Dandruff

Table of Contents

1. An Introduction To Dandruff
2. What Causes Dandruff?
3. How To Treat Dandruff Effectively
4. Common Misconceptions About Dandruff
5. The Dandruff Blacklist: Ingredients To Avoid If You Have Dandruff
6. Conclusion
7. References

An Introduction To Dandruff

Dandruff presents as white flakes that can be visible on the scalp and in your hair and is often confused with having a dry scalp. However, the two conditions are separate and despite a common misconception, neither are caused by bad hygiene. It is not harmful to you, nor is it contagious.

There are many different possible causes of dandruff, including seborrheic dermatitis, eczema, psoriasis and ringworm. Stress and cold weather can also make it worse.

Various treatments are available to manage dandruff, with most involving the use of anti-dandruff shampoos containing anti-fungal agents. These agents work by controlling the growth of Malassezia, thereby reducing flaking and itching [1]. There are also plants and herbs with similar properties that may be effective.

While dandruff can be a persistent and bothersome condition, it can be effectively managed with the right treatments and care.

What Causes Dandruff?

Dandruff can be caused by a number of different skin conditions and various factors can impact the severity of dandruff, such as cold weather and stress [2]. Some common skin conditions that can result in dandruff include:

Seborrheic Dermatitis. This is caused by an overgrowth of a yeast-like fungus called Malassezia which is naturally present on our scalps. In some individuals, it can proliferate excessively, leading to the shedding of dead skin cells in the form of white flakes [3]. To learn more about this skin condition, read our detailed article on seborrheic dermatitis here.

Eczema. Also known as atopic dermatitis, this skin condition leads to dry, flakey skin and can affect the scalp, leading to white flakes.

Psoriasis. This is characterized by red, flaky patches of the skin covered with silvery scales. It can also affect the scalp and lead to dandruff.

Cradle Cap. This is a name given to seborrheic dermatitis in infants. It’s usually harmless and improves after the first year.

How To Treat Dandruff Effectively

There are a wide range of treatments available for dandruff. Many include anti-fungal shampoos, but there are some natural treatments available that can be effective.

Natural Treatments For Dandruff

Aloe Vera. A thick, short-stemmed plant that has anti-fungal properties and can help soothe and moisturize the scalp, reducing dandruff symptoms [4].

Apple Cider Vinegar. This also has anti-fungal properties that can help to reduce dandruff [4].

Tea Tree Oil. Derived from an Australian plant, this popular essential oil has been shown to have strong anti-microbial and anti-inflammatory properties [5] and a 2014 study showed it to be effective in the treatment of mild to moderate seborrheic dermatitis [6].

Over-The-Counter And Prescription Treatments For Dandruff

Climbazole. This anti-fungal agent has been shown to be effective against the yeast Malassezia, reducing dandruff and skin redness [7].

Coal Tar. This ingredient can be found in some anti-dandruff shampoos and has been shown to be effective in controlling or improving symptoms of seborrheic dermatitis and dandruff, as demonstrated in a 1985 study [8]. However, it can be irritating for some as well as having an unpleasant smell. Some components of coal tar, including benzene and naphthalene, have been identified as carcinogenic.

Ketoconazole. This is an anti-fungal medication that works by inhibiting the growth of the yeast-like fungus Malassezia which is often associated with dandruff [9]. Also known by different brand names, it has been shown to be as effective as a 1% hydrocortisone cream for seborrheic dermatitis [10] and more effective in reducing dandruff than ciclopirox olamine [11].

Piroctone Olamine. This ingredient has anti-bacterial and anti-fungal properties, helping to inhibit the growth of Malassezia. It has been shown to effectively treat seborrheic dermatitis [12] and control symptoms of flaking, itching and redness. It is well-tolerated by most individuals and often used in conjunction with other ingredients.

Salicylic Acid. This common skincare ingredient is a keratolytic agent, meaning it helps to exfoliate the skin. A beta hydroxy acid, it can help to remove excess oil and soften scaly skin, helping to control dandruff [13].

