Credit:

DR P. MARAZZI/SCIENCE PHOTO LIBRARY https://www.sciencephoto.com/media/256156/view

The flakes are often more noticeable in darker hair and if they fall from your scalp onto your shoulders.

Your scalp may also feel dry and itchy.

How to treat dandruff yourself

Use an anti-dandruff shampoo to treat dandruff. There are several different types you can buy from pharmacies or supermarkets.

Look for a shampoo that contains 1 of these ingredients:

  • zinc pyrithione
  • salicylic acid
  • selenium sulphide (or selenium sulfide)
  • ketoconazole
  • coal tar

A pharmacist can tell you how to use the shampoo.

Use the shampoo for a month to see if your dandruff gets better. You might need to try more than 1 type to find a shampoo that works for you.

Non-urgent advice: See a GP if:

  • you still have dandruff symptoms after using anti-dandruff shampoo for a month
  • your dandruff is bad or your scalp is very itchy
  • your scalp is red or swollen
  • you have flaky, itchy patches on your face or other parts of your body

The GP can check your scalp for skin conditions that could be causing your dandruff.

Causes of dandruff

Dandruff is not caused by poor hygiene, although it may be more obvious if you do not wash your hair regularly.

Stress and cold weather may also make dandruff worse.

A list of conditions that cause dandruff and their main symptoms.
SymptomsPossible causes
Scaly, itchy and red patches on skin on scalp, face and other areas of the bodySeborrheic dermatitis
Red or silver rash on scalp, sometimes with patchy hair lossTinea capitis, known as ringworm
Dry, red, flaky and very itchy skin on areas of the bodyEczema
Red, irritated skin, may also have blisters and cracked skin; reaction to products such as hair dye, sprays, gels or moussesContact dermatitis
Red, flaky, crusty and sore patches of skin covered with silvery scalesPsoriasis
Greasy, yellowish crusts on baby’s scalp, eyebrows and nappy areaCradle cap

Information:

Do not worry if you’re not sure what’s causing your dandruff. Follow the advice on this page and see a GP if things do not get better in a month.

Page last reviewed: 23 December 2022
Next review due: 23 December 2025

What Is Dandruff? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Dandruff occurs, essentially, when small bits of dry skin are shed from the scalp. You might spy these flakes in your hair or on your shoulders. Dandruff may make your scalp itchy, too. It’s a common problem, but it isn’t as simple as it seems. Dandruff is actually quite tricky to define because it overlaps with seborrheic dermatitis (a chronic form of eczema) and other skin conditions that lead to a scaly scalp. Here’s what you need to know.

Signs and Symptoms of Dandruff

The big tip-off that an individual may have dandruff are the telltale patches of white flakes on the scalp, made up of dead skin, that come loose in your hair. According to the Merck Manual, other signs include:

  • At times, the scalp can be itchy
  • Greasy or dry scales on the scalp
  • Yellowish to reddish scaly raised bumps along the hairline (in severe cases)

Common Questions & Answers

How do I stop my dandruff?

Try washing daily with a gentle shampoo, an over-the-counter or prescription dandruff shampoo, and cutting back on styling products. Medicated shampoos might not be useful for healthy Black hair, however, but if used on the scalp alone they could be helpful.

What causes dandruff?

It’s caused by dry skin, or the buildup of oil. Skin conditions like seborrheic dermatitis, a weakened immune system, and certain neurological disorders, such as Parkinson’s disease, can also cause dandruff.

Is having dandruff healthy?

It’s not usually the sign of a serious medical problem, but if it’s a chronic condition due to something like a skin issue such as seborrheic dermatitis, it requires treatment.

How long can dandruff last?

It can’t be cured, and can be chronic, but in some cases, a change of habit — washing your hair more often, for example — can clear up flakes fairly quickly.

Is dandruff a fungus?

In some cases, it’s caused by yeast, which is a fungus. The yeast can feed on scalp oils, and bodies will mistake this breakdown of oils for an irritant. The scalp then speeds up skin cell renewal, which causes dandruff.

Causes and Risk Factors of Dandruff

Dandruff can happen for a number of reasons.

