What Type of Dandruff Do You Have?

Dandruff is a common scalp condition that causes the skin on the scalp to flake. It is caused by the rapid turnover of skin cells.

Normally, skin cells have a life cycle in which they multiply as needed and then die off and shed at the end of their life cycle. When a person has dandruff, the skin cell cycle is accelerated, which causes more dead cells to collect on the scalp and flake off.

The symptoms include white to yellowish or gray flakes that appear in the hair and on the shoulders as they fall from the head. The scalp is often dry and itchy. 

This article discusses the types of dandruff and treatment options.

Types of Dandruff

Dry Skin–Related Dandruff

This is the most common type of dandruff. It usually occurs during the winter months and results from cold, dry weather.

It is linked with using hot water to shampoo the hair. Hot water dries out the scalp, which can cause flakes.

Oil-Related Dandruff

This occurs from a buildup of sebum (oil) on the scalp. The sebum is overproduced by the hair follicles. The result is the clumping together of sebum and dead skin cells on the scalp.

The clumps of dead skin cells—along with dirt on the scalp—form the itchy dandruff flakes, which are oily and a yellowish color.

Fungus-Related Dandruff

This is caused by a type of yeast, or fungus, called Malassezia. This yeast is part of the skin’s natural flora (microorganisms that live naturally on the skin) that helps keep microorganisms like fungus in check, preventing infection. When there is excess sebum, however, Malassezia is known to proliferate because it grows in sebum.

This type of yeast also produces a by-product that causes the skin cells to clump together, forming the white flakes commonly seen in dandruff.

Skin Condition–Related Dandruff

Several skin conditions cause skin flaking. The skin condition most often linked with dandruff is seborrheic dermatitis (SD), which causes:

• Severe redness
• Red scaly patches
• Itching
• Inflammation of the scalp (and other areas of the body, such as the face and ears)

SD causes visible signs of inflammation, whereas dandruff symptoms usually involve mildly reddened skin.

SD occurs more frequently in those with oily skin and is considered a type of oily dandruff. It appears in areas of the skin containing oil glands.

There are other types of skin conditions that can cause flaking of the scalp, such as:

• Eczema
• Psoriasis
• Sebopsoriasis (a skin condition that has some symptoms of seborrheic dermatitis and some symptoms of psoriasis)

Skin conditions that cause dandruff should be diagnosed and treated by a healthcare provider.

When to See a Doctor

Under most circumstances, it’s not necessary to consult with a physician about dandruff. It can usually be effectively treated with over-the-counter (OTC) medicated shampoo.

In some instances, however, dandruff doesn’t respond to OTC treatments. You should call your healthcare provider when:

• Dandruff doesn’t improve after several weeks of using medicated over-the-counter shampoo.
• The skin becomes very red and swollen or begins to drain fluid or pus.
• The symptoms get worse and spread to other parts of the body, particularly to areas that don’t have hair.
• You notice hair loss.

Treatment

Home Remedies

There are many types of home remedies touted to treat dandruff, but many of these lack enough clinical research evidence to give them credibility. Those that do have some scientific evidence to back up their claims of effectiveness are agents that have antimicrobial (antibacterial or antifungal) properties. These include:

• Tea tree oil: Studies on tea tree oil have shown it to be anti-inflammatory, antimicrobial, and antiseptic (slows the growth of microorganisms). Tea tree oil also contains antifungal properties that specifically target Malassezia yeast. 
• Lemongrass oil: Shampoo with lemongrass oil was specifically studied for its effectiveness on dandruff caused by Malassezia yeast. The study looked at solution concentrations comprised of 5%, 10%, and 15% lemongrass oil. The study outcome reported that a 10% concentration worked the best and that after seven days, dandruff showed a 51% improvement. By day 14, dandruff had improved by 74%.
• Apple cider vinegar: Apple cider vinegar has been shown in studies to be an antifungal agent. This treatment could be helpful if the type of dandruff you have derives from a fungus. It has not been proven as a treatment for dandruff.

Be sure to consult with your healthcare provider before using any type of home remedy for dandruff. Keep in mind that natural and herbal products can have dangerous side effects, and there’s no guarantee that they will be as effective as some of the OTC and prescription treatments for dandruff.

Medical Treatment

While there is no cure for dandruff, there are some medicated shampoos that can help manage symptoms.

Treatment depends on several factors, such as the underlying cause of your dandruff and how severe the condition is.

When medical conditions cause dandruff, a healthcare provider should be consulted about the type of treatment that is best:

• For mild to moderate dandruff involving flaking of the scalp, mild redness, and itching, OTC dandruff shampoo is usually all that is needed to prevent flare-ups and manage symptoms.
• For severe dandruff, particularly when it does not respond to OTC medicated dandruff shampoos, a healthcare provider should be consulted.  Common dandruff treatment includes OTC dandruff shampoo (for mild to moderate dandruff) that contains the active ingredients selenium sulfide, zinc pyrithione (ZPT), or coal tar.

Medicated shampoo options include:

• Selenium sulfide shampoo: This slows the rate of skin cell death, thus reducing the number of dead skin cells that accumulate and flake off. It may also help to treat fungus-related dandruff.
• Tar-based shampoo: A medicated shampoo made from coal tar that also slows the rate of skin cell death, reducing the presence of the resulting skin flakes.
• Zinc pyrithione shampoo: Studies have shown that ZPT normalizes sebum production and significantly reduces yeast. This type of shampoo may help oil-related dandruff, as well as fungus-related dandruff in those with oily hair.
• Salicylic acid shampoo: This promotes the removal of skin flakes caused by dandruff. Because it also causes dryness, using this shampoo could result in more flaking. This type of shampoo could be helpful for those with oil-related dandruff.
• Antifungal shampoo: This includes medicated shampoos that contain ketoconazole (Nizoral) for controlling the fungus that can cause long-term symptoms of dandruff. This type of shampoo is for fungus-related dandruff. Antifungal shampoo is available over the counter, but stronger concentrations are available by prescription.