Dandruff: An Overview

Medically Reviewed by Zilpah Sheikh, MD on November 06, 2024
Written by Lori M. King, PhD
13 min read

Dandruff is a skin condition that causes white or yellow skin flakes on your scalp. It may be itchy and spread to your hairline, eyebrows, and behind your ears. Dandruff is a milder form of seborrheic dermatitis (pronounced seb-or-ray-ic dur-muh-ty-tis) that happens just on your head. Seborrheic dermatitis is a common skin condition that causes itchy patches and greasy scales on your skin where you have a lot of oil (also called sebaceous) glands, including your scalp. 

You can manage most cases using an over-the-counter dandruff shampoo according to the directions on the bottle. There are several different types, so if one type of shampoo doesn't help after about four to six weeks, try a different kind. If that doesn't help, it may be time to visit your doctor. They can prescribe creams, lotions, and shampoos that will help.

Is dandruff a fungus?

Experts think that one of the main contributors to dandruff is the overgrowth of a type of yeast or fungus calledmalassezia. All people have malassezia yeast on their skin; it's one of the many microbes that live in or on the human body. They're part of your body's microbiome. Malassezia feed off the oil your skin makes and help keep other microbes on your skin in balance. But when there are too many, it can start a cycle of irritation that leads to the itching and flaking of dandruff.

Experts think the overgrowth of a type of yeast or fungus called malassezia is one of the main causes of dandruff. This yeast lives on your skin naturally and feeds off the oil your skin makes. When your skin is irritated, it will make more oil and skin cells to help soothe the irritation.

Your skin may become irritated because you're sensitive to some of the ingredients in your hair care products. Or, the weather is harsh and it makes your skin dry and raw. Or because you have other skin conditions, such as eczema or psoriasis, that make your skin more easily irritated.

More oil on your skin means more food for the yeast, which can make it overgrow. The extra skin cells will die and fall off, but they get mixed with the extra oil and yeast on your head. This mix can be further irritating, which sets off a cycle that leads to dandruff.

Researchers aren't exactly sure what causes seborrheic dermatitis or dandruff, but it's probably a mix of several different factors. Some factors that may play a role include:

Overgrowth of a type of yeast called malassezia. It's normal to have this yeast on your skin, but if it grows out of control, it may trigger a flare of seborrheic dermatitis or dandruff. These yeast feed on the oil in your skin, so if your skin is oily, it can cause an overgrowth.

Irritated, oily, or dry skin. Dry skin can trigger your skin to overproduce oil. This may start a cycle of continuous irritation that leads to dandruff.

Inflammatory reactions For instance, you may have a reaction to ingredients in your hair care products.

Family history of dermatitis, which is inflammation, irritation, and swelling in your skin. This could be due to eczema (or atopic dermatitis), an allergy or reaction to certain chemicals (contact dermatitis), or seborrheic dermatitis. 

Other skin conditions, such as psoriasis or eczema, which cause irritated skin.

An increased level of androgen hormones. Higher androgen levels can make your skin produce more oil. Your hormone levels naturally fluctuate over time, but you may make extra androgen if you have polycystic ovary syndrome (PCOS), Cushing's disease, or certain tumors on your adrenal glands.

Washing your hair too much or not enough. How much you should wash your hair varies between individuals. You want to strike the right balance by washing enough to keep oil and dirt from building up on your scalp, but not so much that you dry your scalp out.

Childhood dandruff

About 42% of infants will get seborrheic dermatitis on their scalp, face, and in their diaper area. When they get it on their scalp, it's called cradle cap. This tends to happen in their first three months of life. It most commonly looks like red-yellow plaques with thick, greasy scales.

Children generally don't get dandruff until puberty. This is when the oil glands in your skin start to produce more oil, which can trigger dandruff. Men and people assigned male at birth tend to get dandruff more often than others because their skin tends to be more oily. In teens, the triggers, symptoms, and treatments are the same as they are in adults.

