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However, Dandruff is a skin condition that primarily affects the scalp. It causes those annoying flakes to fall from your scalp onto your shoulders. You know the ones that make you afraid of wearing your favorite black sweater. “It’s so embarrassing” is the most common complaint I hear from patients with dandruff.

Myths about dandruff

Before discussing the condition and treatment options, let’s dispel some of the myths:

  • First of all, dandruff is not contagious
  • Nor does not cause hair loss
  • It is not caused by poor hygiene

Rather, dandruff is a very common chronic scalp condition that affects almost half of the population regardless of gender or ethnicity. The good news, this flaky scalp is fairly easy to control.

Dandruff is easy to identify. It is those white flakes of dead skin that are seen on the scalp, in the hairs themselves and/or on the tops of the shoulders, especially when wearing dark-colored clothing. The condition may cause mild itching. Although dandruff can occur at any time of the year, it seems to be more prevalent during the winter months.

Dandruff is a non-inflammatory condition. The exact cause of dandruff formation is unknown. How it differs from normal skin exfoliation is not clearly understood.

What’s the difference between dandruff and seborrheic dermatitis?

By definition, dandruff is limited to the scalp. Another scaly scalp disorder called seborrheic dermatitis, or seborrhea also causes scaly scalp flakes. Unlike dandruff, seborrheic dermatitis has an inflammatory component. It also may extend outside the scalp.

It causes redness and itching to many different areas of the body, including:

  • eyebrows
  • ears
  • folds around the nose
  • forehead
  • chest

It is uncertain if these two skin conditions share the same pathophysiology. In other words, we do not know whether they are part of a continuum with dandruff being the mildest form of non-inflammatory scalp scaling and seborrheic dermatitis being a more advanced inflammatory version. However, there does seem to be a link between these two conditions. 

Potential causes of dandruff

  • Microbial

It has long been recognized that the scalp density of lipophilic yeast of the genus Malassezia is increased in those with dandruff compared with normal scalp skin. However, this may just be a result of the increase in the volume of scales.

So, whether the yeast increases the scales of dandruff or the scales account for an increase in Malassezia is still unclear. Interestingly, antifungal shampoos that decrease Malassezia colonization of scalp skin is a popular and oftentimes successful way to treat dandruff. 

  • Non-microbial

Although there are no definitive scientific explanations for these hypotheses, many non-microbial causes of dandruff are well known. They include:

      • Excessive sunlight to the scalp (It can increase desquamation of scalp skin).
      • Over-shampooing,
      • frequent combing
      • the use of irritating hair products may cause dandruff.  

Infrequent shampooing can make dandruff appear more obvious but there is no evidence that under shampooing causes dandruff.

General information about dandruff shampoos 

There are many treatments available to treat dandruff. The majority are in the form of shampoos. Both prescription and over-the-counter anti-dandruff shampoos are available.

Take care to follow the instructions on the shampoo bottle. Some products are best if left on the scalp for 5-10 minutes. While other shampoos should be washed off immediately. Depending on the anti-dandruff shampoo, some are to be used weekly, while others more frequently.

Other scalp conditions may also mimic dandruff. Psoriasis, eczema, and fungal infections are examples of conditions that can present with a scaly scalp. Always seek medical attention if symptoms persist despite using over the counter dandruff shampoos. Ask your dermatologist for a shampooing regimen that is most appropriate for you.

Specific types of anti-dandruff shampoos

  • Keratinolytic agents

These treatments help detach the dandruff scales from the scalp so that they can be washed off the scalp. Shampoos containing salicylic acid and sulfur fall into this category. Some examples include T-Sal and Sebex/Sebulex.

  • Keratinization regulators

Zinc pyrithione is an ingredient that normalizes both sebum production and skin keratinization (the process of skin cell formation and exfoliation of skin cells). Examples include Head & Shoulders and ZNP Bar.

  • Dandruff products containing tar

Products containing tar may decrease the proliferation of skin flakes. Due to the odor, staining properties, and mess, skincare products containing tar are often undesirable. It is important to note that tar shampoos can discolor blonde, grey, and white hair. Therefore, tar containing shampoos are best for those with dark-colored hair.

Tar containing products can also increase sun sensitivity causing sunburn on the scalp. Be sure to protect the scalp when outdoors by seeking shade and wearing a head covering when outdoors. Some examples include Zetar, T-gel, and Tegrin.

  • Antiproliferative and anti-inflammatory agents

Although dandruff has minimal or no anti-inflammatory properties, products containing corticosteroids can be effective. Some examples include Clobex and Clodan.

  • Antimicrobial Agents

Products containing selenium sulfide reduce cell turnover. In that, they have an anti-Malassezia effect. It may leave the hair feeling oily after use. Some examples include Selsun Blue and Head & Shoulders Clinical Strength.

  • Antifungal compounds

Antifungal compounds like ketoconazole and ciclopirox, which effect fungal cell membranes, can be very effective in treating dandruff. Some examples include Nizoral (ketoconazole) and Loprox (ciclopirox).

The bottom line

Dandruff is a common and often embarrassing condition. But, it can usually be treated with a dandruff shampoo. However, it is sometimes confused with other skin conditions, such as seborrheic dermatitis, psoriasis, eczema, and fungal infections. Therefore, if over-the-counter shampoos aren’t doing the job, be sure to consult with a dermatologist to confirm the diagnosis and prescribe a better treatment.  

Additional Content by this Author:
How Do I Know if I Have Skin Cancer?
Skin Care Products: Are You Being Deceived?

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Financial disclosure: The products in this article have affiliate links to Amazon. These products were added by the TDWI staff, not the author. Dr. Frey did, however, provide these as product examples. We will receive a small commission from sales made through the links. That revenue helps support our editorial activities. 

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Fayne Frey, MD

Fayne Frey, M.D., is a board-certified clinical and surgical dermatologist practicing in West Nyack, New York, where she specializes in the diagnosis and treatment of skin cancer. She is a nationally recognized expert in the effectiveness and formulation of over-the-counter skincare products, and, as a speaker, has captivated audiences with her wry observations regarding the skincare industry. She has consulted for numerous media outlets, including NBC, USA Today, and, the Huffington Post, and has shared her expertise on both cable and major TV outlets.

Dr. Frey is the Founder of FryFace.com, an educational skincare information and product selection service website that clarifies and simplifies the overwhelming choice of effective, safe and affordable products encountered in the skincare aisles.

Dr. Frey is a graduate of the Weill Cornell Medical College and is a fellow of both the American Academy of Dermatology and the American Society for Dermatologic Surgery.

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