Overview
Dandruff is a common scalp condition characterized by the shedding of white or yellowish flakes and itching. It affects half of the adult population. It is not contagious and not dangerous to health, but it can be bothersome cosmetically and socially.
It usually starts at puberty, peaks between ages 40-50, and decreases with age.
Symptoms
- White, oily flakes on the scalp
- Flakes on the hair and shoulders
- Scalp itching
- Flaking on the scalp
- Sometimes redness
In severe form (seborrheic dermatitis):
- Yellowish, oily flakes
- Thick, sticky layers
- May affect eyebrows, face, around the ears, chest
- Redness and inflammation
In infants (cradle cap):
- Yellowish, oily flakes on the scalp
- Usually resolves spontaneously within 1 year
Causes
1. Malassezia fungus:
- Overgrowth of yeast on the scalp
- Feeds on oil
- Triggers inflammation
2. Other factors:
- Seborrheic dermatitis: Oily, sensitive skin
- Dry skin: Small, white flakes
- Sensitivity to hair products (contact dermatitis)
- Not washing hair enough
- Skin diseases: Psoriasis, eczema
- Weakened immunity: HIV, cancer
- Stress
- Hormonal changes
- Vitamin B, zinc deficiency
- Cold, dry weather
Risk Factors
- Between ages 30-60
- Being male
- Oily hair
- Some medical conditions (Parkinson's, HIV, depression)
- Stress
- Oily, sticky hair products
- Not washing hair for a long time
- Excessive use of hot water
- Some factors that reduce skin's natural resistance
When to See a Doctor
- If over-the-counter shampoos do not work within 4-6 weeks
- Severe itching, pain
- Redness, swelling on the scalp
- If hair loss accompanies
- If scaling occurs outside of dandruff areas (face, chest)
- Open sores, pus
- If infant cradle cap does not resolve after 1 year
Diagnosis and Treatment
Diagnosis: Visual examination is sufficient. Biopsy may be done in case of suspicion.
Treatment:
Antifungal shampoos (main treatment):
- Ketoconazole (most effective, 2%)
- Selenium sulfide (2.5%)
- Zinc pyrithione (most common over-the-counter)
- Salicylic acid (dissolves scales)
- Coal tar (slow-acting)
- Ciclopirox
Usage tips:
- Use 2-3 times a week
- Leave for 5-10 minutes then rinse
- Rotate regularly
- Alternate between different shampoos
- You can wash your hair with regular shampoo for fragrance
Severe cases:
- Topical corticosteroids (hair lotion)
- Topical calcineurin inhibitors
- Oral antifungals (itraconazole, terbinafine)
- Phototherapy
For infant cradle cap:
- Mild baby shampoo
- Gentle brushing with soft brush
- Softening with mineral oil
- Usually resolves in 6-12 months
Prevention and Lifestyle
Hair care:
- Wash your hair regularly (more frequently if oily)
- Prefer warm water (very hot water increases dryness)
- Rinse thoroughly
- Limit oily hair products (gel, spray)
- Limit hair holders, gels per day
- Use a soft brush
- Do not brush hair until it dries
Lifestyle:
- Manage stress
- Eat a balanced diet
- Pay attention to B vitamins and zinc intake
- Drink plenty of water
- Get enough sleep
- Avoid extremely hot and dry environments
- Moderate sun exposure (UV can reduce fungus)
- Maintain regular hair cleansing
Other:
- Keep hair brushes and combs clean
- Do not pick at dandruff (worsens it)
- Avoid excessive chemical hair treatments (dyeing, perming)
- Change hats, headscarves frequently (prevents sweating)