Dandruff - Causes and Treatments

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Dandruff - Causes and Treatments

Dandruff is a harmless, common condition that occurs when the scalp becomes dry or greasy and produces flakes of dead skin. Dandruff is not common in infancy, although it increases progressively from adolescence. By the age of 20, about half of the population has suffered an outbreak, which gives an idea of its prevalence. Although the cause of dandruff is complex and controversial, it is worth considering the elements that cause this condition in order to understand the treatments used both to correct it and to prevent hair loss.


The epidermal layer constantly replaces itself. New cells that are produced from the bottom layer of the epidermis are pushed upwards which eventually reach the outer most layer and eventually die and flake off. These flakes are too small too to be seen; however, there are some conditions where the cells rapidly replicate, especially in the scalp. Normally, it would take months for skin cells to mature and shed off compared to a person with dandruff which will only take 2 to 7 days. The effect is that dead skin cells are shed in large, oily clumps, which appear as white or grayish patches on the scalp, skin, and clothes.

Dandruff has been shown to be a result of three required factors:

1. Sebum or sebaceous secretions which is a natural occurring skin oil

2. Skin microorganisms’ metabolic by-products (most specifically Malassezia yeasts)

3. Susceptibility of the individual.

There is a scalp specific fungus called Malassezia globosa that causes dandruff. This fungus metabolizes triglycerides present in sebum by the expression of lipase, resulting in a lipid byproduct oleic acid. Oleic acid penetrates stratum corneum; the top layer of the epidermis and results in an inflammatory response in susceptible persons, which disturbs homeostasis and results in erratic cleavage of stratum corneum cells.

There is no proof that food, excessive perspiration, or extreme/change of climate have any part in the occurrence of dandruff. However, too much junk food or oily food products can generate the appearance of dandruff. Stress can also cause dandruff.

Types of dandruff:

There are several types of dandruff but the most common varieties are dry dandruff and oily or greasy dandruff.

1. Dry dandruff (Common dandruff) or Pityriasis simplex
There is slight mitosis, dead cells that look like small white scales. Excessive desquamation occurs from the scalp without any sign of inflammation. Common dandruff flakes are dry, silvery white scales that are scattered throughout the scalp.
These are small, white scales spread over the scalp that easily peel off, accompanied by an itching sensation that can aggravate the scalp's state and create skin lesions due to scratching. Washing removes the scales and therefore itching but eventually come back a few days after. If left untreated pityriasis simplex could worsen and lead to steatoid pityriasis, which can cause loss of hair.

2. Oily dandruff of Steatoid pityriasis
This is characterized by an increase in oil or sebaceous secretion that changes the appearance of the scales and makes them appear larger and oilier.

In this case the scales that are already present in the scalp are now covered with sebaceous secretion and thus stuck on the scalp, which are now called scalls. An excess secretion of sebum produces this type of pityriasis, causing the saprophyte organisms to break down. Baldness is imminent if not treated or not treated correctly by this dandruff.

Treatment of Dandruff

During puberty, more than 50% of the hair produces pityriasis because of hormonal change. Steatoid pityriasis is more common in men than in women but pityriasis simplex is common on both sexes.

Since pityriasis is an excessive amount of desquamated, keratinous cells that are produced by an increase in cellular reproduction that leads to the development of microorganisms, therapeutic products aimed at treating pityriasis act directly on the mechanism that is responsible for the disorder.

Treatment should focus on the following:
  • Break up and dissolve the scales.
  • Slow down cellular turnover.
  • Clean the dandruff (Pityrosporum Ovale).
  • Eliminate microorganisms
Dandruff can be a chronic condition but with the proper treatment, dandruff can be controlled. First, use a non-medicated shampoo, massaging the scalp firmly, and then rinse well to remove all the flakes. If this fails, use special anti-dandruff shampoos. These are usually helpful. Instructions for use depend on the specific shampoo used. Some are used on a daily basis, while other are used only once or twice weekly.

Frequent shampooing removes flakes and helps control dandruff outbreaks by slowing production and shedding of skin cells on the scalp. When selecting an over-the-counter shampoo, look for anti-dandruff ingredients such as ketoconazole, selenium sulfide, salicylic acid, sulfur, or zinc pyrithione. Shampoos that contain ketoconazole appear to be more effective in the treatment of seborrhea and dandruff when compared with other non-prescription medicated shampoos.

Hair sprays, styling gels, mousses and hair waxes can all build up on hair and scalp, making it oilier. Some people may even develop allergies to various hair-care products. It is best to stay away from these products and also use a mild shampoo, especially natural and organic ones that will not add more damage to the hair and scalp.

Shampooing tips:

Use dandruff shampoo two to three times per week.

Rub the dandruff shampoo into your hair thoroughly and give it time to work - at least five minutes.

For mild cases of dandruff, alternate dandruff shampoo with regular shampoo.

Rotate dandruff shampoos since they can lose their effectiveness over time.

Different shampoos work in different ways on different people.

NISIM Shampoo for Normal to Dry Hair has been particularly successful in managing scalp disorders. It has been proven to control dandruff and itchy scalp, and even cradle cap. Its active components are organic in origin are proven safe and completely drug-free. Moreover, since it is made only from natural ingredients, it can be used for extended periods unlike other medicated shampoos that can only be used for a limited time. The gentle but effective formulation in NISIM has been known to manage itchy scalp and control dandruff.

In addition,  Nisim Shampoo for Normal to Dry Hair combined with NISIM Gel Extract provides added control to dandruff conditions. This is because  NISIM Gel Extract formula, compared to synthetic agents, contains herbs that are natural, effective, and gentle for hair and scalp use. These herbal oils are especially useful to extensively improve and normalize the scalp condition.

Coal tar preparations may be mildly effective for dandruff, but they can be messy and can stain clothing and blonde or grey hair and also have an unpleasant odor. Coal tar preparations can also cause tar acne and other rashes and can increase sensitivity to the sun.

If non-prescription preparations are not successful after two weeks, or if the condition worsens, you should consider seeing a doctor. A doctor may prescribe a corticosteroid lotion. This can be used on the scalp or other areas of the skin. A doctor will likely use only weak corticosteroid lotions such as 1% hydrocortisone to treat a seborrheic dermatitis rash on the face. Never use corticosteroids for a long time period without advice from a doctor. They can thin out the skin and cause other side effects.
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