Beard dandruff

Facial hair grows in the same areas on your face where seborrheic dermatitis flares up, such as your sideburns, around your mouth, and under your nose. You can help prevent beard dandruff by shampooing your facial hair with the same shampoo you use on your head hair.

You usually won't need to shave your beard or mustache off to treat it. But if beard dandruff is a regular problem for you, consider using an over-the-counter anti-dandruff shampoo to cleanse the area. And keep the skin on your face moisturized, especially in the winter. Use products that are gentle and made for your face since the skin on your face is often more sensitive and more exposed to the elements than the rest of your skin.

Dry dandruff (or dry scalp)

You may get flaking and itching of the skin on your scalp because you've lost too much moisture or oil on your skin. Reactions to hair care products, aging skin, and dry weather can cause this. It can be hard to tell the difference, but it isn't really dandruff because it's not related to seborrheic dermatitis. Dry scalp is actually the opposite of dandruff, which is usually caused by too much oil on your skin.

One way to tell the difference is that, in addition to dry scalp, you'll usually also have dry skin elsewhere on your body. With dry scalp, your skin flakes may be small and white, which fall out of your hair more easily. The skin flakes from dandruff tend to be off-white or yellow, large, and sticky or greasy.

Since this isn't caused by seborrheic dermatitis, dandruff shampoo likely won't help that much. But you may be able to prevent dry scalp by:

  • Washing your hair less often
  • Using a gentle, moisturizing shampoo
  • Managing your stress
  • Quitting smoking
  • Using a humidifier in your home
  • Staying well-hydrated

Oily dandruff

This is true dandruff that's caused by too much oil on your scalp and an overgrowth of malassezia yeast. Using a medicated dandruff shampoo can help you get rid of oily dandruff. Shampooing two to three times per week can reduce the amount of oil on your scalp and slow the growth of the yeast.

Fungal dandruff

In a sense, all dandruff is likely fungal dandruff because it mainly results from an excess of malassezia yeast. So, controlling this yeast overgrowth is a key strategy for treating dandruff. Some medicated anti-dandruff shampoos have ingredients such as pyrithione zinc and ketoconazole that can help kill this yeast.

The symptoms of dandruff include:

  • Off-white or yellow flakes of skin on your scalp. You may notice them mixed in with your hair or falling to your neck and shoulders when you scratch or run your hands through your hair.
  • Itchy skin, especially on your scalp, but it may spread to parts of your face, as well.
  • Flakes of skin on your eyebrows, beard, mustache, or behind your ears.
  • In infants with cradle cap, it may appear as scaly, crusty, or greasy scales on their head.

Some things that may make your dandruff worse include:

  • Emotional stress
  • Cold, dry winter weather
  • Chemicals in hair care products

Both dandruff and lice can cause an itchy head and white stuff in your hair, but they are two completely different conditions. Dandruff is a skin reaction to irritants on your scalp. Lice are parasitic insects that live in your hair and feed on your blood.

Lice cause itching because when they bite you to feed, they release spit into the bite that causes a reaction. Adult lice are light gray or tan and about the size of a sesame seed. Another person may be able to spot them crawling around on your scalp.

Lice lay eggs in your hair called nits. These can be white or clear if they've hatched, which is a similar color to dandruff flakes. If they haven't hatched, the nits will be yellow, tan, or brown. Nits are usually stuck to individual hairs, often close to your scalp where the heat from your skin helps them hatch. And they're hard to get rid of; you can't brush or shake them off. You'll need a very fine-toothed comb to get them out of your hair. Dandruff flakes will usually slide easily off your hair, and you'll likely see flakes on your scalp, as well.

Lice like to feed and lay their eggs in a couple of different places on your head: behind your ears and in your hairline at the back of your neck. You may see small red bite marks and be extra itchy in these areas. The flaking and itching of dandruff is more generalized, so it can happen anywhere on your head.

