What is Dandruff?
Dandruff is a non-infectious skin condition affecting the scalp. It is characterized by white flakes of skin between the hairs.
Dandruff is believed to be a mild version of an inflammatory skin condition called seborrheic dermatitis. This rash can occur on any part of the body where hair is growing. Dandruff, however, will only appear on the scalp.
It is a common scalp disorder, affecting anyone at any age. It may begin as early as the onset of puberty, where for many it remains throughout teen years and adulthood. (1)
The scalp is enriched with sebaceous glands. These produce a greasy substance called sebum. This oily matter helps to shed the dead skin cells as well as keeping the scalp hydrated. (2)
However, when these are compromised this will trigger hyperactivity causing overproduction. Now, instead of shedding the dead skin cells, it will glue them together forming visible clusters, known as dandruff.
Dandruff remains a prevalent skin condition, and it is often a cause of insecurities and low self-esteem. Even so, it continues to be a bit of a mystery disorder.
Experts are not exactly sure of its precise causes. Seborrheic dermatitis is a leading theory, as it induces an overgrowth of yeast creating dry, scaly skin. (3)
One cause which has been ruled out is bad hygiene. Even though it may be more apparent when the hair goes unwashed, less frequent showers have not been linked to dandruff.
Symptoms of dandruff may include:
When too much or not enough oil is produced, the shedding of skin cells is delayed. This results in a flaky looking appearance as the cells pile together. These become visible as dandruff. (4)
The flakes will usually fall off the head quite easily and might have a white or yellow appearance. They may have a greasy texture and can be sticky.
Crusty patches may appear if the cause of dandruff is seborrheic dermatitis. This condition will cause mild inflammation across the scalp forming patches or plaques. (5)
These may range in size and color. They might appear white or yellowish with harsh, rough edges.
Those affected by dandruff or seborrheic dermatitis are likely to experience an unusual oily scalp. This may be apparent across larger areas, or it may appear as small patches of grease. (6)
An itchy scalp is very common and may have various explanations.
Itching may cause more flakes or scales to loosen and fall off. Excessive scratching may also damage the skin and make it vulnerable to infections.
The skin around the affected areas is likely to appear red. This is mostly an indicator of more severe cases of dandruff. (8)
Redness of the scalp may also be a result of excessive itching. This could progress to raw, exposed skin inducing a burning sensation.
More severe cases of dandruff may result in temporary hair loss. (9)
If the scalp becomes very dry, the hair follicles may be unable to hold on to the strands of hair. This will cause these hairs to fall out. Fortunately, the hair will normally grow back once the follicles are rehydrated.
Dandruff has proven to be a difficult condition to cure, and many individuals will continue to be affected throughout life.
Exact causes of dandruff are not known. However, it is classified as either primary or secondary stage depending on the possible cause. (10)
Doctors must determine if the reason was a microorganism (fungus, bacteria) or an underlying condition of other origins. This is an essential distinction, as these require two different treatments.
It is later graded in severity ranging from mild to severe to determine the extent of treatment needed. (11)
Stage #1 (Primary)
The primary stage is general dandruff. These patients have not contracted a bacteria or had a fungus overgrowth. There are 2 possible causes.
The first possibility would be that the patient has an underlying condition which increased the chances for dandruff. This could be diseases such as eczema or psoriasis.
The second scenario would be that the patient was influenced by non-specific contributing factors. These could include things such as stress or cold temperatures.
Stage #2 (Secondary)
Patients who show signs of bacteria or fungus as the cause of dandruff will be evaluated as secondary stage.
These patients usually require a different treatment. This will likely involve antifungal medications to kill the culprit. As with the primary stage, there are two sub-stages.
The first is where evidence suggests that the patient’s scalp was influenced by a fungus or bacteria. These are likely to have been triggered by a specific event and was able to multiply and create a dandruff-like appearance.
The second is due to impaired immunity. If the immune system of the patient is compromised, the response pattern towards foreign bodies is likely to be impaired. So when influenced by fungus or bacteria the body may not respond as well as it normally would.
Mild dandruff will likely manifest with little to no symptoms. The skin may feel itchy, and flakes might be visible. However, there are no significant indicators of inflammation and is not expected to bring much discomfort to the patient.
Moderate to severe dandruff is often influenced by seborrheic dermatitis. It can usually be defined by inflammatory symptoms such as swelling, redness and itchy scaling in the affected areas.
Dandruff is very recognizable, so a dermatologist can usually determine a diagnosis by examining the scalp. If there’s suspicion of other conditions, further testing might be done. These could involve a skin biopsy. (12)
Treatment of general dandruff is relatively straightforward. It will usually involve an anti-dandruff shampoo.
Anti-dandruff Shampoo, Cream or Ointment
These contain specific substances and chemicals such as zinc pyrithione and salicylic acid which help heal the scalp and lessen dandruff. (13)
It is usually recommended to leave the shampoo on the scalp for a few minutes before rinsing. However, this may vary between products, so it is important to read the instructions.
If the dandruff is harder to remove, your doctor might prescribe a stronger medical shampoo. These may contain ciclopirox or sodium sulfacetamide.
If impaired immune responses caused the condition, your doctor is likely to prescribe a different shampoo or cream. These may contain either tacrolimus or pimecrolimus, which will work to suppress immune responses.
You might be prescribed creams or ointments containing antifungal medicine if a fungus or bacteria caused the condition. (14)
This is done by exposing the surface to ultraviolet light. Although it has been proven that sunlight may improve the condition, this treatment is not always used. It has shown in some cases to cause more harm than benefit. (15)
What is dandruff? Dandruff is a skin condition which causes clusters of flaky skin to appear on the scalp.
What are the signs of dandruff? A telltale sign usually includes white or yellowish scales of skin. Those affected will generally also have either a dry or oily scalp. Patches of crusty scales with surrounding red skin may be apparent. It is typically very itchy, which may be an indicator of infection. If so, it’s likely to feel warm to touch and appear red.
How do you develop dandruff? Even though it is a prevalent condition, exact causes have proven hard to pinpoint. However, it is believed that different factors may influence the development. These can include: yeast infections, eczema, allergies, and psoriasis. Other contributors could involve excessive sun exposure, cold temperatures and stress.
How are you diagnosed for dandruff? Dandruff is generally treated by a dermatologist. This specialist is usually able to recognize the condition merely by looking at the scalp. However, if there is suspicion of another disease or a fungal infection, a skin sample might be taken for further examination. (16)
What is the best treatment of dandruff? Anti-dandruff shampoos or creams are usually quite successful. These contain different medical substances which help heal the scalp. If dandruff is caused by a fungus, antifungal medicine might be prescribed. There are alternative treatments available such as phototherapy. However, this is generally only recommended in severe cases. (17)
What are the long term complications of dandruff? Some people might develop insecurities about their appearance. However, dandruff will usually not cause any long term medical complications.
Is dandruff considered a disability? No, dandruff is not a disability.
Is there any cure for dandruff? It depends on the cause. Although it is usually a long term condition, it can be managed with treatment.
Is dandruff life threatening? Dandruff on its own is not life threatening.
Dandruff is a non-infectious skin condition affecting the scalp of many adults. It is generally caused by seborrheic dermatitis. However exact causes remain unknown.
It is considered one of the most commercialized conditions, due to the extensive availability of anti-dandruff shampoos. (18)
Although it may be harmful to self-esteem, dandruff is usually not a concern for general health. It may be a long-lasting condition, however people can suppress its symptoms with the help of treatment.