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Dandruff can have many causes, including fungus and shampooing too often or not enough. Treatments like dandruff shampoo typically loosen flakes or target fungal overgrowth.
Most people focus on the flakes. Itching, on the other hand, may be the most uncomfortable side effect.
So what exactly is your scratchy scalp trying to tell you? Read up on the most common symptoms of dandruff and ways to get your scalp healthy again.
Flakes and an itchy, scaly scalp are the main symptoms of dandruff. White, oily flakes typically accumulate in your hair and on your shoulders and often get worse during the fall and winter months, when the air is dry.
Additional symptoms can include:
- erythema, which is red patches on the skin of the scalp, and sometimes on the face
- eyebrow dandruff
- hair loss
- dry flakes on the skin of the face
Getting rid of dandruff can consist of taking medications that you can get both through prescriptions and over the counter. There are also some home remedies you can try.
The best way to get rid of dandruff is to use dandruff shampoo and scalp treatments. The American Academy of Dermatology Association (AAD) recommends taking the following steps:
- Follow instructions. Since there are many different types of dandruff treatment shampoos, and each comes with its own instructions, it’s important that you carefully read and follow the directions of the product of your choice. Be sure you know if you’re supposed to leave the shampoo on your scalp for a certain amount of time before washing, or if you should wash out immediately.
- Different skin and hair types require different care. African American people may only need to wash once a week with a dandruff shampoo. Asian American people and those who are white may need to alternate between different dandruff shampoos that contain different ingredients to achieve the best results. Your best course of action may be to speak with a board-certified dermatologist who can recommend the best products for your hair and skin type, and the frequency with which you should use them.
Shampoos for dandruff can be medicated (which requires a prescription to purchase) or available over the counter. Usually, this means that the amount the medication in medicated shampoos is just higher.
Typical ingredients include ketoconazole, selenium sulfide, coal tar, and zinc pyrithione. These ingredients usually loosen the dandruff flakes from the scalp or they fight the overgrowth of the Malassezia fungus, which may play a role in the development of the dandruff.
Some specific products you may see on the shelves include:
- Head & Shoulders and Jason Dandruff Relief contain zinc pyrithione, which is antibacterial and antifungal. Dandruff is not caused by fungus, but these shampoos can help to slow the production of excess skin cells.
- Neutrogena T/Gel is a tar-based shampoo. Coal can ease conditions from dandruff to psoriasis by slowing how quickly your scalp’s skin cells die and flake off. This type of shampoo can discolor hair, so be careful if you’re blonde or gray.
- Neutrogena T/Sal has a dose of salicylic acid and may lessen the amount of scale you have. It can leave your scalp dry, however. If you find that your scalp is particularly dry, make sure you follow up with a moisturizing conditioner.
- Selsun Blue has the power of selenium sulfide. It can slow your skin cells from dying and also reduce Malassezia. This type of shampoo may discolor lighter shades of hair.
- Nizoral is a ketoconazole shampoo, meaning it contains a broad-spectrum antifungal. You can find this type of wash over the counter or by prescription.
However, the AAD warns about using coal tar shampoo. This kind of shampoo can discolor light hair and make your scalp more sensitive to the sun. If you use it, make sure you take extra precautions when you’re exposed to sunlight.
If you want to try some natural remedies before you turn to medicated solutions, you can consider the following options:
- Baking soda. Gently rub it into your scalp in the shower and rinse after a few minutes.
- Apple cider vinegar. Mix 1/4 cup with a 1/4 cup of water. Apply to your hair for 15 minutes to 1 hour, and then rinse out. Do this twice a week.
- Coconut oil. Rub 3–5 teaspoons into your scalp and leave for 1 hour. Then shampoo your hair and wash out.
- Lemon juice. Rub 2 teaspoons into your scalp and rinse out. Then rub one more teaspoon mixed with 1 cup water. Do this every day.
- Aloe vera. Rub into your scalp before you wash your hair.
- Olive oil. Rub 10 drops into your scalp. Cover your head with a shower cap and leave overnight. Shampoo and wash your hair in the morning.
