When Kevin went for his school physical, he told the doctor that his biggest worry about going back to school was the dress code. This year the uniforms were dark blue, and Kevin hated wearing dark colors. He told his doctor that he got embarrassed because dandruff always showed up on his shoulders. When the doctor said that dandruff was treatable, Kevin was relieved.
What Is Dandruff?
The flaking accompanying dandruff is caused by something called seborrheic dermatitis (sometimes just called seborrhea). Dandruff flakes may be white or light yellow and will usually rub off a person’s head easily.
Someone who has dandruff may notice his or her scalp feels crusty, red, and raw in the areas where seborrhea is getting worse. If this happens, seborrhea can cause the scalp to itch pretty badly. In very rare cases, seborrhea may cause hair loss if it isn’t treated. But any lost hair should start to grow back once seborrhea is treated.
For some people, seborrhea just causes a relatively mild case of dandruff — a bit of flaking and itching in the scalp. Other people with seborrhea have crusty, red, irritated skin that may spread to different areas of the body. Common locations to find seborrhea include inside the ear, the armpits, and even the belly button.
Seborrhea and dandruff aren’t contagious. So you can’t catch dandruff from (or give it to) another person.
Who Gets Dandruff?
If you’re worried about dandruff, you’re not alone. Dandruff can start in early adolescence during puberty, and lots of teens and adults live with it. Doctors don’t know exactly what causes dandruff, but some people think it happens when the oil glands and hair follicles produce too much skin oil (sebum). Hormone levels are high during teen years, causing more oil production, which can lead to dandruff.
People who get eczema may notice that their dandruff gets worse when they have an eczema flare-up. Dandruff also often gets worse during the winter and in cold weather. Other things that can increase a person’s chances of getting seborrhea include stress, immune system problems (like HIV), and neurological problems.
Most of the time dandruff can be treated and controlled with over-the-counter dandruff shampoo. More severe dandruff may need prescription shampoo, steroid creams, or antifungal creams to help improve the skin irritation.
If you have seborrhea only on your scalp, you should be able to treat it just with dandruff shampoo. Depending on your hair type, it also may help to massage mineral oil into your scalp to help loosen the flakes.
Many types of dandruff shampoo are available over-the-counter and they all work pretty well. They are sold under many different names so check the labels for “active ingredients” or ask the pharmacist if you have any questions:
- selenium sulfide 1% shampoo
- sulfur shampoo
- tar-based shampoo
- zinc pyrithione shampoo
- ketoconazole shampoo
If you have dandruff, you may need to use a dandruff shampoo every day at first. Once your dandruff has improved, it is OK to use your dandruff shampoo less often. Using dandruff shampoo once a week may be enough to keep dandruff flakes off your shoulders.
If one type of dandruff shampoo irritates or bothers your scalp, try a different one. You might need to experiment with a couple to figure out which one works best for you.
Some dandruff shampoos have a strong smell. But you can still smell like you by using your regular shampoo and/or conditioner after rinsing the dandruff shampoo out.
If you have seborrhea in areas other than your scalp, or if shampoos alone are not controlling your dandruff, talk to your doctor about other treatments.
Your doctor will examine you and get your medical history in order to work out the best treatment for you. If your doctor decides you need medicine for seborrhea, he or she may recommend:
- prescription-strength dandruff shampoos
- antifungal shampoos, creams, and lotions
- steroid creams, lotions, and ointments
After treatment, some people notice that areas of skin that had severe seborrhea may be lighter than the surrounding skin. This is more common in people with darker skin. Over time, this color difference will fade and the skin’s color will return to normal.
Living With Dandruff
Most people are able to control dandruff with shampoos. Some need to use these shampoos as often as twice a week; others can go a month between uses. Other people may need special prescription shampoo to keep dandruff away. It all depends on the person.
Dandruff can’t be cured, but it can be kept under control. And, once it’s under control, most people can’t tell that someone has it. In fact, the only way someone might know you have dandruff is by looking at the shampoos in your shower.
Reviewed by: Rupal Christine Gupta, MD
Date reviewed: August 2014