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Dandruff is a term used to describe excessive scaliness of the scalp. The skin cells on the scalp are constantly being renewed. As new skin cells are formed, the old cells are shed. Normally, shedding of old cells passes unnoticed, but with dandruff, the cell turnover is faster and the dead cells are larger and so more visible.
Research has shown that a fungus that occurs naturally on everyone's scalp may be the cause of dandruff. This fungus, called Malassezia (formerly known as Pityrosporum), usually causes no symptoms. However, certain factors such as climate, hormonal changes or stress can cause the fungus to multiply. This causes irritation of the skin and leads to an increased turnover of skin cells, causing the typical symptoms of itching and flaking.
Dandruff is usually seen as white, transparent flakes varying in size, depending on the stage of the problem. It is usually also accompanied by itching of the scalp. The irritation is not caused by the flakes themselves or by greasy hair, but is usually a result of inflammation of the scalp. If the scalp is greasy, the dandruff may stick together and appear as clumps.
Over-the-counter dandruff shampoos are the mainstay of treatment for most people with dandruff. Shampoos containing a mild detergent used twice per week will help rid the scalp of scale, but will not cure it. Similarly, shampoos containing salicylic acid or sulphur can be used to dislodge clumps of flakes. Selenium sulphide reduces sebum production, will make the hair less greasy and dandruff less likely to form into clumps. Antifungal agents such as pyrithione zinc, coal tar and ketoconazole all exert an antifungal effect against the fungus causing the dandruff. Ketoconazole also has an anti-inflammatory action which will help reduce the redness and irritation often associated with dandruff. In more severe conditions, corticosteroid preparations may be used to reduce inflammation.
When to see your pharmacist
All preparations for the treatment of dandruff are available from your local pharmacy without the need for a prescription. Your pharmacist will recommend a product that is best for you. If the pharmacist considers that you have a condition other than dandruff, for example psoriasis of the scalp, or if your scalp has become infected, you will be advised to see your doctor.
When to see your doctor
Severe cases of dandruff can be accompanied by redness and inflammation. If the scalp is very red then you might have a condition called seborrhoeic dermatitis and you should see your doctor for advice.
Living with dandruff
Regular use of an anti-dandruff shampoo will usually get rid of dandruff and prevent it from recurring. Do not apply more frequently than recommended on the product's label. In between these times use an ordinary shampoo and conditioner, but do not use excessive amounts as they tend to strip the hair of its natural oils and dry the scalp.

After washing, allow the hair to dry naturally or gently blow dry with a hair dryer on a cool setting. A hot setting and holding the hair dryer to close to the head damages the hair and scalp and increases the risk of dandruff.

Avoid excess bleaching, perming and tinting if you know these affect your hair and scalp.
If you need to change the colour or style of your hair, go to a professional hairdresser or barber who is experienced in the proper use of these hair products.

Try not to scratch your scalp if your head itches. Although it is tempting and sometimes almost irresistible, scratching damages the layers of skin and will only tend to make dandruff worse. Continual scratching may also break the skin and risks causing a skin infection. Similarly, avoid using hard brushes and combs to groom the hair as these too may irritate the scalp. Instead, use a soft hairbrush and brush gently over the scalp.

While your dandruff is getting better, wear light coloured clothes to hide the appearance of dandruff, particularly in clubs and bars where artificial light makes dandruff stand out.
Useful Tips
  • Try not to scratch your scalp
  • Avoid using too much shampoo and shampooing too often
  • Use a soft hairbrush. Avoid sharp or hard bristle brushes and combs
  • Use your hair dryer on a slower, cooler setting. Hold it quite a long way from the scalp and only blow-dry your hair until it is almost dry

Reviewed on 22 September 2010