How to get rid of dandruff for good

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Itchy, flaky scalp getting you down? Here’s everything you need to know about dandruff – including how to get rid of it.

By Dr Louise Wiseman MBBS, BSc (Hons), DRCOG, MRCGP

Dandruff is often a genuine cause of insecurity, but in reality most people have it at some point in their life. If you’re plagued by an itchy scalp and white flakes on your shoulders, the good news is with a few simple lifestyle changes and the right shampoo, dandruff can be treated easily at home.

Dr Louise Wiseman looks at dandruff causes and treatment options, so you can prevent those pesky flakes from ruining your day:

What is dandruff?

Dandruff is characterised by small pieces of dead skin that appear on the scalp, in the hair and on your shoulders as white or grey flakes. Humans naturally have a type of yeast or fungus that lives happily on the skin called Malassezia (previously called pityrosporum).

This yeast enjoys warm and damp environments and for some people this causes irritation. It is believed that the sebum or natural oil produced by hair follicles and oil glands is an ideal breeding ground for yeast. Paradoxically very dry environments can dry out the scalp skin causing flaking that can look like dandruff.

What is seborrheic dermatitis?

Seborrheic dermatitis and dandruff are common problems affecting any areas where there are sebaceous glands. They are considered the same basic condition except dandruff is restricted to the scalp and does not have inflammation. Seborrheic dermatitis however affects many areas and can have marked inflammation, scaling and redness.

Dandruff is really a mild version of seborrheic dermatitis. Between the two conditions almost half the population are affected yet we do not always know the cause. It is most common from teenage years (when the sebaceous glands become more active) and throughout midlife. It seems to decline after menopause in women – most likely due to decreased gland activity. The good new is that dandruff is easily treated, and is not contagious.

Dandruff symptoms

Dandruff symptoms typically include the following:

  • White or grey flakes on the scalp and in the hair, often only noticeable on the shoulders of dark clothes or when brushing hair.
  • Dry patches may be felt on the scalp where itching is worse.

Dandruff causes

A number of factors can lead to dandruff including:

  • Lack of sleepor rest.
  • Some hair treatments or styling products may worsen dandruff.
  • Weather or temperature can worsen dandruff, for example prolonged hat wearing may encourage microbe growth, while exposure to sunlight may promote a healthy scalp by suppressing fungal growth.
  • Poor hygiene does not cause dandruff, but washing hair too little or too often can make the flakes look worse.
  • Leaving hair damp for long periods of time can exacerbate dandruff, as can piling wet hair into a bun with little air flow around the scalp.
  • Nutrient deficiencies including Zinc, vitamins B2, B3 and B6 have been associated with dandruff in studies. If you are concerned, speak to your doctor as it is most likely not just your scalp that is affected.

Dandruff treatment

Dandruff will most likely be self-diagnosed and those affected can find initial treatments easily at your local chemist or supermarket. Try the following over the counter dandruff treatments, or if these don’t work speak to your pharmacist or GP about prescription treatments:

️ Over the counter treatment for dandruff

If your scalp is not inflamed or irritated, try the following over the counter anti-dandruff shampoos:

  • Vosene– products containing Salicylic acid remove excess skin cell debris.
  • Head and Shoulders– products containing Zinc pyrithione reduce yeast growth.
  • Tea tree oil shampoo– Tea tree oil is thought to be antifungal and antibacterial.
  • Ginger anti-dandruff shampoo– products containing ginger are thought to reduce scalp infections and dandruff by its antiseptic properties.

️ Prescription treatment for dandruff

Your doctor or pharmacist may advise stronger agents, especially if they suspect a diagnosis of seborrheic dermatitis. These are available over the counter in the UK but they need to be handled with care. They may have side-effects or be contraindicated in some patients, as some are not suitable for children or should be used with caution in pregnancy or breastfeeding.

