Dandruff (Seborrhea)

  • Medical Author:
    Gary W. Cole, MD, FAAD

    Dr. Cole is board certified in dermatology. He obtained his BA degree in bacteriology, his MA degree in microbiology, and his MD at the University of California, Los Angeles. He trained in dermatology at the University of Oregon, where he completed his residency.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

Quick GuideFight Dandruff: How to Treat, Control, and Prevent Flakes

Fight Dandruff: How to Treat, Control, and Prevent Flakes

What are the causes of dandruff? What are dandruff symptoms and signs?

Dandruff itself produces no symptoms. However, the most common cause of dandruff, seborrheic dermatitis (seborrhea), is an itchy red rash that tends to occur on the scalp, ears, face, mid-chest, and mid-back. The cause of seborrhea is unknown, although a yeast that often lives on the skin, Malassezia furfur, may play a role.

The most common secondary manifestation of seborrhea of the scalp is dandruff. Seborrhea produces plaques of itchy red skin with scaling. It is the accumulated scale that we call dandruff. Reddish, scaly plaques may also appear in the eyebrows, on the forehead, in the ear canal, on the folds of skin that extend from the nostril to the commissure of the lips. Although skin affected by seborrhea may feel and look dry, this is not the case; moisturizers are of little help in its control.

Scalp seborrhea may slow hair growth but does not cause permanent hair loss. Often, scalp seborrhea doesn't even itch significantly. Seborrhea can appear during infancy, starting shortly after birth and lasting several months. It may affect the scalp ("cradle cap") or produce scaly plaques on the body. Seborrhea may occur at any age.

Some people who have weakened immune systems, such as those on chemotherapy or those with HIV disease or certain neurological disorders, may have very severe seborrhea. It is important to emphasize, however, that seborrhea is a very common condition, affecting perhaps 5% of the population (with men predominating). The vast majority of those who have it are completely healthy and have no internal or immune problems.

There are a variety of other inflammatory diseases that can produce excessive scaling and therefore dandruff, including psoriasis, fungal infection of the scalp skin (tinea capitis), and allergic contact dermatitis.

How do doctors diagnose the cause of dandruff?

After a thorough scalp examination, the cause of most cases of dandruff is usually apparent. Occasionally, physicians may find it necessary to perform a scalp biopsy where a small amount of scalp skin is removed under local anesthesia and submitted for examination under a microscope.

Medically Reviewed by a Doctor on 9/2/2016

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