- Dandruff is a less serious form of a skin condition known as seborrheic dermatitis.
- Scientists don’t fully understand what causes dandruff, although there are known triggers.
- Several treatments — some of which are entirely natural — can help manage dandruff.
Dandruff can be quite frustrating to deal with, even if it’s more of a cosmetic problem than a medical one. The numbers are actually staggering: Americans spend a combined $300 million annually on dandruff treatment products — many of which are ineffective or only offer temporary relief.
Can you get rid of dandruff forever in one wash, as some manufacturers claim? Unfortunately, no single treatment is quite that effective, but there are ways to address the symptoms of this common skin concern.
What causes dandruff?
Despite the prevalence of dandruff, medical professionals still don’t completely understand it. There are a number of potential causes, both microbial and non-microbial, but it’s important to note that dandruff is non-communicable — you can’t ‘catch’ it from someone else.
Because it’s received so little attention in the field of dermatology, clinical studies have been few, and the causes of dandruff remain mysterious. It is known, however, that dandruff is an early or less severe form of seborrheic dermatitis.
Your body plays host to a number of different microbes, most of which are completely harmless. Still, an unbalanced number of microbes — including malassezia, a microbial fungus that sometimes lives on the scalp — can cause problems.
Malassezia is found naturally on the skin of many animals, including humans. It requires fats to grow, which is why it is favors the scalp, where sebaceous glands produce the lipids it needs to thrive. Dandruff may result as these lipids are metabolized by the fungus.
Confusingly, dandruff is commonly associated with a dry scalp. Since malassezia needs lipids to grow, the relationship between these two factors is poorly understood. This has led some experts to challenge the belief that malassezia actually causes dandruff.
Dry skin and a damaged skin barrier
Damage to the dermal barrier caused by dry skin or irritants can lead to loss of water through the skin. This can contribute to the formation of dandruff and scalp scabs, since the dermal barrier prevents the entrance of toxic substances and the excessive colonization of microbes like malassezia.
A weakened dermal barrier can also lead to further sensitivity to irritants, thus creating a self-sustaining cycle.
Dandruff affects both men and women, but it’s more common in men. There are two commonly suggested reasons why:
- Men are generally less selective in choosing hair care products. Consequently, they may use products that are too harsh, thus exacerbating scalp sensitivity and skin conditions.
- Because women tend to wear their hair longer, dandruff may not be as visible.
It’s worth noting that dandruff does not affect bald scalps, suggesting that the hair follicle and its sebaceous gland are required for dandruff to form.
There are numerous causes that may make an individual more susceptible to both seborrheic dermatitis and dandruff, including:
- Immune problems, from a depressed immune system to more serious medical conditions
- A disrupted epidermal layer, which could be caused by various chemical or environmental irritants
- Lifestyle factors, such as stress and an improper diet
Miracle treatments: Can dandruff be cured permanently?
Is there a cure to dandruff? Can it really be treated in one wash, as some product manufacturers claim? Unfortunately not.
“Dandruff is a chronic condition,” explains Dr. Sejal Shah, a New York-based cosmetic dermatologist. “It can be managed, but it isn’t really curable. While some cases may clear after one wash, it will recur if some form of maintenance treatment is not continued.”
A brief visit to any supermarket or drugstore shampoo aisle will present you with an overwhelming choice of purported dandruff treatments. These products are meant to fight malassezia colonization, reduce skin cells overproduction, and help rid the scalp of dead skin cells.
Dr. Shah suggests that there are several active ingredients you should look for, many of which may be combined in the same shampoo.
Tea tree oil
In one study a 5% tea tree oil solution was shown to produce a 41% improvement in the severity of dandruff. This effectiveness appears to be connected to the antifungal properties of tea tree oil, which is overall a safe and effective treatment for dandruff.
Salicylic acid is useful for a host of skin conditions, including dandruff and seborrheic dermatitis. It’s readily available over the counter and is frequently found in antidandruff shampoos, combined with coal tar and sulfur.