Seborrheic dermatitis If you have a particularly bad case of dandruff, it’s likely a mild case of seborrheic dermatitis (SD), according to the American Osteopathic College of Dermatology.

SD is a chronic form of eczema that affects areas of the body that secrete the most sebum, or oil, notes the National Eczema Association.

People with oily skin are often more prone to dandruff. The reason: A yeast called Malassezia globosa feeds on oils on the scalp. Some people’s bodies perceive this breakdown of oil as an irritant, so the scalp reacts by upping the speed at which skin cells renew, causing dandruff, notes Amy McMichael, MD, a professor of dermatology and the chair of the department of dermatology at Wake Forest School of Medicine in Winston-Salem, North Carolina. For those without dandruff, it takes a whole month for new skin cells on the scalp to mature, die, and shed. But for those with dandruff, this process occurs in a mere two to seven days, according to a report in the Journal of Medical Chemistry.

Still, it’s important to note that while M. globosa has long been thought to be the main risk factor for dandruff, a causal relationship has yet to be firmly established, noted a July 2019 report in the journal Experimental Dermatology.

Contact dermatitis Contact dermatitis is skin irritation caused by either an allergen or an irritant, resulting in an itchy, possibly painful rash. And in the case of dandruff, that reaction is on the scalp. This generally occurs because of hair-care products or dyes, according to the American Academy of Dermatology Association.

Dry skin If cold winter air dries out your skin all over, including your scalp, then dry skin may be the cause of your dandruff. When dry skin causes dandruff, the flakes are usually smaller and less oily than the flakes caused by SD. (In addition, cold and dry climates can worsen SD, according to the Cleveland Clinic.)

Almost anyone can have dandruff, but the following factors can make you more susceptible.

Shampooing habits “For those who are already at risk for dandruff, washing infrequently can worsen the condition,” says Dr. McMichael. Taking extended breaks can lead to a buildup of oil that can lead to dandruff.

Age Dandruff often begins at puberty and peaks around age 20, becoming far less prevalent among folks over 50 years old, according to a review published in the Journal of Clinical and Investigative Dermatology.

Sex Androgen hormones, such as testosterone, stimulate activity in the sebaceous glands. More oil means an increased chance of an inflammatory reaction and dandruff. Men are more frequently affected by dandruff than women.

Weakened immune system SD is more prevalent in individuals who’ve undergone an organ transplant and those with HIV or AIDS, hepatitis C, or alcoholic pancreatitis. For example, 30 percent to 83 percent of those with HIV report SD.

Neurologic and psychiatric conditions Parkinson’s disease, Alzheimer’s disease, epilepsy, traumatic brain injury, and spinal cord injury are among the conditions that elevate one’s risk of SD, including dandruff.

Those with Parkinson’s disease, for example, have an impaired autonomic nervous system that helps to control things like oil gland secretions, which can lead to an overproduction that leads to dandruff, according to the American Parkinson’s Disease Association.

History of other skin disorders Eczema, rosacea, psoriasis, or acne can trigger or worsen seborrheic dermatitis.

Oily skin If you have naturally oily skin, you’re at an elevated risk for seborrheic dermatitis.

Oiling your scalp “Certain oils applied to the scalp can cover the scale, but worsen the flaking and itching response,” notes McMichael.

How Is Dandruff Diagnosed?

A dermatologist can usually diagnose dandruff simply by looking at your scalp. If your dandruff does not respond to treatment, your healthcare provider may opt to perform a skin biopsy in order to rule out other possible issues, notes the Cleveland Clinic.

Duration of Dandruff

Dandruff due to seborrheic dermatitis is a chronic condition that warrants repeated or long-term treatment. As for dandruff that arises from contact dermatitis, dry skin, or shampooing habits, a change of habits should clear up flakes fairly quickly.

Treatment and Medication Options for Dandruff

Dandruff is an often chronic, but treatable, condition.

Gentle over-the-counter shampoo To reduce oil and skin cell buildup, wash hair daily with a gentle shampoo, lightly massaging the scalp to loosen flakes, per the Mayo Clinic.

(See the Black Women and Dandruff section, below, when daily washing isn’t recommended.)

OTC dandruff shampoo If gentle shampoo is not helping, try an over-the-counter (OTC) dandruff shampoo.

