Everything You Need To Know About Dandruff

Dandruff is a common scalp condition that causes an itchy scalp and a build-up of skin cells that develop into flakes. With dandruff, you may notice small, white, or yellowish-colored flakes (or, small pieces of your scalp build-up) in your hair or on your shoulders. These flakes are dead skin cells from your scalp that shed more rapidly than usual when the skin on your scalp produces excess oil (also known as sebum).

Several factors can contribute to the development of dandruff, including an overgrowth of the yeast Malassezia, scalp irritation due to hair care products, and certain skin conditions. While not a serious medical concern, dandruff can be bothersome. Fortunately, treatments like specialized dandruff shampoos are available over the counter and by prescription to help keep dandruff under control.

Dandruff is common—affecting approximately 50% of adults worldwide. Though dandruff can be an annoyance, understanding the causes and finding suitable treatment options can help you effectively manage this common scalp concern.

Types of Dandruff

All types of dandruff look similar and cause white, grey, or yellowish-colored flakes. However, each type of dandruff has its own unique causes, and treatment approaches may differ depending on the underlying cause. 

• Dry skin dandruff: This type often occurs from an excessively dry scalp, leading to flaking. Harsh weather, inadequate hydration, or hair care products that strip the scalp of natural oils can lead to this type. 
• Oily skin dandruff: Occurs due to an overproduction of sebum—the skin’s natural oil. As a result, you may have a greasy scalp and larger, yellowish flakes.
• Fungus-related dandruff: Caused by the yeast-like fungus Malassezia, which is part of the skin’s natural microbiome (or, community of bacteria, fungi, and viruses). Malassezia thrives on sebum, and excess oil can cause an overgrowth of the fungus, triggering an inflammatory response and an increase in scalp flaking.
• Skin condition-related dandruff: Certain skin conditions, including psoriasis, eczema (e.g., contact dermatitis), and seborrheic dermatitis, cause excess skin flaking.  

Symptoms

Symptoms of dandruff primarily affect the scalp, but sometimes it can extend to other areas, such as the eyebrows, ear creases, beard, groin, or armpits. Common symptoms of dandruff include:

• White, gray, or yellowish flakes on the scalp and hair 
• Itchy scalp 
• Patches of red, irritated skin on the scalp 
• Crusty or greasy patches on the scalp 

Causes

Your skin cells continuously die and regenerate as part of a natural body process. Dandruff occurs when skin cells on the scalp regenerate more quickly than usual, causing dead skin cells to accumulate and flake off. Several factors can increase the turnover rate of skin cells and lead to dandruff, including:

• Malassezia overgrowth: Malassezia yeast exists on almost everyone’s skin as part of the natural skin microbiome. The yeast thrives on oil and increased amounts of oil on the scalp can to more Malassezia yeast. As a result of the increase in production, your scalp produces more skin cells which can lead to a build-up of cells and cause dandruff.
• Scalp irritation: Some hair care, styling, and coloring products contain certain chemicals that can irritate the scalp. In response, the body produces more skin cells to repair the damage, which can lead to dandruff. 
• Skin conditions: Certain skin conditions associated with skin flaking can also affect the scalp and cause dandruff. These include seborrheic dermatitis, eczema, scalp ringworm, and psoriasis.

Risk Factors

Certain factors can increase the likelihood of developing dandruff. These include:

• Age: Dandruff is more common during adolescence and young adulthood, possibly due to hormonal changes that increase sebum production. 
• Sex: People assigned male at birth are more prone to dandruff than assigned females. 
• Neurological conditions: Certain neurological conditions, such as Parkinson’s disease or traumatic brain injury, are associated with an increased risk of dandruff. 
• Hair care: Using harsh hair care products, infrequent washing, taking hot showers, or excessive use of styling products can worsen dandruff.
• Climate: Cold and dry weather can contribute to scalp dryness, while hot and humid conditions may increase the risk of fungal growth. 
• Genetics: Having a family member with dandruff may increase your chances of experiencing the condition.
• Weakened immune system: People with weakened immune systems, including organ transplant recipients and those with HIV/AIDS, have a higher likelihood of having dandruff.
• Lifestyle factors: Experiencing high levels of stress, drinking alcohol, and eating a diet high in sugar can also increase your risk of dandruff.

