Dandruff

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Question

What is dandruff?

Answer

Dandruff is a condition that results in excessive scaling of skin on the scalp. People with dandruff have twice the rate of scaling as those with a normal scalp. Dandruff affects more than 63 million Americans - about 12 million noticeably.

Dandruff causes

Although the specific cause of dandruff is unknown, a yeast called pityrosporum ovale is believed to be the culprit. Signs of dandruff are an itchy scalp and flakes that appear all over the head rather than just in patches. There is no rash or redness. Dandruff typically becomes more noticeable in the winter months. It usually begins to show up around puberty, and is rarely seen in people older than age 75.

While there's no cure for dandruff, the condition usually can be managed easily by washing the hair and scalp daily with regular shampoo. If dandruff flakes persist, a medicated shampoo may be required. Both over-the-counter and prescription shampoos are available.

Dandruff shampoos work best when they are left on the scalp for at least one full minute before rinsing and repeating use.

Alternative therapies

Other than washing the hair daily with a non-medicated shampoo, there are no good alternative methods for treating dandruff. Some do people claim that nettle is helpful for the treatment of dandruff, but there is no proof that it works. Shampooing with tea tree oil seems to be helpful. The only risk is if a person is allergic to the oil. Non-prescription dandruff shampoos are almost always effective in controlling dandruff flakes.

Over-the-counter dandruff treatments

There are several over-the-counter treatments for dandruff including several shampoos. There are many non-prescription medicines available to treat dandruff.

  • Coal tar is an antiseptic, antifungal, and anti-itch ingredient. A product that contains coal tar is Walgreens T+Plus Tar Gel Dandruff Shampoo.

  • Products containing pyrithione zinc (such as Head & Shoulders®) and selenium sulfide (such as Selsun Blue®) work by decreasing the rate at which the cells on the scalp reproduce.

  • Salicylic acid and sulfur loosen the skin cells and allow them to be removed. Neutrogena T/Sal® Therapeutic Shampoo is a product that contains salicylic acid. Sulfur 8® products contain sulfur.

  • Ketoconazole is an antifungal agent that targets the yeast pityrosporum ovale, which is commonly seen in dandruff sufferers. Nizoral A-D® is a ketoconazole shampoo.

Prescription dandruff treatments

There are prescription treatments for dandruff, but there are several non-prescription remedies that can be considered before trying prescription options. If over-the-counter products do not seem to be effective after several weeks of use, you may want to see a dermatologist. Several prescription medications can be used to control dandruff.

  • Lotions: When itching from dandruff becomes severe or causes redness, lotions containing mild steroids, such as hydrocortisone (Hytone®) or triamcinolone (Kenalog®), may be prescribed. These dandruff lotions should not be used for more than two weeks in a row, since longer use may lead to skin damage.

  • Shampoos: Ketoconazole shampoo (Nizoral®) is now available both by prescription and over-the-counter. The over-the-counter product contains 1% ketoconazole while the prescription strength is 2%. A 2.5% prescription-strength solution of selenium sulfide is also available by prescription.

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