Dandruff: Causes, Symptoms, and Effective Treatments

Dandruff (seborrheic dermatitis of the scalp) is a common, non-contagious condition causing flaking, itching, and sometimes redness. It is not caused by poor hygiene.

Primary Cause

Overgrowth of Malassezia, a yeast-like fungus naturally present on the scalp. It feeds on sebum (skin oil), producing oleic acid that irritates the scalp in susceptible individuals, accelerating skin cell turnover and causing visible flakes.

Contributing Factors

• Oily skin / seborrhea
• Dry skin (winter, low humidity)
• Sensitivity to hair products (contact dermatitis)
• Skin conditions: psoriasis, eczema
• Stress, fatigue, hormonal changes
• Infrequent or excessive shampooing

Symptoms

• White or yellowish flakes on scalp, hair, shoulders
• Itchy scalp
• Redness or irritation
• Greasy or dry scales

Treatment

Over-the-Counter Medicated Shampoos (rotate active ingredients for best results)

• Zinc pyrithione (antifungal, antibacterial)
• Selenium sulfide (antifungal, reduces cell turnover)
• Ketoconazole 1% (potent antifungal)
• Coal tar (slows skin cell growth, reduces inflammation)
• Salicylic acid (exfoliates scales)

Use 2–3 times weekly, leaving on 5 minutes before rinsing. Once controlled, reduce to weekly maintenance.

Prescription Options

• Ketoconazole 2% shampoo
• Topical corticosteroids (short-term for inflammation)
• Topical calcineurin inhibitors (tacrolimus, pimecrolimus)

Self-Care Tips

• Shampoo regularly (daily if oily, every 2–3 days if dry).
• Avoid heavy styling products on the scalp.
• Manage stress.
• Eat a balanced diet with zinc, B vitamins, omega-3s.
• Limited sun exposure may help (UV has antifungal effect), but protect skin.

If OTC treatments fail after 4–6 weeks, see a dermatologist.