Dandruff

Medically Reviewed By William C. Lloyd III, MD, FACS
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What is dandruff?

Dandruff, also called seborrheic dermatitis, is an inflammatory condition that forms on oily areas of the skin, particularly on the scalp or inside the ear. The inflammation results in flaking scales that range in color from white to yellow. In infants, this condition is called cradle cap.

Dandruff is a chronic, lifelong disorder that is usually manageable with ongoing treatment and can disappear completely between flare-ups. Although it can cause embarrassment or social stress in some cases, it is not contagious and is rarely severe.

Dandruff can be emotionally taxing in severe cases, but it is not a life-threatening condition. Left untreated, it can lead to secondary bacterial or fungal infections. Seek prompt medical care if you are being treated for dandruff and any skin patches form crusts, exude pus, or become very red or painful.

What are the symptoms of dandruff?

Symptoms of dandruff include flaky scales that range in color from white to yellow, usually on oily parts of the skin such as the scalp or inside of the ear. Sometimes the affected skin is also red.

Common symptoms of dandruff

You may experience fluctuations in dandruff symptoms, with extended inactive periods between flare-ups. Symptoms during flare-ups usually include:

  • Dry, white, flaking skin
  • Itchy skin
  • Oily, yellow, adhering scales of skin
  • Plaque (broad, raised area of skin)
  • Redness, warmth or swelling
  • Skin lesions (any abnormal skin tissue )

Symptoms that might indicate a serious condition

In some cases, dandruff can be part of severe seborrheic eczema, severe psoriasis, or blepharitis (inflammation of the eyelids) that should be immediately evaluated in an emergency setting. Seek prompt medical care if you have any of these serious symptoms including:

  • Burning sensation in the eye
  • Eye pain
  • Eyelashes that grow abnormally or fall out
  • Flaking or crusted eyelids
  • Gritty feeling in the eye
  • Hives
  • Increased sensitivity to light
  • Itchy eyes
  • Lip inflammation
  • Oozing, wet skin
  • Red, sore eyes (bloodshot eyes)

What causes dandruff?

Although the exact cause of dandruff is not known, it is likely caused by a combination of skin oil overproduction and Malassezia, a type of yeast found on the scalp. Experts propose that dandruff is not a disease of the sebaceous glands of the skin or its secretions. However, sebaceous glands appear to be necessary for the development of dandruff because of its preference for body sites with increased numbers of sebaceous glands and larger sebaceous glands.

Dandruff flare-ups can be triggered by factors such as infrequent washing or shampooing; using skin or hair products that contain alcohol; stress or fatigue; other skin disorders such as acne; and weather extremes.

What are the risk factors for dandruff?

Several factors increase your risk of developing dandruff. Not all people with risk factors will get dandruff. Risk factors for dandruff include:

  • Acne and other skin disorders

  • Exposure to topical alcohols

  • Family history of dandruff

  • Fatigue

  • Infrequent cleansing

  • Obesity

  • Oily skin

  • Stress

  • Weather extremes

Reducing your risk of dandruff

It may not be possible to prevent developing dandruff, but you can minimize some of the triggers. You may be able to lower your risk of dandruff by:

  • Avoiding skin and hair products that contain alcohol

  • Cleaning your face and ears frequently

  • Diligently managing oily skin

  • Eating a diet that is low in fat and salty and smoked foods, and high in fiber and fruits and vegetables

  • Getting plenty of rest

  • Maintaining a healthy weight

  • Protecting yourself adequately against weather extremes

  • Seeking prompt and thorough treatment for other skin disorders

  • Shampooing your hair frequently

  • Treating the effects of stress in your life

How is dandruff treated?

There is no cure for dandruff, but you can usually manage dandruff with a combination of diligent use of medication, excellent hygiene, and general good self-care to help avoid triggers. Use of special dandruff shampoos can help prevent flare-ups or manage a current flare-up. In severe cases, prescription medications, such as a corticosteroid shampoo or corticosteroid lotion added to your normal dandruff shampoo, may help relieve inflammation and itching. If you develop a secondary bacterial infection, your doctor may also prescribe an antibiotic.

Practicing self-care strategies to help avoid triggers can go a long way toward controlling your dandruff. Also, it is important that you follow your treatment regimen, making it a part of your regular routine. Dandruff treatments include:

  • Over-the-counter shampoos that contain one of the following: selenium sulfide (Selsun Blue, Exsel), salicylic acid (Scalpicin, X-Seb), zinc pyrithione (DHS Zinc, Head & Shoulders), or coal tar (DHS Tar, Neutrogena T/Gel, Polytar)

  • Prescription antifungal ointments like ketoconazole (Nizoral)

  • Prescription corticosteroid treatments (lotions or shampoos to relieve inflammation and itching from dandruff), such as clobetasol propionate (Cormax, Temovate, Olux), hydrocortisone (Emo-Cort, Locoid), and fluocinolone acetonide (Capex)

    What you can do to improve your dandruff

    In addition to reducing your exposure to dandruff triggers, such as skin and hair products that contain alcohol, you can prevent or limit flare-ups by:

    • Cleaning your face and ears frequently

    • Diligently managing oily skin

    • Eating a diet that is low in fat and salty and smoked foods, and high in fiber and fruits and vegetables

    • Getting plenty of rest

    • Maintaining a healthy weight

    • Protecting yourself adequately against weather extremes

    • Shampooing your hair frequently

    • Treating the effects of stress in your life

    What are the potential complications of dandruff?

    Complications of untreated or poorly controlled dandruff are rare. You can help minimize your risk of complications by following the treatment plan you and your health care professional design specifically for you. Complications of dandruff include:

    • Embarrassment

    • Secondary bacterial infections

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    Medical Reviewer: William C. Lloyd III, MD, FACS
    Last Review Date: 2021 Jan 19
    View All Skin, Hair and Nails Articles
    THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
    1. Seborrheic Dermatitis. PubMed. U.S. National Library of Medicine. https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0022916/
    2. Seborrheic dermatitis. American Academy of Dermatology. https://www.aad.org/public/diseases/scaly-skin/seborrheic-dermatitis
    3. Tierney LM Jr., Saint S, Whooley MA (Eds.) Current Essentials of Medicine (4th ed.). New York: McGraw-Hill, 2011.