Selenium Sulfide. This is another agent that works by inhibiting the growth of Malassezia and has been shown to be effective at treating seborrheic dermatitis and dandruff [14]. It helps by reducing the production of sebum and slowing down the growth of skin cells to prevent flaking.

Zinc Pyrithione. This is an anti-fungal and anti-bacterial agent that was once found in many anti-dandruff shampoos. It works by slowing the production of skin cells, which can help reduce inflammation and itching and improve dandruff [15]. As of 2023, zinc pyrithione has been banned in the U.K. and EU.

Common Misconceptions About Dandruff

Dandruff Is Caused By Poor Hygiene

Although not washing your hair regularly can contribute to dandruff, it is not the primary cause and usually requires treatment.

Dandruff Is Contagious

Dandruff is not contagious and cannot be spread from one person to another.

Dandruff Is Caused By A Dry Scalp

A dry scalp can lead to dandruff, but an oily scalp caused by seborrheic dermatitis can also lead to dandruff.

Dandruff Can Lead To Hair Loss

Whilst some individuals may experience dandruff and hair loss, the two conditions are separate and hair loss is not caused by dandruff.

The Dandruff Blacklist: Ingredients To Avoid If You Have Dandruff

As well as using the right ingredients to treat dandruff, it’s important to avoid others that could worsen the condition. Here is a list of some common ingredients found in hair care products that individuals with dandruff may wish to avoid. This is not an exhaustive list, and the quantity and formulation of each product should be taken into account.

Fragrances. Fragrances can cause allergic reactions and irritate the scalp, potentially leading to an increase in dandruff.

Parabens. Although generally considered safe for use, some individuals may be sensitive or have an allergic reaction to parabens so they are best avoided if possible.

Silicones. These are commonly found in hair care products for their ability to soothe and add shine to the hair. Whilst they do not directly cause dandruff, they can build up on the scalp and hair over time if not properly washed out, creating an environment that can encourage the growth of Malassezia, leading to dandruff [16].

Sodium Chloride. Also known as common table salt, this ingredient can be used in shampoos as a thickening agent. Although not a direct cause of dandruff, it can contribute to scalp dryness and irritation in some individuals, potentially exacerbating dandruff.

Some Types Of Alcohols. Some hair care products contains alcohols for their quick-drying properties and their ability to distribute other ingredients evenly across the hair. However, some short-chained alcohols like ethanol and isopropyl alcohol can be drying to the scalp and exacerbate dandruff [17]. Not all types of alcohol have a drying effect on the hair, however, with some fatty alcohols like cetyl alcohol having moisturizing properties that may be beneficial.

Sulphates. Individuals with sensitive skin may find harsh sulphates like SLS and SLES problematic. A study in 1994 found that volunteers who used a dilute solution of SLS suffered from skin damage [18]. They can also strip the skin of its natural oils, leading to dryness and irritation.

Conclusion

Dandruff is a common scalp condition, characterized by the shedding of dead skin cells from the scalp in the form of white flakes, that affects a significant portion of the population. There can be multiple different causes such as an overgrowth of a yeast-like fungus called Malassezia, eczema, psoriasis and more. Other factors can also play a role such as individual skin and hair characteristics, environmental conditions, and the use of certain hair products.

While dandruff can be a persistent and bothersome condition, it can be effectively managed with the right treatments. These often include anti-fungal shampoos and some natural remedies like tea tree oil and aloe vera may also be effective. It may be necessary to try different treatments or a combination of treatments to find the most effective solution.

Despite common misconceptions, dandruff is not a result of poor hygiene and it is not contagious. It's a chronic condition that can be managed but may not be completely curable.

As with any health condition, it's recommended to consult with a healthcare provider or dermatologist for personalized advice and treatment options. With the right care and treatment, individuals with dandruff can effectively manage their symptoms and improve their quality of life.

References

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[2] nhs.uk. (2017). Dandruff. [online] Available at: https://www.nhs.uk/conditions/dandruff/.

[3] Dawson, T.L., DeAngelis, Y.M., Kaczsvinsky, J., & Schwartz, J.R. (2004). Broad-spectrum anti-fungal activity of pyrithione zinc and its effect on the causes of dandruff and associated itch 1. Journal of The American Academy of Dermatology, 50, 36.