Finally, lice are more common in kids and they spread easily. Dandruff is more common in adults, and you can't get it from or give it to someone else.

If your dandruff is mild, you may just need to change your shampoo or how often you wash your hair. If that doesn't help, over-the-counter dandruff shampoo is usually enough to help control it.

Dandruff shampoos

They come in several types, each with different medicines. You may need to try several to see which works for you, but give it four to six weeks before you try a new one. And make sure you follow the directions on the bottle. Examples include:

  • Pyrithione zinc shampoos, such as Head & Shoulders. Pyrithione zinc is an antimicrobial that helps keep bacteria and fungi on your scalp from growing out of control.
  • Tar-based shampoos, such as Neutrogena T/Gel. These shampoos contain coal tar, which slows down how fast your skin cells die and flake off and can help keep the fungi on your scalp in check. Coal tar shampoos can make your scalp sensitive to the sun, so if you use any of them, wear a hat or scarf when you go out in the sun. Don't use it on dyed or processed hair. And it may darken light-colored hair.
  • Salicylic acid shampoos, such as Jason Dandruff Relief Treatment Shampoo. Salicylic acid helps prevent your skin from flaking.
  • Selenium sulfide shampoos, such as Selsun Blue. Selenium sulfide can help keep the yeast on your scalp in balance. This can discolor your hair, so make sure you rinse your hair really well.
  • Ketoconazole shampoos, such as Nizoral Anti-Dandruff. Ketoconazole is another medicine to help keep the yeast on your scalp in check.
  • Fluocinolone shampoos, such as Capex. Fluocinolone is a corticosteroid that can help ease itching, flaking, and irritation of your scalp.

Once your dandruff is under control, you can use a medicated shampoo once a week or a few times a month to help prevent a recurrence. You can alternate between a couple of different kinds of medicated shampoo, too, if that helps. But if you've tried a couple of different kinds and still have dandruff, it's time to see your doctor for a prescription-strength shampoo or steroid.

Prescription medications for dandruff

If you have moderate to severe dandruff that isn't getting better using medicated shampoo, your doctor will likely suggest a prescription-strength shampoo. These may include:

  • Betamethasone valerate (Luxiq)
  • Clobetasol (Clobex)
  • Fluocinolone solution (Synalar)

If you have severe dandruff, your doctor may also prescribe you a steroid cream or a calcineurin inhibitor, such as pimecrolimus cream (Elidel) or tacrolimus ointment (Protopic). These medicines can help ease your itching and flaking.

If you'd like to try some home remedies before a medicated shampoo, you probably have a few things around your house that can help ease your symptoms, such as:

  • Aspirin. Aspirin contains salicylic acid, which can help prevent your skin from flaking. Crush two aspirin tablets and mix into your regular shampoo. Lather up and leave on for two minutes, then rinse completely.
  • Baking soda. After you wet your hair in the shower, put about a handful on your scalp, and leave it on for two to three minutes, then rinse completely. This temporarily changes the pH level of your scalp and hair to make it more alkaline. It can damage your hair.
  • Apple cider vinegar. This may help keep the malassezia yeast on your scalp in check. Mix a quarter cup of vinegar with a quarter cup of water. Apply this mix to your scalp and leave it on for 15-60 minutes. Then rinse completely. You can do this twice a week.
  • Lemon juice. Apply about two teaspoons of lemon juice to your scalp and massage in. Rinse completely. Then, mix one teaspoon of lemon juice into water and apply to your scalp.
  • Aloe vera. Massage a bit of aloe vera gel onto your scalp before you shampoo. Aloe vera has anti-inflammatory effects that can help calm the irritation of your scalp.
  • Olive oil. This may help moisturize your scalp. Massage about 10 drops into your scalp at night before you go to bed. Cover your head with a shower cap to sleep. In the morning, shampoo as you normally would.

Coconut oil for dandruff

Coconut oil has anti-inflammatory and antimicrobial effects. It can soothe your itching and flaking and help keep bacteria and fungi on your skin in check. It's also a good moisturizer. 