Many factors can contribute to the development of dandruff, so pinpointing the exact cause of your itchy, flaky scalp can be difficult. Here are a few
- secretions from your sebaceous glands
- fungal colonization on the surface of your skin
- not shampooing enough, which may cause skin cells to accumulate and create flakes and itching, or alternatively overshampooing and overdrying the scalp.
- Overbrushing the hair on the head, creating too much friction with the sensitive skin on the scalp
- yeast called Malassezia, which aggravates your scalp and causes excess skin cell growth
- different personal care products may cause contact dermatitis, which makes your scalp red and itchy
- too much exposure to sunlight
- excessive pressure on the scalp from hats
- what you eat routinely
- exposure to dust or dirt
Some people may be more predisposed to dandruff than others for reasons that are unknown. However, it’s known that men develop dandruff more frequently than women.
People who tend to have oilier hair or live with certain illnesses (such as Parkinson’s disease or HIV) are also at higher risk. You may have started to notice symptoms around puberty, but dandruff can develop at any age.
You may find it hard to tell the difference between dandruff and dry scalp, as they can both present similarly. Both can cause flakes and an itchy sensation on your scalp.
But while dandruff is related to seborrheic dermatitis, dry scalp is simply related to your skin losing too much water. This can happen when you’re not getting enough fluids.
But, it can also happen from some hair products that you might be using on your scalp that may be stripping your scalp of its natural oils. If you live in a cold and dry climate, you may also be more susceptible to having a dry scalp.
Treating a dry scalp usually involves switching to a gentle, unmedicated shampoo that contains as few additives as possible that may remove moisture from your scalp.
Here are some tips for things you can do to avoid dandruff:
- Practice good hygiene. Do your best to resist the urge to touch your scalp, especially if it’s already itchy. Scratching can increase irritation and lead to a vicious cycle. When you touch and scratch, you can also introduce dirt into the mix that can make dandruff worse.
- Find the right shampooing balance for your scalp. Shampoo often enough to keep oils at bay, but don’t use too many products in your hair as that can irritate the scalp.
- Reduce stress. Stress can aggravate or even worsen dandruff for some individuals. While Malassezia is not introduced to your scalp by stress, it can thrive if your immune system is compromised, which is exactly what stress does to your body. Do your scalp a favor and relax. Try taking a restorative walk or practicing yoga. You may even find it helpful to keep a log of stressful events. Write down what they are and how they impact your dandruff. That way, you can do your best to avoid potential triggers in the future.
- Breath fresh hair. Research shows that including regular exposure to the outdoors, especially where the air is more fresh, can help reduce oil buildup on the scalp.
- Massage your scalp. This may also help prevent dandruff symptoms.
- Brush those locks. Brush your hair when it’s damp (not wet) at least twice daily.
- Limit friction. Limit the wearing of hats and scarfs, especially those of synthetic materials.
The good news is that many cases of dandruff can be treated effectively with over-the-counter (OTC) shampoos and other lifestyle measures.
That being said, dandruff isn’t the only reason you may have an itchy scalp. If your dandruff is particularly stubborn or itchy, you may have psoriasis, eczema, or a true fungal infection. Your doctor can help.
If your itch isn’t letting up or your scalp becomes red or swollen, speak with your doctor. Check in as well if shampoos don’t help, redness and flaking spread to your face or other areas on the body, or the itching starts to interfere with your everyday life.
Sometimes the symptoms can indicate other, more serious, conditions such as Actinic keratoses (AKs) or Tinea capitis (scalp ringworm), and it’s best to be checked out to get the best treatment.
Q: When should I see a specialist for dandruff? What kind of specialist treats it?
A: Consider speaking with a dermatologist if flaking from the scalp persists even after you’ve consistently followed the recommended habits below and used OTC remedies.
Use an anti-dandruff shampoo for a minimum of 2 to 3 weeks. If you don’t experience an improvement, switch to a product that has a different active ingredient. You may have to try two or three products before contacting a specialist.
Speak with a doctor if you experience:
- patches of redness or rash on your scalp or hairline
- bleeding when the flakes come off your scalp
- signs of infection, such as pain or pus
While dandruff can be annoying and embarrassing at times, it usually doesn’t indicate a more serious health issue. The itching and flaking often respond well to OTC shampoos and treatments. Keep trying different brands and types until you find something that works for you.