It’s best to alternate between two or three of these shampoos, notes the American Osteopathic College of Dermatology.

For mild to moderate cases, look for dandruff shampoos that contain the following active ingredients.

  • Selenium sulfide This antifungal slows the death of skin cells. This active ingredient can be found in Head & Shoulders Clinical Strength and Selsun Blue, among other shampoos.
  • Pyrithione zinc This antibacterial and antifungal combo is in Head & Shoulders, DermaZinc, and Jason Dandruff Relief 2 in 1.
  • Salicylic acid Neutrogena T/Sal and Baker’s P&S both rely on salicylic acid to slough away flakes and promote healthier skin.
  • Ketoconazole Nizoral A-D is a treatment that contains the antifungal ketoconazole; it can be found both OTC and via prescriptionand can be formulated as a shampoo, gel, or mousse.
  • Tar Tar-based shampoos, like Neutrogena T/Gel, act as both an antibiotic and antifungal. But if you have blond, white, or gray hair, a tar shampoo can cause discoloration. This treatment can also make the scalp extra sensitive to sunlight.

Prescription Dandruff Treatment

If regular and proper use of OTC shampoo, for several weeks, does not alleviate dandruff, ask your dermatologist if you’d benefit from a prescription-strength antifungal shampoo like Loprox or Nizoral, or a topical corticosteroid lotion,

such as Capex or Synalar (fluocinolone topical), Luxiq (betamethasone topical), or Clobex (clobetasol topical).

An alternative to corticosteroids for dandruff treatment is a class of drugs called calcineurin inhibitors. These, like Protopic (tacrolimus topical) and Elidel (pimecrolimus topical), work by helping to suppress the immune response, according to Harvard Health.

Alternative and Complementary Therapies

Tea tree oil Shampoos or topicals that contain 5 percent tea tree oil (an antiseptic, antibiotic, and antifungal) appear to be a safe and effective treatment for dandruff, according to a small randomized study in the Journal of the American Academy of Dermatology.

Healthy fats Increasing your intake of omega-3 fatty acids, like those found in salmon, tuna, and mackerel, will help regulate oil production on the skin, notes Cedars-Sinai.

Additional Approaches

Get some sun. Brief bouts of sunshine can help reduce yeast production on the scalp.

But if you are also using a tar-based dandruff treatment, avoid direct sun exposure, as your scalp is especially sensitive to sunlight.

Cut back on hair products. Styling gels, sprays, pomades, and more can build up on the hair and scalp, increasing oiliness and dandruff.

Prevention of Dandruff

“You can prevent the signs and symptoms of dandruff, but there is no cure for dandruff,” says McMichael. If you’ve got an especially oily scalp, daily shampooing with a gentle cleanser, coupled with a light scalp massage, may help prevent dandruff in certain cases. If you’re using an OTC dandruff shampoo, talk to your dermatologist about how often to use it for maintenance and prevention. Finally, increased omega-3 intake, brief exposure to sun, and fewer hair products can help prevent dandruff as well.

Black Women and Dandruff

In a study in the Journal of Clinical and Aesthetic Dermatology, 44 percent of Black women reported a history of seborrheic dermatitis symptoms, such as excessive itching or scaling on their scalp.

Unfortunately, Black women also tend to face some common dandruff-treatment barriers. “Because many Black women do not wash their hair frequently through the week, this can make dandruff worse and treatment challenging,” notes McMichael, who recommends Black women aim to wash at least every two weeks, but once weekly is best. Another barrier: Medicated shampoos tend to be great for the scalp, but not for healthy Black hair, due to hair shaft dryness. “That means that using these shampoos on the scalp alone, not the whole head of hair, is often best,” says McMichael.

Research and Statistics: How Many People Get Dandruff?

Dandruff affects approximately 50 percent of the general adult population worldwide, according to past research.

Dandruff is more prevalent in males than females.

Conditions Related to Dandruff

“Sometimes what you think is dandruff is simply product debris, like hair gel or hair spray,” says McMichael. Other times, it may be one of these conditions.

