Waging War on Dandruff

Last Editorial Review: 1/30/2005

Most dermatologists and hair experts say that by tackling dandruff head-on, you may be able to sweep away those drifts of unsightly flakes.

By Richard Trubo
WebMD Feature

Reviewed By Michael Smith

For millions of men and women, blizzards of white flakes atop the head have turned their daily grooming into a hairy situation. Although certainly not life-threatening, dandruff can cause plenty of embarrassment as it clutters the crown, week after week, month after month, often despite routine shampooing.

Nevertheless, most dermatologists and hair experts say that by tackling the problem head-on, you may be able to sweep away those drifts of unsightly flakes that can blanket your shoulders and leave your dark suits in desperate need of a trip to the cleaners.

Brushing Up on Dandruff Facts

Dandruff is a persistent scalp condition in which skin cells on the head shed excessively. It is also often accompanied by itching and redness. Because most people struggle with the condition without seeking a doctor's care, no one is sure of its exact prevalence. But it is believed to be the most common scalp condition, affecting about one of every three adults, including more men than women.

Even on a healthy scalp, the shedding of skin cells is a normal process; new cells are continuously forming on the lower layers of the skin, gradually making their way to the top layer where, during about a 28-day renewal cycle, they replace those that are above it. But if you have dandruff, there has been an acceleration of this process and an overgrowth of the cells. As dead cells are rapidly cast off, they tend to clump together (with the help of the natural oils from your hair and scalp) in what look like small white flakes.

To make matters worse, these dead skin cells are filled with chemicals that can be reabsorbed by the scalp. These chemicals, says dermatologist Jerome Shupack, MD, may trigger inflammation, redness and itching.

But why does this cell proliferation shift into overdrive and shed at such a rapid rate? No one knows for sure, but a yeast-like fungus (called Pityrosporum ovale) could play a role. This fungus lives naturally on everyone's scalp in small amounts. But if its numbers increase, the body's immune system may mount an attack from time to time in an attempt to get rid of it. "When that happens, there are increased cell turnovers, redness, and dandruff," says Shupack of New York University School of Medicine.

A number of other factors - including heredity, hormonal fluctuations, illness, and stress -- can also contribute to the development and worsening of dandruff. "We sometimes see entire families with this problem," says Karl Beutner, MD, PhD, a dermatologist at the University of California, San Francisco, School of Medicine.

Making a Splash

To get to the root of the dandruff problem, you should start with routine, daily use of a regular shampoo, which can rinse away the excess oils and dandruff flakes. If that doesn't work, step up to an over-the-counter, medicated dandruff shampoo, which is available in a variety of formulations classified by their active ingredients. Some shampoos slow down the production of skin cells; others remove the cell overgrowth and keep the dead cells from clumping together and/or reduce the inflammation on the scalp.

These OTC products include salicylic acid-based shampoos (such as X-Seb T and Sebulex), as well as those containing selenium sulfide (Selsun Blue), pyrithione zinc (Head & Shoulders), tar (Neutrogena T/Gel), and the antifungal ketoconazole (Nizoral A-D).

If you try one of these products, and it still leaves you scratching your head, switch to a different shampoo containing another of the key ingredients. You may have to try several products before discovering one that works well for you.

"Some people find that using two different types of shampoo -- for example, alternating a tar shampoo with a non-tar shampoo -- works best," says Beutner.

For particularly stubborn cases, your doctor may recommend a more potent dandruff shampoo, such as a prescription-strength ketoconazole product, or a prescription shampoo containing cortisone-type medicine.

Making Headway Against Dandruff

Doctors sometimes recommend additional strategies for attacking dandruff. For instance:

  • Slash your stress levels. "Stressful times can cause a flare in your symptoms," says Beutner. "When you're under a lot of stress, make sure you're using a medicated dandruff shampoo."
  • Shampoo frequently. No matter what dandruff shampoo you choose, use it as often as once a day, says Shupack. Rub it into the hair thoroughly, leave the lather on for several minutes before rinsing, relather, and rinse again.
    "Some women only have their hair washed at a beauty parlor every week or two, but they may need to use a medicated shampoo more often to get and keep their dandruff under control," says Beutner.
  • Put a lid on hair products. See if reducing the use of hair sprays, gels, and mousses has an effect on your dandruff. In some people, these products might contribute to the accumulation of oils on the hair and scalp.
  • Let the sun shine. Exposure to ultraviolet light could have an anti-inflammatory effect when dandruff is present, which may explain why dandruff is less common in summer. Even so, the sun's benefits may be limited since the hair acts as a natural sunscreen.

Originally published April 15, 2002.

Medically updated April 23, 2003.

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