In one study a shampoo with a 2% salicylic acid solution, combined with piroctone olamine and elubiol, garnered a 70% approval rating from participants.
Tar is a useful treatment for psoriasis, and it helps with dandruff as well. Coal tar causes the skin to shed dead cells and prevents it from producing too many new cells. It may also be effective in combating malassezia colonization.
Sulfur helps to both remove dead skin cells and fight microbe colonization. For a long time it’s been used as a treatment for a number of skin conditions, including acne, scabies, warts, and rosacea, as well as seborrheic dermatitis and dandruff.
Sulfur is often combined with other compounds like salicylic acid. While it’s generally safe, it may elicit a mild local reaction in those who are sensitive to it.
Ketoconazole (KET) has been shown to be effective in reducing dandruff. The believed mechanism is its antifungal properties, though it helps to reduce flaky skin as well. Shampoo with a 2% KET solution was shown to be more effective than a 1% solution.
Selenium sulfide is known for its antifungal properties, and may also help prevent overproliferation of skin cells. Take note that selenium sulfide has been reported to leave hair overly greasy, something you may want to avoid.
Use of a zinc-pyrithione skin care products and shampoo has shown considerable effectiveness in helping to reduce seborrheic dermatitis and dandruff. By the end of two weeks, most patients reported a significant reduction or elimination of the condition. Participants were said to be “very happy” with the speed and effectiveness of the treatment.
The bottom line
For such a widespread condition, dandruff management has been studied far less often than other skin conditions. Nonetheless, there are several different ways to treat the condition, and most products are available over the counter.
Because everyone’s skin is different, trial-and-error may be the easiest way to find out which one works best for you. If you have severe, uncontrollable dandruff, or full-blown seborrheic dermatitis, it’s a good idea to consult a dermatologist. They can assess the needs of your skin and help you find the right treatment.
» For more information on dandruff treatments, use Zwivel’s directory to locate and contact dermatologists in your area.
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- Medicated shampoos for the treatment of seborrheic dermatitis.
- Borda, L. J., & Wikramanayake, T. C. (2015). Seborrheic Dermatitis and Dandruff: A Comprehensive Review. Journal of Clinical and Investigative Dermatology, 3(2), 10.13188/2373–1044.1000019.
- Manuel, F., & Ranganathan, S. (2011). A New Postulate on Two Stages of Dandruff: A Clinical Perspective. International Journal of Trichology, 3(1), 3–6. http://doi.org/10.4103/0974-7753.82117
- Treatment of dandruff with 5% tea tree oil shampoo.
- Dandruff and seborrheic dermatitis: what works?
- A randomised, single-blind, single-centre clinical trial to evaluate comparative clinical efficacy of shampoos containing ciclopirox olamine (1.5%) and salicylic acid (3%), or ketoconazole (2%, Nizoral) for the treatment of dandruff/seborrhoeic dermatitis.
- Gary, G. (2013). Optimizing Treatment Approaches in Seborrheic Dermatitis. The Journal of Clinical and Aesthetic Dermatology, 6(2), 44–49.
- Comparative anti-dandruff efficacy between a tar and a non-tar shampoo.
- A multicenter randomized trial of ketoconazole 2% and zinc pyrithione 1% shampoos in severe dandruff and seborrheic dermatitis.
- Turner, G. A., Hoptroff, M., & Harding, C. R. (2012). Stratum corneum dysfunction in dandruff. International Journal of Cosmetic Science, 34(4), 298–306.
- Therapeutic efficacy of anti-dandruff shampoos: a randomized clinical trial comparing products based on potentiated zinc pyrithione and zinc pyrithione/climbazole.
- Barak-Shinar, D., & Green, L. J. (2018). Scalp Seborrheic Dermatitis and Dandruff Therapy Using a Herbal and Zinc Pyrithione-based Therapy of Shampoo and Scalp Lotion. The Journal of Clinical and Aesthetic Dermatology, 11(1), 26–31.