Cradle cap Technically, seborrheic dermatitis and cradle cap and dandruff are all the same thing. Cradle cap affects infants between two weeks and 12 months old; they develop greasy, scaly, or crusty red or yellow patches on the scalp, according to KidsHealth. (The flaky rash can also appear on the face, diaper area, and other areas of the body.)

Scalp psoriasis About 50 percent of people who have plaque psoriasis experience a flare-up on the scalp at some point. On the scalp, you may have reddish patches, dandruff-like flaking, silvery-white scale, and dryness. Scalp psoriasis is often itchy, with the itch ranging from mild to intense, notes the American Academy of Dermatology Association.

Tinea capitis This highly contagious fungal infection is also called ringworm of the scalp and hair shafts. Symptoms may include itchy, scaly, and bald patches on the head. Tinea capitis is most common in toddlers and school-age children, per the Mayo Clinic.

Resources We Love

Skin of Color Society

This professional dermatologic organization is dedicated to promoting awareness of (and excellence within) the dermatological care of skin of color. SCS offers a Find a Doctor database to help those of Asian, Hispanic or Latino, African, Native American, and Pacific Island descent find local dermatologists who are especially knowledgeable about their skin concerns. Whether you’re struggling to find a dermatologist who can help treat persistent dandruff in Black hair or you’ve got another skin-related issue, SCS’s Find a Doctor database can help.

American Academy of Dermatology

The AAD is the largest dermatology group in the United States and its website is full of resources, tips, and more. Curious how to ease your itchy skin? Check out their Everyday Care section. Craving some insider secrets to tackle your rosacea? Try the AAD’s Diseases and Conditions area. Not sure how to combat your child’s dandruff? Go to the areas dedicated to Parents and Kids.

Editorial Sources and Fact-Checking

  • Seborrheic Dermatitis. Merck Manuals: Consumer Edition. September 2022.
  • Seborrheic Dermatitis. American Osteopathic College of Dermatology.
  • Seborrheic Dermatitis. National Eczema Association.
  • Hewitson KS, Vullo D, Scozzafava A, et al. Molecular Cloning, Characterization, and Inhibition Studies of a B-Carbonic Anhydrase From Malassezia Globosa, a Potential Antifungal Target. Journal of Medical Chemistry. March 19, 2012.
  • Wikramanayake TC, Borda LJ, Miteva M, Paus R. Seborrheic Dermatitis — Looking Beyond Malassezia. Experimental Dermatology. July 16, 2019.
  • 10 Reasons Your Scalp Itches and How to Get Relief. American Academy of Dermatology Association.
  • Seborrheic Dermatitis. Cleveland Clinic. May 29, 2020.
  • Borda LJ, Wikramanayake TC. Seborrheic Dermatitis and Dandruff: A Comprehensive Review. Journal of Clinical and Investigative Dermatology. December 2015.
  • Sweating and Other Skin Problems in People With Parkinson’s Disease. American Parkinson’s Disease Association. July 23, 2019.
  • Seborrheic Dermatitis. Cedars-Sinai.
  • Seborrheic Dermatitis Diagnosis and Tests. Cleveland Clinic. May 29, 2020.
  • Dandruff Diagnosis and Treatment. Mayo Clinic. September 21, 2021.
  • Dandruff. American Osteopathic College of Dermatology.
  • Drugs and Supplements Ketoconazole (Topical Route): Description and Brand Names. Mayo Clinic. February 1, 2022.
  • Seborrheic Dermatitis: Management and Treatment. Cleveland Clinic. May 29, 2020.
  • What Is the Best Way to Treat Severe Dandruff? Harvard Health Publishing. May 2017.
  • Satchell AC, Saurajen A, Bell C, Barnetson RS. Treatment of Dandruff With 5 Percent Tea Tree Oil Shampoo. Academy of Dermatology. December 1, 2002.
  • Barak-Shinar D, Green LJ. Scalp Seborrheic Dermatitis and Dandruff Therapy Using a Herbal and Zinc Pyrithione-Based Therapy of Shampoo and Scalp Lotion. Journal of Clinical and Aesthetic Dermatology. January 2018.
  • Dandruff: What It Is and What to Do About It. Cedars-Sinai. September 25, 2019.
  • Gathers RC, Mahan MG. African American Women, Hair Care, and Health Barriers. Journal of Clinical and Aesthetic Dermatology. September 2014.
  • Elewski BE. Clinical Diagnosis of Common Scalp Disorders. Journal of Investigative Dermatology Symposium Proceedings. December 1, 2005.
  • Cradle Cap (Seborrheic Dermatitis) in Infants. KidsHealth. February 2019.
  • Ringworm (Scalp) Symptoms and Causes. Mayo Clinic. January 22, 2022.

