Everything You Need to Know About Dandruff
11.08.17

I’ve kept Head & Shoulders in my haircare rotation since high school. It’s not something I use every day, but it’s what I fall back on whenever I notice tiny flakes upon parting my hair after a shower. It works well enough, but I’ve never really understood why I got dandruff in the first place, nor whether simply “keeping it at bay” was the right approach. According to the National Institute of Health, I’m not alone: nearly half of adults suffer from some form of dandruff.

If you count yourself among those numbers and, like me, have been dealing with it quietly and to mixed results, read on for the official expert-consulted rundown.

What even is dandruff?

Dr. Debra Jaliman, board-certified dermatologist and Assistant Professor of Dermatology at New York’s Icahn School of Medicine at Mount Sinai, says dandruff happens when the skin isn’t exfoliating properly and dead skin gets stuck on the scalp and begins to flake and itch.

“It can be genetic or environmental,” Jaliman says, but has nothing to do with poor hygiene! “It’s a real skin condition. However, it’s very treatable so nothing to worry about.”

Dandruff is the common name for seborrheic dermatitis on the scalp, a condition that causes red, flaky and itchy skin as a result of too much yeast that’s present on oily areas of the skin. The only difference is that dandruff is restricted to the scalp, while seborrheic dermatitis can affect other areas, like the T-zone, and often causes inflammation. “It’s characterized by fine greasy, flaky scale that is often accompanied by itch and underlying skin redness,” says dermatologist Shereene Idriss of Union Square Laser Dermatology.

What causes it?

Here’s how it works: A yeast-like fungus called malassezia globosa feeds on your scalp oils, says Rebecca Lee, a nurse and founder of the natural health resource, RemediesForMe.com. “As these fungi feed on the oils by using enzymes, it creates oleic acid which seeps into the scalp and causes your skin to shed.”

In other words, it’s not caused by dry skin, too much or too little oil, or the frequency of your showers. In fact, researchers are still not completely sure what causes dandruff or seborrheic dermatitis. “Although the exact cause is still unknown, [seborrheic dermatitis] is believed to be an abnormal immune response to a very common yeast that goes unnoticed on most people, called Pityrosporum,” Idriss says.

A note about dandruff: A flaky scalp does not necessary mean dandruff. Flakiness not related to seborrheic dermatitis can also be psoriasis, fungal infections of the scalp or eczema.

Why treat it?

If it’s so common, why do we need to treat it at all? Well, other than the embarrassing fact that it makes us want to constantly scratch our heads and that it can be noticeable when wearing your favorite dark-colored T-shirt, “there is no definitive cure for dandruff. It is a long-term, chronic condition that will come and go over time,” Idriss says. This is why it’s important to know the signs of dandruff and how to treat it properly.

Additionally, Lee says, dandruff can actually block the hair follicles and prevent new hairs from growing, causing thinning.

How do you treat it?

Medicated shampoo

While shampooing regularly can help to reduce symptoms of dandruff, it won’t really solve the underlying problems or eliminate the flakes altogether. That’s why there’s a massive market for dandruff shampoos — people spend about $300 million each year on dandruff treatment products.

Look for shampoos that contain zinc pyrithione, selenium disulfide, sulfur, salicylic acid, ketoconazole and tar. Jaliman says they are all ingredients known to be effective against dandruff and flaky scalps. (Zinc pyrithione is the key ingredient in Head & Shoulders, which is why it works.)

Idriss says she usually recommends patients start with Nizoral shampoo, as it contains 1% ketoconazole, an ingredient that’s a notch below the prescription-strength antifungal that is usually prescribed. “Alternating this with either selenium sulfide shampoo, such as Selsun Blue, or tar shampoos, such as Neutrogena T/Gel, will improve the efficacy over time,” she says. (Be aware that you can’t use tar shampoos if you have blonde hair as it can cause discoloration.)

Dr. Cynthia Bailey recommends a 2% pyrithione zinc treatment, like her Foaming Zinc Cleanser that can be used on the scalp and body. Before shampooing, try applying warm coconut oil for 30 minutes to remove thick buildup. Then massage your shampoo into your scalp. Adds Idriss: If your dandruff is thicker and sticks to your scalp, shampoos with salicylic acid, like Neutrogena T/sal, can help loosen up thick buildup to make it easier to treat the actual yeast below.

