Dandruff

Overview

Dandruff is flakes of dead skin that come off your scalp. Your skin sheds all the time, but with dandruff the skin turns over faster and sheds in bigger clumps. These show up as white or yellowish flakes in your hair and on your shoulders. Dandruff is not a sign that you are dirty, and you cannot catch it from someone else.

Yes. Dandruff is one of the most common scalp problems. Around half of people get it at some point in their lives, and many people have some flaking all the time.

Anyone can get dandruff. It usually starts after puberty and is most common in the twenties and thirties. It tends to affect men a little more than women, and it often gets worse in cold, dry weather or during stressful times. Babies can get a form of flaking on the scalp called cradle cap.

Symptoms

Common symptoms

• White or yellowish flakes on the scalp, in the hair, and on shoulders and clothing
• An itchy scalp, which may be worse in winter or in dry air
• A scalp that feels dry, or sometimes oily
• Mild redness or soreness of the scalp
• Flaking in the eyebrows, beard, moustache, or around the ears
• Flakes that come back soon after washing

Symptoms in children

• Dandruff is less common before puberty
• Babies can get cradle cap, which looks like greasy yellow crusts on the scalp — this is usually harmless and clears up on its own
• Flaking in children can sometimes be caused by other skin or scalp conditions, so it is worth asking a doctor or pharmacist if it does not settle

Symptoms in older adults

• Dry skin becomes more common with age, so flaking can be due to dryness rather than true dandruff
• Some long-term health conditions make scalp flaking more likely
• Certain medicines can dry the skin, so it is worth asking a pharmacist or doctor about your medicines if flaking starts suddenly

Causes

Main causes

• A yeast called Malassezia that normally lives on everyone's scalp. Sometimes the scalp reacts to it, the skin renews itself too fast, and flakes form.
• Dry skin, which flakes easily, especially in cold or dry weather
• Seborrhoeic dermatitis, a common red, greasy, flaky skin condition that affects the scalp, face and chest
• Irritation from harsh shampoos, hair dyes, or styling products
• Build-up of oils and skin cells on the scalp

Risk factors

• Oily skin or an oily scalp
• Not washing your hair often enough, so oils and skin cells build up
• Cold, dry weather
• Stress and tiredness
• Some long-term conditions, such as Parkinson's disease or a weakened immune system
• Age — it is more common in young and middle-aged adults
• Using strong or irritating hair products

When to see a doctor

See a doctor urgently if:

• Spreading redness, swelling or heat on the scalp, or pus or weeping
• Fever with a painful scalp
• Sudden hair loss with scaly or broken skin
• A severe allergic reaction after using a product — call emergency services

Book a routine appointment if:

• You have used an anti-dandruff shampoo for about 4 to 6 weeks and it has not helped
• The itching is severe or stops you sleeping
• Flakes also appear on your face, eyebrows, beard or chest
• Your scalp is sore, cracked or bleeding
• Your child has flaking that does not clear up
• You feel very self-conscious about it and want advice

Diagnosis

Most of the time, a doctor or pharmacist can tell it is dandruff just by looking at your scalp and asking a few questions about your hair care and symptoms. No special tests are usually needed.

Tests that may be done

• Usually none — the diagnosis is based on your symptoms and a look at your scalp
• Your doctor may ask about products you use, how often you wash your hair, and any other skin problems
• Rarely, a small scraping of skin from the scalp may be tested if the doctor is not sure what is causing the flaking
• If another skin condition is suspected, you may be referred to a skin specialist (dermatologist)

What to expect at your appointment

The check-up is quick and painless. Your doctor will part your hair to look at the scalp. You may be given advice on shampoos, or a prescription scalp treatment if over-the-counter products have not helped. Most people do not need to be seen again unless the problem keeps coming back.

Treatment

Dandruff cannot be cured, but it can usually be controlled. The main treatment is washing your hair regularly with a gentle shampoo and using an anti-dandruff shampoo if needed. These shampoos work in different ways: some reduce the yeast on the scalp, and some help loosen and remove flakes. If these do not help, a doctor can suggest other options.

Self-care at home

• Wash your hair regularly with a gentle shampoo — how often depends on your hair type and how oily it gets
• If you use an anti-dandruff shampoo, follow the directions on the label and leave it on the scalp for the time it says before rinsing
• Rinse your hair well, since leftover product can irritate the scalp
• Try a different type of anti-dandruff shampoo if the first one stops working, as some people find switching helps
• Avoid scratching your scalp, which can make itching and soreness worse
• Choose mild shampoos and limit gels, sprays and dyes that may irritate your skin
• Wear light-coloured clothes if flakes on your shoulders make you feel self-conscious
• Manage stress where you can, as stress can make flare-ups worse

Medical treatments

If over-the-counter anti-dandruff shampoos have not worked after a few weeks, your doctor or pharmacist may suggest a different type of medicated shampoo, a scalp lotion, foam or cream, or a prescription-strength scalp treatment. They may also advise you to alternate between products so the scalp does not get used to one. If your scalp is very red or inflamed, or another skin condition is suspected, you may be referred to a skin specialist. Always check with a pharmacist or doctor before trying a new product, especially if you have sensitive skin or use other medicines.

When is surgery considered?

Surgery is not used to treat dandruff.

Living with this condition

Dandruff is something you manage rather than cure. It often comes and goes, getting better in summer and worse in cold, dry weather. A simple routine — regular washing, a good anti-dandruff shampoo, and gentle hair care — keeps most people comfortable. Flare-ups are normal and do not mean you are doing anything wrong.

Lifestyle tips

• Keep a simple hair-care routine and avoid too many products
• Wash your hair after exercise or heavy sweating
• Use a gentle shampoo and conditioner for sensitive skin
• Protect your scalp from very dry indoor air in winter if it makes flaking worse
• Get regular sleep and find ways to unwind, as stress can trigger flare-ups
• See your pharmacist if a product stops working, rather than buying many things at once

Diet and exercise

There is no special diet that cures dandruff, and no food is known to cause it. A balanced, varied diet and regular physical activity are good for your general health and can help you manage stress. Wash your hair after sweaty exercise, as sweat and oils can build up on the scalp.

Mental health and emotional wellbeing

Dandruff is harmless, but it can still bother people. Feeling embarrassed about flakes on your clothes, or worrying that others notice, is very common and understandable. Remember that dandruff is not a sign of poor hygiene and most people barely notice it. If it is affecting your confidence, sleep or mood, talk to your doctor — they hear this all the time and can help. If you ever feel overwhelmed or in crisis, contact your local mental health crisis service or your local emergency number right away.

Prevention

Dandruff cannot always be prevented, because it partly comes down to how your skin and the yeast on your scalp interact. But you can reduce flare-ups by washing your hair regularly, using gentle products, rinsing well, and managing stress. If you know certain weather or products make it worse, plan ahead.

Vaccines

There is no vaccine for dandruff.

Screening programmes

There is no screening test for dandruff. You only need to see a doctor if symptoms are severe, unusual, or do not improve with self-care.

Complications

If left untreated

• Ongoing itching and scalp irritation
• Scratching that breaks the skin, which can occasionally lead to a minor skin infection
• Flaking spreading to the eyebrows, beard, ears or chest
• Embarrassment and lower confidence in social situations
• Flare-ups that keep coming back, which can be frustrating

Long-term outlook

The outlook is good. Dandruff does not damage your hair or your health, and it is not a sign of anything serious. Most people find a routine that keeps flakes and itching under control. If one shampoo stops working, another type often will — so it is worth asking a pharmacist or doctor for advice rather than giving up.

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