Dandruff results from a dry scalp and can have various causes, including fungus and your shampooing schedule. Treatments like dandruff shampoo typically loosen flakes or target fungal overgrowth.
Dandruff happens when dry pieces of your scalp flake off. Understanding the underlying cause can help you manage, treat, and prevent it.
Read up on the most common symptoms of dandruff and ways to improve your scalp health.
Dandruff is commonly related to seborrheic dermatitis (SD), which causes itchy and flaky skin on the scalp. It’s so common that it affects about half the global adult population.
Many factors can contribute to the development of dandruff, so pinpointing the exact cause of your itchy, flaky scalp can be difficult. Here are a few likely culprits:
- secretions from your sebaceous glands
- fungal colonization on the surface of your skin
- a yeast called Malassezia, which can irritate the scalp and cause excess skin cell growth
- not shampooing enough, which may cause skin cells to accumulate and create flakes and itching
- shampooing too frequently, which can overdry the scalp
- brushing your hair too much or too forcefully, which can create friction with the sensitive skin on the scalp
- a reaction to personal care products, or contact dermatitis, which makes your scalp irritated and itchy
- sun damage
- excessive pressure on the scalp from hats
- a diet that is lacking certain nutrients
- exposure to dust or dirt
Some people may be more predisposed to dandruff than others for unknown reasons. For instance, males tend to have dandruff more often than females. You may have noticed symptoms around puberty, but dandruff can develop at any age.
People who tend to have oilier hair or live with certain illnesses (such as Parkinson’s disease, HIV, or other health conditions or medications that affect the immune system) also have a higher risk.
The main symptoms of dandruff include skin flakes and an itchy, scaly scalp. Oily flakes typically accumulate in your hair and shoulders and often get worse during the fall and winter months when the air is dry.
Symptoms may also be more severe in some people.
Symptoms of dandruff can include:
- oily flakes
- itching
- irritated patches on the skin of the scalp and sometimes on the face
- eyebrow dandruff
- hair loss
- dry flakes on the skin of the face
Medications, both prescription and over-the-counter (OTC), can help get rid of dandruff. Home remedies can also relieve dry scalp.
Experts typically recommend dandruff shampoo and scalp treatments. The American Academy of Dermatology Association (AAD) recommends taking the following steps:
- Follow instructions: Since there are many different types of dandruff treatment shampoos, and each comes with its own instructions, it’s important that you carefully read and follow the directions of the product of your choice. Be sure you know if you’re supposed to leave the shampoo on your scalp for a certain amount of time before washing or if you should wash out immediately.
- Different skin and hair types require different care: People with naturally coily, coarse, or curly hair may only need to wash their hair as needed and use dandruff shampoo once weekly, as some of the products can dry out hair. People with fine or naturally straight hair may need to wash their hair daily and use dandruff shampoo twice weekly. Your best action may be to speak with a board certified dermatologist who can recommend the best products for your hair and skin type and the frequency with which you should use them.
You can buy some dandruff shampoos over the counter without a prescription. Stronger, medicated formulas usually require a doctor’s prescription.
Typical dandruff shampoos include ingredients to loosen the dandruff flakes from the scalp or target the overgrowth of the Malassezia fungus, which may play a role in the development of the dandruff. These ingredients may include:
- ketoconazole
- selenium sulfide
- coal tar
- zinc pyrithione
However, the AAD warns against using coal tar shampoo. This shampoo can discolor light hair and make your scalp more sensitive to the sun. If you use it, take extra precautions when exposed to sunlight.
Choose an OTC dandruff shampoo that best suits your hair type and the severity of your dandruff.
If you want to try some natural home remedies for dandruff before you turn to medicated solutions, some people recommend:
- Baking soda: Gently rub baking soda into your scalp in the shower and rinse after a few minutes.
- Apple cider vinegar: Mix 1/4 cup apple cider vinegar with 1/4 cup water. Apply to your hair for 15 minutes to 1 hour, then rinse. Do this twice a week.
- Coconut oil: Rub 3 to 5 teaspoons of coconut oil into your scalp and leave for 1 hour. Then, shampoo your hair and wash it out.