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Causes

Classification

Symptoms

Complications

Diagnosis

Treatment

Prevention

Dandruff – small scales of the epidermis, which, after peeling off, remain on the scalp. Almost every person has experienced this unpleasant condition. These small scales are formed due to the accelerated growth of the main cells of the epidermis in the process of renewal of the cellular layer of the skin.

Dandruff is considered a mild manifestation of seborrheic dermatitis. It is not contagious, most often occurs in people aged 15-25 years and very rarely in the elderly. It is believed that this is the result of non-compliance with the rules of personal hygiene. However, in most cases, dermatologists define this condition as the result of a disease.

Causes and triggers

Dandruff never appears on its own, there are always certain reasons for this. The main of them is the defeat of the scalp with a yeast fungus of the genus Malassezia furfur (Pityrosporum ovale). The favorite localization of these fungi is areas of the skin where sebum is present in large quantities.

Among the predisposing factors are:

  • heredity – if there are people in the family who suffer from such a problem, then with a high probability it will be in children;
  • increased work of the sebaceous glands, especially in the transitional adolescence with the onset of sex hormones;
  • seborrhea – excessive formation of sebum;
  • diseases of the nervous system;
  • taking certain drugs used in the treatment of mental illness;
  • emotional overload;
  • intestinal dysbacteriosis;
  • diseases of the digestive tract;
  • avitaminosis;
  • diabetes mellitus;
  • the use of chemicals and thermal effects on the scalp.

Why does dandruff still appear? It can occur when using cheap and low-quality shampoos, which include aggressive surfactants, and also be the result of too frequent or, conversely, too rare shampooing.

Dandruff in young children is often the result of an allergic reaction, as well as the wrong choice of scalp care products. In adolescents, it is associated with the transition period and the strengthening of the hormonal system. Often it is diagnosed along with too oily facial skin, as well as acne.

Classification

According to the international classification, dandruff belongs to seborrheic dermatitis. It is customary to distinguish three options:

  1. Oily dandruff (seborrhea) occurs against the background of increased sebum production. At the same time, the skin and hair are oily and shiny. This type of dandruff is divided into thick and liquid. In the first case, the scales stick together, the hair becomes hard and rough, there are comedones on the skin. The second is distinguished by enlarged pores and shiny skin, the scales fit tightly to the skin, and the hair sticks together in strands.
  2. Dry dandruff (seborrhea) is the result of minimal sebum secretion by the scalp, which is associated with its increased viscosity. Because of this, the scalp becomes too dry, and the hair is thin and brittle, severe itching appears.
  3. Mixed form (seborrhea) – when signs of both oily and dry seborrhea appear.

As a result, a lot of scales appear on a person’s head, their number significantly exceeds the norm, so they become visible to the naked eye. If this is accompanied by itching and irritation, and foci of redness appear, then the diagnosis is “Seborrheic dermatitis”. Scales are easily separated from the scalp, fall on clothes. The hair itself becomes thin, brittle, they have split ends.

Dandruff on the head is always an unpleasant phenomenon, and it will not be possible to cope with this problem with cosmetics. It is necessary to consult a dermatologist or trichologist and prescribe medications.

Symptoms

The symptoms of dandruff are easy to identify. It does not go unnoticed and is a real aesthetic problem for people with this diagnosis. Excessive shampooing and combing, as well as the use of a hair dryer, other chemical and thermal agents, will only exacerbate the existing problem.

The signs of dandruff are especially noticeable in people with dark hair, as against such a background, white scales will be clearly visible both throughout the scalp and along the length of the hair. Among the main manifestations are oily sheen of hair and peeling of the scalp with flaking of a large number of skin flakes. Also, patients note severe itching, redness and increased sensitivity of the skin. Some people start to lose their hair.

