Dandruff

Overview

Dandruff is a common condition that causes the skin on the scalp to flake. It isn't contagious or serious. But it can be embarrassing and difficult to treat.

Mild dandruff can be treated with a gentle daily shampoo. If that doesn't work, a medicated shampoo may help. Symptoms may return later.

Dandruff is considered to be a mild form of seborrheic dermatitis. In babies, seborrheic dermatitis is called cradle cap.

Symptoms

Dandruff signs and symptoms may include:

  • Skin flakes on your scalp, hair, eyebrows, beard or mustache, and shoulders
  • Itchy scalp
  • Scaly, crusty scalp in infants with cradle cap

The signs and symptoms may be more severe if you're stressed, and they tend to flare in cold, dry seasons.

When to see a doctor

Most cases of dandruff don't require a doctor's care. See your primary care doctor or a doctor who specializes in skin conditions (dermatologist) if your condition doesn’t improve with regular use of over-the-counter dandruff shampoo.

Causes

Dandruff may have several causes, including:

  • Irritated, oily skin
  • Not shampooing enough
  • A yeastlike fungus (malassezia) that feeds on oils on the scalps of most adults
  • Dry skin
  • Sensitivity to hair care products (contact dermatitis)
  • Other skin conditions, such as psoriasis and eczema

Risk factors

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.
  • Certain illnesses. Parkinson's disease and other diseases that affect the nervous system also seem to increase risk of dandruff. So does having HIV or a weakened immune system.

Diagnosis

A doctor can often diagnose dandruff simply by looking at your hair and scalp.

Treatment

The itching and flaking of dandruff can almost always be controlled. For mild dandruff, first try daily cleansing with a gentle shampoo to reduce oil and skin cell buildup. If that doesn't help, try a medicated dandruff shampoo. You may need to try more than one shampoo to find the hair care routine that works for you. And you'll likely need repeated or long-term treatment.

If you develop itching, stinging, redness or burning from any product, stop using it. If you develop an allergic reaction — such as a rash, hives or difficulty breathing — seek immediate medical attention.

Dandruff shampoos are classified according to the medication they contain:

  • Pyrithione zinc shampoos (DermaZinc, Head & Shoulders, Jason Dandruff Relief 2 in 1). These contain the antibacterial and antifungal agent zinc pyrithione.
  • Tar-based shampoos (Neutrogena T/Gel). Coal tar slows how quickly skin cells on your scalp die and flake off. If you have light-colored hair, this type of shampoo may cause discoloration. It can also make the scalp more sensitive to sunlight.
  • Shampoos containing salicylic acid (Neutrogena T/Sal, Baker's P & S, others). These products help eliminate scale.
  • Selenium sulfide shampoos (Head & Shoulders Intensive, Selsun Blue, others). These contain an antifungal agent. Use these products as directed and rinse well after shampooing, as they can discolor the hair and scalp.
  • Ketoconazole shampoos (Nizoral A-D). This shampoo is intended to kill dandruff-causing fungi that live on your scalp. It's available over-the-counter or by prescription.

If one type of shampoo works for a time and then seems to lose its effectiveness, try alternating between two types of dandruff shampoos.

Read and follow the directions on each bottle of shampoo you try. Some products need to be left on for a few minutes, while others should be rinsed off quickly. At first, use a medicated shampoo one to three times a week to treat dandruff. Then taper to once a week or less frequently for maintenance and prevention.

If you've used medicated shampoo regularly for several weeks and still have dandruff, talk to your doctor or dermatologist. You may need a prescription-strength shampoo or a steroid lotion.

Lifestyle and home remedies

You can take steps to reduce your risk of developing dandruff or to control it:

  • Learn to manage stress. Stress affects your overall health, making you susceptible to a number of conditions and diseases. It can even help trigger dandruff or worsen existing symptoms.
  • Eat a healthy diet. A diet that provides enough zinc, B vitamins and certain types of fats may help prevent dandruff.
  • Shampoo often. If you tend to have an oily scalp, daily shampooing may help prevent dandruff. Gently massage your scalp to loosen flakes. Rinse thoroughly.
  • Get a little sun. Sunlight may be good for controlling dandruff. But because exposure to ultraviolet light damages your skin and increases your risk of skin cancer, don't sunbathe. Instead, just spend a little time outdoors. And be sure to wear sunscreen on your face and body.
  • Limit hair styling products. Hair styling products can build up on your hair and scalp, making them oilier.

Alternative medicine

Small studies have found that tea tree oil can reduce dandruff, but more study is needed.

Tea tree oil, which comes from the leaves of the Australian tea tree (Melaleuca alternifolia), has been used for centuries as an antiseptic, antibiotic and antifungal agent. It's now included in a number of shampoos found in natural foods stores. The oil may cause allergic reactions in some people.

Preparing for an appointment

You don't need any special preparations for an appointment to diagnose dandruff. Your doctor will likely be able to diagnose your dandruff and its cause simply by looking at your scalp and skin. If you've started using any new hair care products, bring the bottles with you to your appointment or be prepared to tell your doctor about them so he or she can determine whether the products may be causing your dandruff.


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