Are you frustrated and a little bit embarrassed by dandruff that falls on to your shoulders, even though you know your hair is freshly washed and clean?

Most shampoo commercials liken dandruff to a recipe for social isolation. Relax, they are being quite dramatic. Yes, dandruff can sometimes be hard to treat, but there are many over-the-counter products that are quite affordable. 

And no, dandruff isn’t an issue of hygiene. Not always, anyway. Many people who suffer from excessive dandruff attest to washing their hair regularly. But in some cases, over-active oil production, paired with a less frequent hair washing routine, could be the cause. 

What is dandruff?

Everyone suffers from dandruff at some point. It can be very itchy and in extreme cases, painful, Scratching the scalp can worsen irritation. People with extreme cases usually scratch the scalp, which makes tiny tears in the skin.  This can lead to infection.  

Dandruff looks like white, dry flakes, which are usually stuck to the scalp, at the root of the hair. It can be loosened by light scratching or movement. Over a few days, older dandruff will fall from the scalp onto your clothes. It is skin cells that grow and die off too fast. 

Exactly why that happens isn’t clear, reports Web MD. A very common fungus called malassezia may cause dandruff. This fungus lives on the scalp of most, healthy adults without causing any problems. One theory is that the immune system of someone with dandruff may overreact to that fungus, causing the reaction.

Dandruff is sometimes mistaken for a mild form of seborrhoeic dermatitis. In babies, this is what is known as cradle cap.

What causes dandruff?

Dandruff isn’t actually ‘dry’ skin, but it happens when the skin on the scalp is very oily. Your skin’s oils, known as sebum, are the perfect fungus growth on the scalp.  If you happen to be sensitive to this process, it can lead to dandruff and sometimes a dry, itchy scalp. So, if you have an oily scalp, you might be more likely to see those white flakes, says Dove.

Medical News Today also says that people who are sensitive to yeast are known to be slightly more prone to developing dandruff, so yeast may play a part. Dandruff is often worse during the winter months and better when the weather is warmer.

This may be because ultraviolet-A (UVA) light from the sun counteracts the yeast.

Seborrhoeic dermatitis.

Seborrhoeic dermatitis mainly affects the scalp. It is a common form of eczema, which is often mistaken for bad dandruff, says Affinity Health. SD causes scaly patches and red skin atop the head and can impair hair growth.

Seborrhoeic dermatitis most generally affects oily areas of the body, such as the face, sides of the nose, eyebrows, ears, eyelids and the chest.

Dandruff can also be an allergic reaction to scented or oil-infused shampoos and other hair-care products. 

This sensitivity is known as contact dermatitis. 

Contact dermatitis

According to the Mayo Clinic, contact dermatitis is a non-infectious red, itchy rash caused by direct contact with a substance or an allergic reaction to it, including soaps, cosmetics, fragrances, jewellery and plants.

The rash can be painful and may need long-term treatment, supervised by a medical professional. Some people are also prescribed pain killers to assist with the discomfort. 

If your dandruff is caused by an allergy, you may need to consider natural ingredient shampoos and conditioners. There are many home remedies that offer relief. 

Contact dermatitis usually clears up pretty easily, but be sure to seek medical emergency attention in the event that your skin is infected. As mentioned above, this usually occurs from scratching the itchy area. It can sometimes be hard to resist, but the nails are usually grimy on the underside, and scratching can put whatever germs are under the nail into the first layer of skin. 

Infections usually present with a fever and pus oozing from blisters.

Also seek medical assistance if you have other symptoms or allergic reactions such as your lungs, eyes or nasal passages being painful and inflamed, perhaps from inhaling an allergen.

The Medical Society is a call away to help with all your medical concerns. 

Which treatments are available?

If your condition doesn’t improve with regular use of over-the-counter dandruff shampoo, it can be really frustrating. Most cases of dandruff don’t require a doctor’s care, says Mayo Clinic. If you feel that having dandruff is negatively affecting your life and mental well-being, see a doctor who specialises in skin conditions, a dermatologist. 

Anti-dandruff shampoo

Dandruff is basically a generic term for the white flakes on the scalp, regardless of what the cause is. When the cause is pinpointed in a specific case, it is then treated accordingly. 

Anti-dandruff shampoo usually has the following anti-dandruff agents; Zinc Pyrithione and Selenium Sulphide. 

Zinc pyrithione (ZPT) prevents the dandruff-forming microbe, Malassezia globosa, from forming scalp irritants. 

Selenium sulphide is a powerful active ingredient that is used to treat more severe flaking conditions; it is found in shampoos that are specifically made to treat seborrhoeic dermatitis.

Natural remedies

Many people swear by natural remedies that reduce both the itching and flaking, regardless of the cause of the dandruff. Many use saltwater rinses before conditioning to remove any excess oil and fungus from the scalp. Many people also add natural, anti-inflammatory oils such as castor oil to the scalp, on particularly red and itch patches. 

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