Diagnosis

If your dandruff becomes bothersome, you may consider seeing your healthcare provider for a proper diagnosis. Your provider can diagnose dandruff based on your symptoms and a physical exam. Your provider will inspect your scalp for white or yellowish flakes, redness, or other signs of inflammation and irritation. They may ask about your hair care practices and whether you’ve made any recent changes to help identify the cause. 

Diagnostic tests are usually unnecessary to diagnose dandruff, but your healthcare provider may order a skin biopsy to rule out other conditions or if dandruff persists despite treatment.

Treatment

There is no cure for dandruff, but treatment can minimize visible signs of dandruff and reduce uncomfortable symptoms. Treatment approaches vary based on the cause and severity of your symptoms. 

For mild dandruff, washing your hair daily with a gentle shampoo may be enough to reduce oil and skin buildup on the scalp. Otherwise, over-the-counter (OTC) medicated shampoos effectively treat most dandruff cases. 

Look for OTC dandruff shampoos containing active ingredients such as: 

• Zinc pyrithione: An anti-fungal agent that helps regulate fungal growth and skin cell turnover on the scalp, reducing flaking and itching associated with dandruff.
• Coal tar: Slows down the rate of skin cell death to reduce flaking.
• Selenium sulfide: Regulates skin cell turnover to reduce flakes and may control the overgrowth of Malassezia fungus to improve dandruff symptoms.
• Salicylic acid: Exfoliates the scalp, removes dead skin cells, and reduces flakiness and itching that dandruff can cause.
  

When over-the-counter shampoos don’t improve dandruff symptoms, healthcare providers may prescribe medicated shampoos or other topical medications to help control your symptoms.

How to Prevent Dandruff 

It’s not always possible to prevent dandruff, but gentle hair care routines may help keep your symptoms at bay and prevent flare-ups. This may include:

• Regular cleansing: Maintain good scalp hygiene by washing your hair regularly with a mild, dandruff-controlling shampoo that works for your hair type. 
• Avoid harsh chemicals and hair care practices: Limit the use of hair products containing alcohol or ingredients you are allergic to, and minimize using products containing harsh chemicals, like hair dyes.
• Stress management: Stress can worsen dandruff symptoms, so practicing stress-reduction techniques like yoga, meditation, or physical activity may be beneficial.

Related Conditions 

It's worth noting that dandruff is not a serious condition and does not lead to complications or increase the risk of other conditions. However, some neurological, autoimmune, and skin conditions can increase the likelihood of developing dandruff. These include: 

• Seborrheic dermatitis: Similar to dandruff, this condition involves an overgrowth of Malassezia and can result in redness, itching, and flaking on the scalp, face, and other areas.
• Psoriasis: An inflammatory autoimmune condition that causes red patches with silvery scales on the skin and scalp that can flake off.
• Contact dermatitis: Allergic reactions to hair care products or environmental irritants can irritate and inflame the skin on the scalp and lead to dandruff.
• Neurological conditions: Research shows a link between dandruff and certain neurological disorders, such as Parkinson’s disease, stroke, and traumatic brain injury.

Living With Dandruff 

Dandruff can sometimes be embarrassing and frustrating to deal with, but it is not a serious condition. With the right treatment and lifestyle adjustments, managing dandruff and minimizing its impact on your self-esteem and quality of life is possible. Here are a few tips:

• Use an anti-dandruff shampoo: Many over-the-counter anti-dandruff shampoos are available to help manage symptoms and eliminate the presence of flakes in your hair and on your clothing. 
• Wash your hair regularly: Good hair hygiene helps remove the buildup of flakes and oil on the scalp.
• Avoid scratching: Scratching your head can irritate your scalp and worsen flaking and itching. 
• See a healthcare provider: If your dandruff becomes difficult to control even with the use of over-the-counter shampoos, talk to a healthcare provider, such as a dermatologist for their recommendations. They may prescribe medicated shampoos to help manage dandruff.