Overview

Dandruff is a common scalp condition characterized by flaking of the skin on the scalp. It often causes itching and visible white or yellowish flakes that may fall onto the shoulders. While dandruff is not contagious or serious, it can cause embarrassment and social discomfort. Most cases of dandruff can be managed with proper scalp care, medicated shampoos, and lifestyle changes. In some cases, dandruff may be linked to underlying skin conditions like seborrheic dermatitis or psoriasis.

Causes

Several factors contribute to the development of dandruff. The most common causes include:

• Dry skin: Flaking is often worse during colder months when indoor heating can dry out the skin.
• Oily skin and seborrheic dermatitis: This condition causes red, greasy skin covered with flaky white or yellow scales and can affect not just the scalp but other oily areas like eyebrows and sides of the nose.
• Fungal infections: The yeast-like fungus Malassezia lives on most adult scalps but can sometimes grow excessively, irritating the scalp and causing more skin cells to grow and shed as flakes.
• Infrequent hair washing: Not washing hair regularly can lead to oil and skin cell buildup, worsening dandruff.
• Sensitivity to hair products: Some people experience allergic reactions or irritations (contact dermatitis) from hair products, leading to dandruff-like flaking.
• Underlying skin conditions: Psoriasis, eczema, and other dermatological conditions can cause flaking and mimic dandruff.
• Stress and poor diet: Psychological stress and nutritional deficiencies, especially of zinc and B vitamins, can exacerbate dandruff.

Symptoms

Dandruff presents with recognizable symptoms, including:

• Flaky scalp: White or yellowish flakes of dead skin on the scalp, hair, and shoulders.
• Itching: Mild to moderate itching of the scalp is common.
• Dryness or greasiness: Scalp may feel dry or oily depending on the underlying cause.
• Red patches: In some cases, especially with seborrheic dermatitis, red and inflamed skin may be present.
• Worsening in certain seasons: Symptoms may flare up during cold, dry seasons and improve in warmer weather.

Diagnosis

Dandruff is usually diagnosed based on clinical examination:

• Physical examination: A doctor or dermatologist examines the scalp to observe flaking and possible redness or inflammation.
• Medical history: Review of personal care habits, diet, stress levels, and use of hair products.
• No laboratory tests needed: In most cases, no tests are necessary unless the doctor suspects psoriasis, fungal infections, or eczema.
• Skin scraping or biopsy: Rarely, scraping or biopsy may be performed to rule out other skin conditions if symptoms are severe or unresponsive to treatment.

Treatment

Treatment for dandruff aims to reduce flaking, relieve itching, and manage the underlying cause:

• Anti-dandruff shampoos: Medicated shampoos containing zinc pyrithione, selenium sulfide, ketoconazole, or coal tar are commonly used.
• Regular washing: Frequent shampooing helps remove flakes and prevent oil buildup.
• Moisturizing shampoos: For dandruff caused by dry scalp, moisturizing shampoos can help maintain scalp hydration.
• Topical treatments: Corticosteroid creams or antifungal lotions may be prescribed for severe cases or seborrheic dermatitis.
• Avoidance of irritants: Limiting the use of harsh hair products reduces scalp irritation.
• Healthy diet: A balanced diet rich in zinc, B vitamins, and healthy fats supports scalp health.
• Managing stress: Stress-reduction techniques like exercise, meditation, or therapy may help prevent flare-ups.

Prognosis

Dandruff is a manageable condition with an excellent prognosis:

• Responsive to treatment: Most individuals experience significant improvement with regular use of anti-dandruff shampoos and proper scalp care.
• Chronic but controllable: Dandruff can be a long-term condition, especially in cases of seborrheic dermatitis, but it is usually well-controlled with ongoing care.
• Low risk of complications: Dandruff rarely leads to serious complications, though untreated severe cases can cause scalp irritation or secondary infection.
• Quality of life: Effective management improves comfort and self-confidence by reducing visible flakes and itching.

With consistent treatment and scalp care, most people with dandruff can maintain healthy, flake-free hair and scalp.