A large number of scales in the hair and on clothes is a clear sign that ordinary shampoos cannot cope with the problem. Moreover, their accumulation is not observed everywhere, but only in places of high pressure and in the forehead.

Complications

If dandruff of the scalp is not treated, then in the future, with the aggravation of the process, all kinds of complications can develop. Their list includes:

  1. Sebopsoriasis with the transition of scaly plaques to other areas of the body.
  2. Hair loss associated with the overlap of hair follicles with scales, due to which they do not receive oxygen. Sometimes this leads to the death of hair follicles, and then baldness forms in places where such dead tissues are concentrated.
  3. Pyoderma as a result of constant scratching of itchy skin with nails. An infection gets into the wounds, which can cause suppuration with the formation of boils, abscesses.
  4. A sebaceous gland cyst that develops due to blockage of its duct, and all the secret of the gland will accumulate inside it.

All this causes severe psycho-emotional discomfort, and a person with such a diagnosis tries to appear less in society. Even with daily shampooing, the problem remains unresolved.

Diagnostics

Identifying dandruff on hair is not difficult at all. It is important to conduct a survey, find the cause and provoking factors that will lead to the further development of seborrhea. Some patients are advised to take a blood test for glucose, thyroid hormones. Examination is performed using a dermatoscope. If necessary, consultations are held with a gastroenterologist, trichologist, endocrinologist.

Differential diagnosis is carried out with psoriasis, irritant dermatitis, trichomycosis, lichen.

Treatment

How to get rid of dandruff forever? Unfortunately, there is no single answer to this question. The first thing to do is to identify and eliminate the cause of the disease.

Dandruff is treated at home using special shampoos, which are bought only in pharmacies. The most popular and effective are:

  1. “Kertiol” – with sulfur and salicylic acid in the composition. With regular use, it helps to get rid of flaking of the scalp, relieves itching and irritation, and eliminates oiliness.
  2. “Seligel” – recommended for the treatment of dry dandruff in men. Thanks to selenium disulfide, it has a pronounced antifungal effect. The therapeutic component helps for a long time to eliminate the cause of increased peeling – a fungus.
  3. “Friderm zinc” – has anti-inflammatory, antibacterial, antifungal activity. Gradually accumulating in the cells of the epidermis, zinc does not allow fungi to reactivate and again lead to inflammation.
  4. “Kelual DS” – recommended for use in case of exacerbation of the disease. Most often used for dandruff in women in the autumn-winter period. Helps to neutralize the action of the fungus, reduces the production of sebum, eliminates itching and redness of the scalp.
  5. Nizoral is one of the popular antifungal agents. However, after stopping use, the risk of recurrence of symptoms is high. Recommended for use in teenagers.
  6. “Sebozol” is a popular remedy in the treatment of diseases caused by fungi that live on the skin and scalp. It also helps in the treatment of seborrhea and lichen.

Use dandruff shampoo only need a therapeutic effect. With it, you should wash your hair 2 times a week, and you need to not only apply the product to your hair, but also carefully rub it into the scalp, and then leave it for 5-10 minutes, then rinse with water. There is also a soap for dandruff, which can be based on the same medicinal ingredients as in shampoos. Most often, doctors recommend tar and sulsen for use.

If within 3 weeks of this treatment the number of skin scales does not decrease or does not disappear at all, you should seek medical advice.

What else should I do if I have dandruff? Dandruff remedies can be supplemented with a balanced diet, avoiding fatty and sugary foods. The diet must contain fermented milk products, as well as vitamin-mineral complexes and fiber.

Prevention

Unfortunately, there are actually no effective measures to prevent dandruff. Despite the fact that it is not so difficult to eliminate the main symptom, scales on the hair, it is necessary to identify and eliminate the cause of the disease. On the recommendation of a dermatologist, it is necessary to wash your hair often using a selected shampoo, eat right, not expose yourself to severe stress and give up bad habits. If you do not start treatment in a timely manner, then over time this problem will develop into a more severe form – dermatitis.

The author of the article:

Shapovalova Valeria Olegovna

cosmetologist, dermatologist, trichologist

work experience 7 years

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