Dandruff: Causes, symptoms and treatment

Around 11% of people in the world have dandruff, but despite how common the condition is, many people don’t fully understand what causes it and what can be done to address it. Read on to learn about the causes and symptoms of dandruff, and find out about treatment options that can reduce flakes.

The cause of dandruff is unknown. However, a number of factors may play a role in developing the condition. These may include:

• Irritation: When skin becomes irritated due to hair care products or general sensitivity, flakes may develop
• Oiliness: People with high levels of oil content in their skin are more prone to dandruff
• Hormones: Elevated levels of male sex hormones called androgens can cause greasy or oily skin, which may lead to dandruff
• Genetics: Dandruff tends to run in families, so if you have a close relative with the condition, you’re more likely to develop it
• Weather: Cold and dry weather can worsen dandruff
• Stress: Although stress isn’t a direct cause of dandruff, it can worsen symptoms in some people

A type of yeast called Malassezia can contribute to dandruff. Everyone has this yeast naturally on their skin, but on some people it becomes overgrown, leading to dandruff on the scalp. It’s also possible to develop dandruff on the eyebrows, dandruff in the beard, and in other areas.

In addition to the scalp, eyebrows, beard and mustache, some people develop dandruff on their shoulders or on other parts of their body.

The most noticeable symptom is flakes of skin. You may be able to see them in your hair or find them on your clothing or pillow. In some people, itching accompanies the flakes.

Dandruff is a form of seborrheic dermatitis, which causes red patches on the skin that are covered with white or yellow flakes. Technically, any time dandruff occurs somewhere other than the scalp, the condition is called seborrheic dermatitis. However, people often use these terms interchangeably.

Dry scalp occurs when moisture levels in the scalp become depleted. You can develop dry scalp if your skin loses moisture because it’s not producing enough natural oil (sebum). Dry scalp can also occur due to exposure to harsh weather, heat from hair styling tools, chemicals in hair dyes, and other harsh hair care products and treatments.

If you have dry scalp, you may develop skin flakes and itching. It can be difficult to tell the two problems apart on your own, but your healthcare provider can help determine the problem with an examination.

Psoriasis is a chronic skin condition that occurs when the immune system attacks healthy skin, causing an overproduction of cells. As a result, skin becomes thicker, forming red patches with silvery scales. Generally, scalp psoriasis occurs in small areas rather than all over the scalp like dandruff. These patches may be elevated, and they may appear raw and inflamed.

Most often, treatment for dandruff involves the use of over-the-counter dandruff shampoos once or twice per week. Some shampoo treatment options include:

• Pyrithione zinc shampoos: These products work by reducing bacteria and fighting the yeast that contributes to dandruff.
• Tar-based shampoos: Made with coal tar, these shampoos slow down the rate at which your skin cells die and fall off. They can discolor light hair and cause scalp sensitivity.
• Salicylic acid shampoos: Using an exfoliating key ingredient, these treatments reduce scales and flakes.
• Selenium sulfide shampoos: Selenium sulfide is an antifungal medication that reduces levels of Malassezia. If these shampoos aren’t rinsed off completely or used as directed, they can cause hair and scalp discoloration.
• Ketoconazole shampoos: Like selenium sulfide, ketoconazole is a topical antifungal medication that eliminates yeast.

Some people find that a dandruff shampoo works well at first but then becomes ineffective. Switching between shampoos may help with this issue. When over-the-counter solutions fail to fully treat dandruff, a healthcare provider can prescribe a more concentrated shampoo and/or a steroid lotion.

Although you can often successfully address dandruff using over-the-counter shampoos, consider talking to your healthcare provider about your symptoms. They can examine your scalp to determine if the flakes are dandruff or signs of another scalp condition. Then they can help you explore your treatment options and monitor your progress toward eliminating flakes.

Updated June 2023.