Why We Get Dandruff (and how to get rid of it)

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Transcript

Jenny is next in line for a really important job interview. She has the experience, the skills and the personality to really fit in with this company. But just as she’s about to go in, she realizes that she also has a whole lot of dandruff sitting on her shoulder. How awkward!

Dandruff is an incredibly common but socially embarrassing problem. Many people assume it’s due to poor hygiene, but in fact it has nothing to do with cleanliness. The issue is that it can look unpleasant and can sometimes cause scalp itching and discomfort.

So what exactly is dandruff and how can we get rid of it?

Those white flakes that sit on the scalp and hair are made up of dead skin cells. Shedding dead skin cells is normal, but in people with dandruff, these skin cells clump together and form visible white flakes.
Although dandruff is very common, understanding the cause is fairly complicated. Dandruff occurs because of 3 different factors: yeast that live on our skin, genetics and immune function, and activity of the oil producing sebaceous glands in the skin.

A group of yeast called Malassezia naturally live on the skin of many animals, including humans. In people who are prone to dandruff, this yeast can cause inflammation which leads to skin flaking and sometimes an itchy rash. Malassezia love feeding off skin oils. Our skin has small glands called sebaceous glands that secrete oils and fats to help keep our skin healthy. Our scalp has many of these glands, so Malassezia love to live on our scalp. Even though Malassezia is very common, it doesn’t cause dandruff in everyone. So there are likely to be some genetic and immune function variations that make some people more prone to dandruff.

So what can we do to actually get rid of dandruff? The first thing to do is to reduce the amount of Malassezia that we have on our scalp. This can reduce skin flakiness and inflammation. There are multiple anti-fungal ingredients that can help. Medicated options include the ‘azole’ shampoos that often contain ketoconazole or bifonazole. In some countries these can be purchased direct from a pharmacy, but in others you may need a doctor’s prescription. Other agents that can help include – Selenium sulfide, zinc pyrithione and ciclopirox.

For those who prefer non-medicated options, there is some evidence that essential oils like tea tree oil and lime oil can improve dandruff. Coal tar can also help but it can be messy to use and may also discolour light hair.

We need to think of dandruff treatment in 2 phases: an initial treatment phase of 4 weeks, then an ongoing maintenance phase. For the first 4 weeks, we need to use an anti-fungal shampoo regularly to help get scalp Malassezia numbers down (on screen comment: follow directions on the bottle). If there is significant itch, then some people may need a prescription anti-inflammatory lotion to help calm the itch. If a person suffers from large and thick dandruff flakes, then a salicylic acid shampoo can be used to break them down and make them smaller so that they are less visible.

Once the initial treatment phase is complete, many people will require ongoing maintenance with an antifungal shampoo applied intermittently, for example once or twice a week. This helps maintain low Malassezia levels and helps prevent dandruff from returning.

As part of the maintenance phase, it is helpful to make sure our scalp sits in the goldilocks zone between being too dry and too oily. Everyone is different but, as a general rule, washing our hair dries out the scalp and washing less often helps retain natural oils. Some people will experience the opposite and find that washing more often leads to an oily scalp due to sebum overproduction. So you’ll need to experiment with using a gentle cleansing shampoo either less or more often to find the right moisture balance for your scalp.

Some people find that if they use a particular antidandruff shampoo for many months, that it stops working. We know that Malessezia can become resistant to antifungal ingredients, so all we need to do is rotate the agent every few months to prevent this from happening. So you might start with an azole based shampoo, then switch to Zinc and then to Selenium and so on.

We know that dandruff is a persisting condition that fluctuates with time. Dandruff seems to get worse in colder weather and improve in warmer months. Many people find that high stress levels can make their dandruff worse. So depending on how severe the dandruff problem is, you may need to use your anti-dandruff shampoo more or less often.

Most people with dandruff don’t need to see a doctor but if you find that your dandruff is not getting better with over-the-counter products, it might be time to see a health care provider. There are some other conditions that can be confused for dandruff because they can also cause an itchy flaky scalp: psoriasis, eczema and tinea just to mention a few.

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References:

- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4852869/

- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6919596/

- https://www.uptodate.com/contents/seborrheic-dermatitis-in-adolescents-and-adults

- https://pubmed.ncbi.nlm.nih.gov/34254910/

- https://dermnetnz.org/topics/seborrhoeic-dermatitis

Why We Get Dandruff (and how to get rid of it)

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