[4] Sonawane, S.K., Shinde, P.P., & Shelke, S.J. (2021). Shampoos: Hair Care Cosmetics. Research Journal of Topical and Cosmetic Sciences.

[5] Pazyar, N., Yaghoobi, R., Bagherani, N. and Kazerouni, A. (2012). A review of applications of tea tree oil in dermatology. International Journal of Dermatology, 52(7), pp.784–790. doi:https://doi.org/10.1111/j.1365-4632.2012.05654.x.

[6] Roy, A., Tavakolifar, B., Huseini, H.F., Tousi, P., Shafigh, N., & Rahimzadeh, M. (2014). Efficacy of Melaleuca alternifolia Essential Oil in the Treatment of Facial Seborrheic Dermatitis: A Double-blind, Randomized, Placebo-Controlled Clinical Trial. Journal of Medicinal Plants, 13, 26-32.

[7] Wigger-Alberti, W., Kluge, K. and Elsner, P. (2001). [Clinical effectiveness and tolerance of climbazole containing dandruff shampoo in patients with seborrheic scalp eczema]. Praxis, [online] 90(33), pp.1346–1349. Available at: https://pubmed.ncbi.nlm.nih.gov/11534318/ [Accessed 29 Nov. 2023].

[8] Fredriksson, T. (1985). Controlled comparison of Clinitar Shampoo and Selsun Shampoo in the treatment of seborrhoeic dermatitis of the scalp. The British Journal of Clinical Practice, [online] 39(1), pp.25–28. Available at: https://pubmed.ncbi.nlm.nih.gov/3157398/ [Accessed 29 Nov. 2023].

[9] Poojary, P.V., Sarkar, S., Adithi Ananda Poojary, Mallya, P., Selvaraj, R., Ananthamurthy Koteshwara, Jesil Mathew Aranjani and Lewis, S. (2023). Novel anti‐dandruff shampoo incorporated with ketoconazole‐coated zinc oxide nanoparticles using green tea extract. Journal of Cosmetic Dermatology. doi:https://doi.org/10.1111/jocd.16027.

[10] Katsambas A, Antoniou CH, Frangouli E, et al. A double-blind trial of treatment of seborrheic dermatitis with 2% ketoconazole cream compared with 1% hydrocortisone cream. Br J Dermatol. 1989;121:353–357.

[11] Shuttleworth D, Squire RA, Boorman GC, Goode K, Journal of dermatological treatment, 1998, 9(3), 157‐162

[12] Del Rosso JQ. Adult seborrheic dermatitis: a status report on practical topical management. J Clin Aesthet Dermatol 2011;4:32–38.

[13] Khan, N.T. (2019). SALICYLIC ACID – An Effective Skin Care Agent.

[14] Silvanose, C., & Jibin, V.K. (2023). Role of Malassezia furfur and M. globosa in Dandruff and Seborrheic Dermatitis. Journal of Clinical and Investigative Dermatology.

[15] Jones, N., Carvalho, M. and Branvold-Herr, A. (2017). Management of Psoriasis with a XemaTop Topical Compounded Formula: A Case Report. International Journal of Pharmaceutical Compounding, [online] 21(3), pp.205–211. Available at: https://pubmed.ncbi.nlm.nih.gov/28557781/ [Accessed 29 Nov. 2023].

[16] Sang, S., Liew, K.B., Lee, S., Keng, J., Lee, S., Akowuah, G.A., Tan, C.S., & Chew, Y. (2023). Formulation of Botanical Shampoo Infused with Standardised Mangosteen Peel Extract for Healthy Hair and Scalp. Cosmetics.

[17] 褚淑祎, 肖继波, & 罗锡平 (2011). Method for preparing shampoo capable of removing dandruff, relieving itching and promoting hair growth.

[18] Piérard, G.E., Arrese, J.E., Rodríguez, C. and Daskaleros, P.A. (1994). Effects of softened and unsoftened fabrics on sensitive skin. Contact Dermatitis, [online] 30(5), pp.286–291. doi:https://doi.org/10.1111/j.1600-0536.1994.tb00600.x.