Dermatologists recommend you use either cold-pressed coconut oil or virgin coconut oil. These methods of purifying the oil don't rely on harsh chemicals that could irritate your skin. Before you buy, make sure you read the ingredients list to ensure your coconut oil doesn't contain any ingredients that you may be allergic or sensitive to.

To use, rub three to five teaspoons of this oil on your scalp. Wait an hour, then shampoo your hair.

Dandruff and seborrheic dermatitis are probably caused by several different factors working together. This means it may keep coming back if you don't keep your management strategies in balance. So, the reason it keeps coming back is related to why you got it in the first place, such as irritated skin and an overgrowth of yeast.

Over-the-counter medicated shampoos are usually effective for dandruff, but it's important that you follow the directions on the bottle. To work, the active ingredients in your shampoo must get to the target areas and stay on your skin for the right amount of time. Following the directions will help ensure this happens.

Dandruff can be annoying, but it's not harmful. The main complication of dandruff is a potential bacterial infection. Dandruff can be itchy, and you may open your skin when you scratch. You may get an infection when bacteria on your scalp gets into your scratches.

Does dandruff cause hair loss?

No, dandruff itself doesn't cause hair loss. But the irritation of your hair follicles from scratching, extra oil, and extra yeast may cause temporary hair loss. To prevent this, try to avoid scratching. If your itch is bad, you may need a steroid cream to help control it. You'll need to see your doctor for a prescription.

It's challenging to prevent dandruff because it probably has several causes that work together. However, here are some strategies that may help prevent it:

  • Avoid scratching your scalp. This can help prevent the cycle of irritation and inflammation that leads to dandruff or makes it worse.
  • Find the right shampoo and wash your hair on the right schedule. Wash your hair often enough to keep oil from building up, but not so often that you dry out your scalp and hair or irritate your skin. And use a mild shampoo without harsh detergents for regular shampooing. This is particularly important if you have dry hair and a sensitive scalp.
  • Reduce and manage your stress levels. Stress can trigger a flare of dandruff, so you may help your scalp by doing some yoga, meditating, or going for a walk. Use a journal to keep track of your stress levels and when you get dandruff. This can help you see if there are patterns in your stress levels and dandruff flares.
  • Give yourself a scalp massage. This can increase circulation in your scalp and reduce inflammation. Another way to increase circulation in your scalp is to brush your hair twice a day.
  • Protect your scalp from sun exposure by wearing a hat that isn't too tight when you're outside in the sun. But do make sure you get at least 15 minutes of sun exposure every day.
  • Practice a healthy lifestyle by eating a healthy diet with plenty of zinc, B vitamins, and healthy fats. Make sure you get plenty of good-quality sleep.
  • Avoid using too many styling products on your hair. Styling products can build up on your scalp , which may irritate your skin.

Go see your doctor if:

  • Your dandruff doesn't go away after you've used over-the-counter dandruff shampoos for a couple of months.
  • The itching and flaking get worse over time.
  • Your scalp is red or swollen.
  • The itching and flaking have spread to areas other than your scalp.

Dandruff is a mild form of seborrheic dermatitis that happens just on your head. It causes the skin on your scalp to flake and itch, and it may spread to your hairline, eyebrows, and behind your ears. One of the main contributors is the overgrowth of a type of yeast on your scalp. Most cases are mild and can be managed by changing the way you care for your hair. Most moderate-to-severe cases can be managed with over-the-counter dandruff shampoo.

How do I get rid of dandruff permanently?

You probably can't get rid of dandruff permanently because you can't control all of the contributing factors. But you can manage it by using an over-the-counter dandruff shampoo according to the instructions on the bottle. This will help reduce the flaking and itchiness. 

What vitamin deficiency causes dandruff?

No single vitamin deficiency causes dandruff. But you may be able to help prevent dandruff by eating a diet with plenty of zinc, B vitamins, and healthy fats.

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