Dandruff, also known as seborrheic dermatitis, is one of the most common skin conditions for which patients seek treatment. It is commonly isolated to the oil-rich scalp, but can occur on any hair-bearing area. Aside from oil production, dandruff is also associated with the overgrowth of a particular type of fungus, Malassezia, and certain markers of inflammation in the body.
Seborrheic dermatitis severity presents on a spectrum. It can be as mild as minimal flaking or itching, or as significant as thick red plaques. On the face, dandruff most often affects the eyebrows, in between the eyes, and the creases of the nose. The diagnosis is usually made clinically, but a skin biopsy can be done if warranted. While this is very common in the general population, it can also be commonly seen in patients with underlying neurological disorders, such as Parkinson’s disease, stroke victims, or individuals with seizure disorders.
Understanding All Things Dandruff
Being such a common issue in the population, we know you have many questions about dandruff. Here are some answers to the most often asked questions:
I Thought Dermatologists Are Skin Doctors – What Do They Know About Hair And Dandruff?
Dandruff is a condition of the scalp skin, not the hair. However, we do also specialize in hair and nail disorders, which are also made of components of skin.
I Have Small White Flakes Falling Out My Hair When I Scratch My Scalp – Do I Have Dandruff?
Yes, likely so.
Is It Contagious?
No it is not contagious. However, there could be some “mimikers” of dandruff that could look the same but may not be seborrheic dermatitis. One example would be “tinea capitis” which is a fungus that occurs on the scalp and is treated with topical and/or oral antifungals
Is It Permanent?
Dandruff is usually a chronic problem. We have many treatments that may eliminate the sympotms, but we do not have a cure. Most patients have flares and remissions, so the sympotms may improve or the condition may seem to go away for a time, but likely it will return. There are different triggers that could cause this, such as stress or medical factors.
Will I Go Bald If I Have Dandruff?
No, dandruff will not cause baldness. If the dandruff is severe and very itchy, the scratching could cause the patient to pull their hair out due to the trauma of scratching, but the hair will always grow back. If the dandruff is under control with medicated products but the scratching persists, that could be an indication that you need an evaluation by a professional, as there are other conditions that can cause itching on the scalp that are not due to dandruff, and those conditions can cause premanent hair loss, such as Lichen Planopilaris.
Am I Dirty Because I Have Dandruff?
Dandruff is not due to dirtiness of the hair or scalp. However, it may improve if the hair is washed with a medicated shampoo more frequently. It is even safe to wash the hair daily if needed, as many patients tend to have more oily hair, skin, or scalps.
Will I Get Lice If I Have Dandruff?
No, they are not related.
Does It Smell?
Dandruff does not smell, but your scalp could get smelly if you scratch hard enough to cause infections from open sores.
Why Does My Scalp Itch?
The inflammatory response to the overgrowth of yeast (Malassezia) is likely the cause of the itch. Additionally, we often say in dermatology that there is a “itch scratch cycle,” which means that the more you scratch, the itchier you become due to histamine release in the skin.
What Is Fungus, Malassezia?
Malassezia is a very common yeast found on the skin. Everyone has normal bacteria and yeast that live on the skin and in the oil glands, and this makes up the skin’s “microbiome”. Malassezia is a common part of the skin flora that has a preference for oily environments, such as the face and scalp. Certain theories suggest that dandruff may be caused by an inflammatory response to the yeast that lives in the oil glands on the face and scalp. Some dandruff responds to anti yeast shampoos, such as ketoconazole, which supports the theory of the relationship.
Is It Genetic?
We don’t think so, but it is very common, so likely could run in families.
Is The Biopsy Painful?
To do a biopsy, we will numb the area locally with a very small needle and inject lidocaine, which sometimes can burn or sting for a few seconds. After that time, the area we will biopsy will be numb and we will take a small sliver of your skin to send to the lab for testing. Keep in mind, dandruff is usually a “clinical diagnosis” which means we usually do not need a biopsy to diagnosis the condition. We would only consider a biopsy if the condition is not responding appropriately to the treatment or if there are other factors on the skin that warrant a biopsy, such as non healng wounds and scarring hair loss, which may suggest an alternative diagnosis.
Do I Have To Use These Special Dandruff Shampoos Forever?
We consider dandruff a chronic disease, with flares and remissions, which means that likely the shampoos will be needed forever, but there may be times when the condition is not flaring and you may be able to stop.
My Hair Is Dry And Brittle, Will The Shampoo Damage My Hair More?
Keep in mind, the treatments for dandruff are for the scalp, not the hair. Often, women do not like the way the dandruff shampoos makes their hair feel or smell. Therefore, we recommend using the dandruff shampoo as a scalp treatment only, often sitting for 10 mintes, then rinse out and follow with normal shampoo and conditioner. If you are worried about your hair being too dry, you can follow with conditioner only.
I Want To Go “Poo Free” And Do Water Only Washing – Will It Cause Dandruff?
It is important to wash your scalp effectively to prevent build up of products and oil in the scalp. This build up could be mistaken as dandruff.
Do Hair Products Help Or Worsen Dandruff?
No, but it is important to wash them out to prevent build up on the scalp. Also, it is important to keep in mind that some people may be having an allergic reaction to their hair products or the fragrance in their products that they may be mistaking for dandruff. If your dandruff does not respond to normal topical prescription treatments, this may be something to consider.
Do I Need To Wash All My Hair Accessories And Combs To Kill The Fungus So I Don’t Keep Reinfecting My Scalp?
No. The fungus (or yeast) lives in the oil glands and needs oil to survive. It is not an infection but rather a colonizaiton of a normal yeast that may overgrow in certain people with the right skin/oil climate and then an inflammatory response to that overgrowth.
Does Diet Play A Role In Dandruff?
We do not recommend any specific diet changes, but do believe a healthy diet is important for all medical conditions, including skin and scalp conditions.
What About Stress?
Yes. Stress Is not the cause, but can often trigger flares in a lot of different skin conditions, including dandruff.
Will Supplements Like Biotin Help?
Biotin is a supplement that has gained press recently for studies showing improvement in hair and nail disease. Many of these studies have been mis-interpreted, as the patients in these studies were actually deficient in the vitamins, so needed supplementation. Recently, many hair experts have suggested against supplementation with biotin for hair loss, as it has shown little benefit in people who are not deficient, and actually can do harm to your body if taken at high doses. Regardless, the vitamin will not help with dandruff.
Is Treatment Expensive?
No, treatment should not be expensive, some is over the counter and some is prescription strength.
Treatment depends on the severity of the condition. Patients with mild seborrheic dermatitis can often be treated with topical shampoos, liquids, or foams. More severe disease may require injectable or temporary oral cortisone. Washing the affected areas on a daily basis and the use of zinc-based shampoos have proven to be helpful. In fact, if one’s face is affected by seborrheic dermatitis, using an anti-dandruff shampoo as a face wash is a useful tip. It is important to remember that this condition is not particularly curable, but can usually be easily managed with the aforementioned treatment plans.