Wash often

If you don’t want to use one of these ingredients, “shampooing daily helps even without medicated shampoos,” Bailey says. At the very least, try washing at least every other day, leaving the shampoo on your scalp for five minutes. These steps are particularly important during the winter, because cold weather can worsen seborrheic dermatitis can worsen, causing more dandruff, Idriss says.

At-home treatments

Lee, a proponent of natural remedies, says you there’s also a range of at-home treatment options. Raw honey, for example, “is great for hair growth and getting rid of dandruff… One study shows relief from itchiness, scaling, skin lesions and dandruff within two weeks. Participants were asked to rub diluted honey onto their scalp daily for three hours. After two weeks, maintenance was only needed once a week.”

Apple cider vinegar, which balances the pH of your scalp, can also be used. The pH neutralization makes it hard for yeast infections, bacteria and other fungi to grow.

Idriss notes natural, at-home remedies aren’t always more cost-effective since there are many, many drugstore options now available.

When is it time to see a doctor?

“Try using a few different home remedies (shampoos, masks, exfoliants, essential oils) before visiting a dermatologist,” Lee says. But if you’ve used a few different products, including over-the-counter medicated shampoos, for months without seeing any improvements (or if you happen to notice redness, swelling, a bleeding scalp or sudden hair loss), it’s time to make an appointment. A dermatologist can help you pinpoint the underlying cause of your dandruff and prescribe a more effective treatment.

Tips for maintaining a healthy scalp

Dandruff shouldn’t be the only reason to pay attention to your scalp health. “A healthy scalp is one that is not neglected. Daily hair brushing, starting from the roots and scalp, is essential to promote healthy scalp circulation,” Idriss says.

She recommends washing your hair at least two or three times a week in order to avoid oil and product buildup. When you wash, massage your scalp, and be sure to limit conditioner to the tips of your hair. “If you do have dandruff and are losing hair, it’s important that you not fear washing your hair. It is normal to lose up to 100 hairs a day, so don’t fret if you notice hair on the floor of your tub after washing,” Idriss says.

Lee also recommends using a clarifying shampoo once a month and eating lots of protein from healthy sources, like eggs, salmon, beef, shrimp, pumpkin seeds and cottage cheese.

Do you suffer from dandruff? What has or hasn’t worked?

Illustrations by Amber Vittoria; follow her on Instagram @amber_vittoria.

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  • Adrianna

    My boyfriend has this, and it’s the most severe in the winter time. It’ll frequently show up “faintly” on his sideburns and eyebrows first. Luckily he ended up in a relationship with someone who isn’t grossed out and likes to pick the pieces off his scalp. I’ve actually gotten to know his head and scalp really well the past 5 years. He claims to have found pieces of skin the size of a nickel during his lifetime. Coincidently, his skin is dry in general. His hands get very dry and peel in the winter. (I introduced him to the concept of lotion.)

    Some of the suggested shampoos work. I’m not sure what his regiment is like, because he still has this problem.

    • Hayley

      Laughing at “I introduced him to the concept of lotion.” My husband is also super dry and I finally convinced him to use a dandruff shampoo, which has helped a bunch.

      • Adrianna

        He literally said that he just keeps his hands in his pockets. I’m like, taking care of your skin doesn’t make you less masculine. I understand that he associated lotion with that cheap perfumey smell

    • Haha my boyfriend has the same, the thing that works for his hair but also face (he gets exzema when he gets stressed and also pretty severe build up and flaking on his scalp) is Pai rosehip oil. It can get pretty expensive when you use it all over your scalp, but it’s the only oil that really works, coconut one is weirdly very drying and other oils don’t seem to have much of an effect…

  • Hayley

    I alternate every other shampoo with a dandruff-fighting one (I use the L’oreal EverFresh version, since it’s sulfate-free) and it seems to work well enough for me. I grew up in a house that had VERY soft well water, and it wreaked havoc on my scalp. Once I left home for college and beyond, my dandruff improved drastically due to different (and much harder) water.

  • Yay, happy to see Amber Vittoria’s illustrations here! I love her work.

    • Amber Vittoria

      <3 oh my goodness, thank you!

  • Cristina

    “It’s normal to lose up to 100 hairs a day” was my most important takeaway. I feel so much better about life and brushing my hair.
    Thanks for the dandruff tips! I have it on and off but the onset of cold weather this year made it come off in SHEETS and I was panicking. I sometimes wonder if it’s eczema, because there are a couple spots on the back of my heard that never go away. But I started treating them with tea tree oil and it has helped IMMENSELY.

    • Alycia

      YES to tea tree oil 👏 I’m surprised it wasn’t mentioned in the article.