- Lemon juice: Rub 2 teaspoons of lemon juice into your scalp and rinse. Then rub one more teaspoon mixed with 1 cup water. Do this every day.
- Aloe vera: Rub aloe vera into your scalp before you wash your hair.
- Olive oil: Rub 10 drops into your scalp. Cover your head with a shower cap and leave overnight. Shampoo and wash your hair in the morning.
Keep in mind that home remedies are typically not backed by research. Some people may have skin reactions to natural ingredients. Applying a new product to a small area for at least 24 hours before applying it to a larger area is best.
You may find it hard to tell the difference between dandruff and dry scalp, as they can both present similarly. Both can cause flakes and an itchy sensation on your scalp.
But while dandruff is related to seborrheic dermatitis, dry scalp is related to your skin losing too much water. This can happen when you’re not getting enough fluids. It can also result from hair products stripping your scalp of its natural oils. If you live in a cold and dry climate, you may also be more susceptible to having a dry scalp.
Treating a dry scalp usually involves switching to a gentle, unmedicated shampoo with fewer additives that may remove moisture from the scalp.
You may be able to reduce or prevent dandruff with certain practices, including:
- Practicing scalp hygiene: Do your best to resist the urge to touch your scalp, especially if it’s already itchy. Scratching can increase irritation and lead to a vicious cycle. When you touch and scratch, you can also introduce dirt that can worsen dandruff.
- Find the right shampooing balance for your scalp: Shampoo is often enough to keep oils at bay, but don’t use too many products in your hair as that can irritate the scalp.
- Reducing stress: Stress can aggravate or even worsen dandruff for some individuals. While Malassezia is not introduced to your scalp by stress, it can thrive if your immune system is compromised, which can happen due to severe or chronic stress. Do your scalp a favor and relax. Try taking a restorative walk or practicing yoga. You may even find it helpful to keep a log of stressful events. Write down what they are and how they impact your dandruff. That way, you can avoid potential triggers in the future.
- Getting fresh air: Research shows that regular exposure to the outdoors, especially when the air is fresher, can help reduce oil buildup on the scalp.
- Massaging your scalp: A scalp massage may also help prevent dandruff symptoms.
- Brushing your hair: Brush your hair when it’s damp (not wet) at least twice daily.
- Protect your scalp from the sun: The AAD recommends wearing a wide-brimmed hat to protect your scalp from harmful UV rays. Opt for one that isn’t too tight to limit friction on your scalp.
Many cases of dandruff can be treated effectively with over-the-counter (OTC) shampoos and other lifestyle measures.
But dandruff isn’t the only reason you may have an itchy scalp. If your dandruff is particularly stubborn or itchy, you may have psoriasis, eczema, or a true fungal infection. A doctor can help.
Speak with a doctor if your itch isn’t letting up or your scalp becomes irritated or swollen. Consider also talking with a doctor if shampoos don’t help, skin discoloration and flaking spread to your face or other areas, or the itching starts to interfere with your everyday life.
Sometimes, the symptoms can indicate other, more serious, conditions such as actinic keratoses or Tinea capitis (scalp ringworm), and it’s best to be checked out to get the best treatment.
Q: When should I see a specialist for dandruff? What kind of specialist treats it?
Anonymous
A: If flaking from the scalp persists even after you consistently follow the recommended habits below and use OTC remedies, consider speaking with a dermatologist.
Use an anti-dandruff shampoo for a minimum of 2 to 3 weeks. If you don’t experience an improvement, switch to a product with a different active ingredient. You may have to try two or three products before contacting a specialist.
Speak with a doctor if you experience:
- patches of skin discoloration or rash on your scalp or hairline
- bleeding when the flakes come off your scalp
- signs of infection, such as pain or pus
Angelica Balingit, MD, board certified, internal medicineAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.
Dandruff doesn’t usually indicate a more serious health issue. The itching and flaking often respond well to OTC shampoos and treatments. Keep trying different brands and types until you find something that works for you. If it doesn’t work, consider talking with a doctor.