  • Nizoral shampoo– products containing Ketoconazole can work as this is an antifungal so it removes the yeast from the scalp.
  • Neutrogena T gel– products containing coal tar reduce excess shedding skin cells and yeast growth.
  • Selsun shampoo– products containing Selenium sulphide reduce turnover of the cells in the top layer of skin which reduces yeast growth.

You may need to use medicated shampoo for up to a month to see results. The shampoo can sometimes be harsh on the hair, so use it two or three times a week (with normal shampoo in between) until the dandruff is cleared. If your dandruff does not improve after a few weeks, speak to your doctor to exclude other causes.

⚠️ Apart from the cosmetic annoyance, dandruff can cause extensive itching. Chronic dandruff does need to be sorted as excessive itching over the long term could cause hair loss.

Dandruff tips and advice

Alongside anti-dandruff shampoo the following tips may help:

✔️ Avoid excessive use of dry shampoo, which can worsen dandruff as it settles on the scalp and stops air flow and natural shedding of the skin at the surface encouraging dermatitis and dandruff.

✔️ Manage your stress levels and get plenty of rest.

✔️ Brush your hair regularly to remove normal skin cell debris and encourage circulation and ventilation of the scalp.

✔️ Try not to itch, as scratching can increase scalp irritation and lead to a vicious cycle.

✔️ In theory healthy fat content in your diet can help skin and hair health. Oily fish, nuts and seeds have a high omega-3 content that supports the skin.

Dandruff complications

Flaking of the scalp can occur in other conditions which might need further medical attention including:

  • Contact dermatitis or eczema

If the scalp is involved this can cause dry patches that will flake and can be triggered by allergens or irritants such as specific shampoos, conditioners, hair styling products or perfumes. Avoiding triggers and using topical steroid creams as prescribed may be necessary in the short term.

  • Seborrheic dermatitis

Seborrheic dermatitis tends to affect the back, face, eyebrows, neck, groin and scalp. Even eyelashes can be affected. White or yellow flakes occur on a background of red or pink swollen areas. There may be extensive burning or itching. The cause of seborrhoeic dermatitis is not always known although hormones and genetics have been suggested. Microorganisms such as yeast that causes dandruff can make seborrheic dermatitis worse. It can be a sign of the immune system being suppressed or more common in some nervous system diseases. Medicated shampoo may be all that is needed but in severe cases anti-fungal agents and anti-inflammatories may be required.

  • Scalp psoriasis

Psoriasis presents itself as distinct red flaky, crusty and sore patches with silvery scales which are easily recognised by a healthcare professional. There are specific treatments for scalp psoriasis that may be used in conjunction with treatment of body psoriasis patches.

  • Head lice

Head lice infestation may cause scalp itching and be wrongly diagnosed as dandruff.

  • Ringworm

Ringworm is also a fungal infection which can lead to an itchy and flaky scalp.

  • Cradle cap

Cradle cap is a form of seborrheic dermatitis that is extremely common in newborns. It does not seem to be that there is any predisposition to having dandruff as an adult if you had cradle cap as a baby.

For unknown reasons patients with certain medical conditions including those affecting immunity can suffer more with dandruff. These include HIV, Parkinson’s Disease, Epilepsy. Sometimes after an event such as a heart attack or stroke dandruff can worsen.

When to visit the doctor for dandruff

Make an appointment with your GP if any of the following occurs:

  • Persistent flaking despite using good anti-dandruff shampoo for a few weeks
  • Swollen or sore red patches on scalp
  • Hair loss in affected areas

Your doctor will take a full history of any scalp conditions and the general state of your health, recent stress, illness and examine your scalp and any other areas of skin affected. Most scalp conditions are easily resolved by prescription treatment, usually in the form of shampoos, lotions or foams. Steroid preparations may be used for more complex cases where the scalp is inflamed.

If your dandruff is part of a more serious condition or is not responding to medical treatment, your doctor may refer you to a dermatologist. Do not suffer in silence or be embarrassed and always talk to your healthcare provider if you are worried about an underlying health condition.

Net Doctor

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