  • nell

    Ugh, I unfortunately have so many tips on this subject. First of all, if you have true seborrheic dermatitis in my opinion the *only* thing that works is that foul smelling Neutrogena T-Gel shampoo. My usual maintenance routine is Head and Shoulders a couple of times a week and spraying diluted apple cider vinegar on my roots and scalp 10-15 minutes before I get in the shower. In the winter I add Kiehl’s “Magic Elixir” which is a blend of oils formulated to be rubbed into your scalp — it doesn’t do much if you have an underlying problem but it feels nice if you just have that dry, itchy winter skin and it makes your hair feel and smell great. My last rec is to get a shampoo brush! It’s a little brush with rigid plastic bristles you use to massage your scalp, loosen up the flakiness and promote circulation — great to use with the ACV or an oil treatment like Magic Elixir. (Just search Amazon)

  • Maya

    I have suffered from severe seborrheic dermatitis my whole life and it flares up significantly every few years. The dead skin cells turn into a large scaly crust on my scalp which weakens the hair follicles (always around the same area) and it resulted in 2 permanent bald patches on my head from when I was young. Another big flare up a few years ago resulted in hair falling out in clumps (with follicles attached to the scaley skin) and it was horrible for my mental health – but it grew back after treatment phew! Thankfully, from lots of trial and error I found the absolute best products that worked for me. When it gets really bad I use Cocois ointment on the patches before I wash my hair, and I now always use Phyto Pytheol Intense shampoo. Pricy, but so worth it! These are two pretty strong products, so only necessary if it’s really bad, but I would highly recommend them.

  • Alycia

    Love the illustrations! And I was so surprised to hear exfoliation recommended. This is generally the last thing on my mind when my scalp gets dry…

    • Amber Vittoria

      Thank you! 😀

  • But how am I supposed to wash my scalp every day but also only wash my hair twice a week as is supposedly best for the shaft? Being a woman is hard….

  • Kat

    I don’t have dandruff, but I get an itchy scalp if I don’t wash my hair most days (also switched to sulphate-free shampoo which has helped.)

    Anyway just came down here to say – this paragraph made me pause:
    “Participants were asked to rub diluted honey onto their scalp daily for three hours. After two weeks, maintenance was only needed once a week.”

    Who on earth has time to rub honey on their head every day for THREE HOURS???!!

    • Hayley

      I’d imagine a side effect (good or bad, depending on personal preference) is that you have killer forearm muscles and would be an EXCELLENT tennis player.

  • Alexi Ueltzen

    LOVE Amber’s illustrations. Thanks for showcasing dope artists like her.

    • Amber Vittoria

      <333333333

  • tiabarbara

    I read on a few sites that tea tree oil works a treat, as it’s an anti-fungal ingredient used in a number of dandruff adjacent shampoos. I bought a small jar of tea tree essential oil and added a bunch to my shampoo and conditioner bottles. It’s too early to tell yet if it’s made a big difference, but I have noticed that my scalp feels slightly less itchy so. Little wins.

  • How do I know if it’s dandruff or just flakiness?

    My scalp is itchy and extremely flakey! I used some special conditioner and treatment oil stuff from Superdrug for a while and it did work… for a while. Should I be using a scalp mask or putting oil on it to moisturize or something!?

    I’m also gonna assume that most/all of the products in the post aren’t vegan as most are medicated ones… if anyone has any vegan suggestions please let me hear them!!

  • Lucy Moore

    I’ve had a terrible runaround with dandruff. The yeast issue has spread to my t-zone and the areas around my hairline, too. I’ve seen 4 dermatologists now and things are slightly better but I’m still having problems. Issues at hand: 1) I have super thick hair that takes hours to dry after washing it, and it is impossible with my schedule to wash my hair every day, but even every other day is rough 2) adult acne also started at the same time 3) I do keratin treatments on my hair to make it somewhat manageable, so I can’t use sulfates
    Some things that have helped…
    1) Philip B Antiflake II shampoo
    2) Apple cider vinegar in the shower; haven’t yet tried on my face
    3) Aquaphor on the sides of my nose, but it just barely helps
    Countless heavy to light types of moisturizer recommended by derms has not gotten rid of my extensive dryness. Some days I wake up in pain still.
    I’m now going to see if limiting my conditioner to my tips helps! I usually use a ton because of the amount of hair and the intensity of my tangles.
    This seems like a lifelong battle to me! Maybe because that’s what my last derm said. But I don’t really trust anyone!