Dandruff is a chronic skin disorder that causes itching and flaking of the scalp. Fortunately, there are treatments to effectively control dandruff as it can be a nuisance since the itching is uncomfortable and the flaking visible.

Mild cases of dandruff can usually be managed with an over-the-counter dandruff shampoo. More stubborn cases may need a prescription-strength shampoo. Although dandruff is chronic, it can be controlled by managing stress, shampooing often and cutting back on styling products.

Causes of Dandruff

There are many causes of dandruff, the simplest of which is dry skin. Patients with this type of dandruff are bothered most in the winter when cold dry air and overheated rooms make the skin dry. The flakes from this variety of dandruff are smaller and less oily than those resulting from other causes. Individuals suffering with this type of dandruff experience dry skin not only on the scalp, but on other parts of the body, such as arms and legs, as well. Dandruff may also result from a number of skin conditions, including:

  • Seborrheic dermatitis or irritated, oily skin
  • Infrequent shampooing resulting in oil buildup
  • Psoriasis, an accumulation of dead skin cells
  • Eczema of the scalp
  • Contact dermatitis
  • Malassezia, a yeast-like fungus

Patients with seborrheic dermatitis may have flaking on other skin surfaces besides the scalp, such as the eyebrows, the breast bone and the groin. The scales of psoriasis or the irritated skin of eczema are as likely to appear on the scalp as well as on other parts of the body, causing dandruff flakes. Contact dermatitis, usually a consequence of an individual's sensitivity to hair product ingredients, may be worsened by excessive hair-washing, dyeing or conditioning. Malassezia lives on the healthy scalps of most adults, but only causes problems when it causes excessive growth of skin cells. It is frequently difficult to distinguish among the various causes of dandruff since the resulting scalp condition is similar.

Risk Factors for Dandruff

Risk factors that may make an individual more likely to suffer with dandruff may include:

  • Being male
  • Being a young to middle-aged adult
  • Having oily hair and scalp
  • Eating a diet low in zinc, B vitamins, or certain fats
  • Having a neurological disease
  • Experiencing excessive stress
  • Recovering from a recent heart attack or stroke
  • Having a suppressed immune system

Treatments for Dandruff

Treatments for dandruff are usually medicated shampoos. Many individuals may find effective relief from over-the-counter products, but some people may require prescriptions for stronger preparations. Dandruff shampoos may contain one of the following ingredients:

  • Zinc pyrithione (Head & Shoulders)
  • Tar-based (Neutrogena T/Gel)
  • Salicylic acid (Ionil T)
  • Selenium sulfide (Selsen Blue)
  • Ketoconazole (Nizoral)

The last on this list, ketoconazole, is an anti-fungal preparation that may work when other products fail. Some of these preparations may work better on certain individuals than others do and it may be helpful to alternate varieties from time to time. It may also be effective to decrease the number of times a dandruff shampoo is used as the condition improves. It is helpful to massage the shampoo into the scalp and let it remain there for several minutes before rinsing, thus giving the medication a chance to work.

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