Dandruff

Who's At Risk?

Dandruff occurs in 15–20% of the population. The problem affects all races, may be a bit worse in men, and starts after puberty (although babies have a version called cradle cap). It peaks around the age of 40 and then may improve. Severe changes are seen frequently in people with Parkinson’s disease and others with central nervous system problems as well as in those with HIV infection.

Signs & Symptoms

• The scalp is itchy and sheds white, oily skin flakes.
• One or more of the following areas may have patches of red, scaly skin: the scalp, hairline, forehead, eyebrows, eyelids, creases of the nose and ears, ear canals, beard areas, breastbone, midback, groin, or armpit.
• In darker skin, some of the affected areas may look lighter in color.

Mild – only some flaking with or without redness in a few small areas
Moderate – several areas affected with bothersome redness and itch
Severe – large areas of redness, severe itch, and unresponsive to self-care measures

Self-Care Guidelines

Most cases of dandruff are easy to control with non-prescription home measures. These include:

• Frequent (daily) shampooing or a longer lather time.
• Use of shampoos containing ketoconazole, selenium sulfide, 2% pyrithione zinc, salicylic acid, or tar-based shampoos.
• Discontinuation of hairspray, gel, mousse, and other hairstyling products.
• Stress reduction and a healthy diet, especially with adequate B vitamins, zinc, omega-3 fatty acids, and reduction of sugar- and yeast-containing foods such as bread, beer, and wine.

If a regular daily shampoo fails, consider an over-the-counter dandruff shampoo. There are several types and one may work better than another. Sometimes one will work well for a time and then become less helpful; then it may help to switch to a different type.

If the scalp is covered with widespread, dense scale, the scale may first be removed by applying warm mineral oil or olive oil to the scalp and washing several hours later with a detergent, such as a dishwashing liquid or a tar-based shampoo.

Treatments

Corticosteroid creams or solutions Sulfur or sulfacetamide products applied topically Ketoconazole shampoo or cream

Visit Urgency

Seek medical help if there is no response to self-care measures.

Trusted Links

• Clinical Information and Differential Diagnosis of Dandruff

References

Bolognia, Jean L., ed. Dermatology, p. 216. New York: Mosby, 2003.

Wolff, Klaus, ed. Fitzpatrick’s Dermatology in General Medicine. 7^th ed, pp. 219-224. New York: McGraw-Hill, 2008.