Dandruff

Dandruff is a common skin condition that causes flakes of dead skin to appear in the hair. Dandruff can also make the scalp feel itchy. The condition is not contagious and does not usually pose a threat to health but can be unpleasant and embarrassing. Dandruff can range from mild to severe.

It is estimated that half of all people will be affected by dandruff at some point in their lives. Dandruff often occurs after puberty and is most common in people in their early twenties, continuing into middle age. It has been reported that dandruff is more common in men than women. It is thought to affect all ethnic groups equally.

Dandruff is caused when the natural cycle of skin renewal is speeded up.  This leads to patches of dead skin forming on the surface of the scalp which come away into the hair, resulting in the flakes associated with dandruff. What causes the skin renewal cycle to speed up is not always clear. Possible factors may include:

• seborrheic dermatitis – a common yet poorly understood condition that causes oily skin; people with seborrheic dermatitis can also experience flaking on other parts of the body such as eyebrows, the side of the nose and anywhere where skin folds together such as the armpits
• malassezia – a type of fungus that normally lives harmlessly on skin but if it grows out of control can accelerate production of new skin

These are thought to be interlinked. The presence of the fungus on skin may provoke an abnormal response from the immune system (the body’s defense against infection) which can then cause skin to become oily. In turn, oiliness of the skin may encourage further growth of the fungus which then triggers symptoms of dandruff.

Other possible risk factors for dandruff include:

• emotional stress
• not washing your hair – or conversely, washing your hair too much; some people can irritate their scalp if they shampoo their hair too often, such as twice a day
• using other hair products such as hairspray, hair gel and hair mousse
• other skin conditions such as psoriasis or eczema – two common skin conditions that can cause skin to become dry, red and flaky
• having a weakened immune system, which can be the result of a condition such as HIV or as a side effect of a treatment such as chemotherapy

The main symptom of dandruff is white or grey dry flakes of skin on your scalp and in your hair. The flakes are often noticeable if they fall from your scalp on to your shoulders. Your scalp may also feel itchy and dry. Dandruff does not usually need to be formally diagnosed because its symptoms are obvious. The characteristic dry, white flakes on your scalp or in your hair are typical of the condition.

The main treatment for dandruff is anti-dandruff shampoo. There are a number of different types available over-the-counter from most pharmacists and supermarkets.  The different types can work in different ways so if one type isn't effective you may want to try another one.

If the symptoms of your dandruff are mild then it may be possible to relieve symptoms using self-care techniques.

These include:

• washing your hair daily with a mild shampoo until dandruff clears; shampoos containing tea-tree oil can be particularly effective
• try not to scratch your scalp when using shampoo; instead gently massage your scalp without scratching as this will not damage your scalp or your hair
• avoid using hair products such as hairspray and gel until the dandruff clears

Also spending time outdoors in the sun can help reduce dandruff. However, ensure you protect yourself with sun screen with the appropriate skin protection factor (SPF) for your skin type.

If your dandruff is severe you will probably require treatment with an anti-dandruff shampoo. These are available over-the-counter from most supermarkets and pharmacists. Some of the most widely used anti-dandruff shampoos include:

• zinc pyrithione – which works by killing the malassezia fungi thought partially responsible for dandruff
• salicylic acid – which helps soften and shed dead skin cells on your scalp (some people experience dryness of their scalp after using salicylic acid; using a conditioner after the shampoo can often help)
• selenium sulfide – this works by both slowing production of skin cells while also killing the fungi
• ketoconazole shampoo – which has a powerful antifungal effect
• coal-tar shampoo – this again can help slow production of dead skin cells

Not every shampoo is suitable for everyone. For example, selenium sulfide may not be recommended for people with blonde or chemically treated hair as it can discolour the hair. And as a precaution the use of certain types of anti-dandruff shampoo may not be recommended if pregnant or breastfeeding. So it is always important to carefully read the instructions that come with the shampoo.

Dandruff usually responds well to treatment but it's common for it to reoccur. Some people find they are free from symptoms for a while before having a 'flare-up’ where symptoms are particularly bad.

If treatment fails to clear your flaky scalp after a few weeks or your scalp is particularly itchy, you should see your GP. You may need stronger prescription shampoo or a short-course of a steroid lotion (topical corticosteroids).

Applying the shampoo

It is normally recommended you apply whatever anti-dandruff shampoo you decide to use daily or every other day (An exception is if you are using ketoconazole shampoo which usually only needs to be applied twice a week.). Once your symptoms improve then you may only need to use the shampoo twice or three times a week. Gently massage the shampoo into your hair and then leave for at least five minutes to allow the ingredients inside the shampoo time to take effect.

NHS UK
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