Dandruff Treatment and Remedies
Dandruff - or pityriasis - is a common skin condition that affects the scalp. According to the British Association of Dermatologists, it can affect almost half of all adults. And while it’s not harmful or contagious, dandruff can be embarrassing, since it causes noticeable flakes of dry, white or grey dead skin in the hair, on the scalp and on clothing (particularly dark clothing). On top of all that, your scalp may feel dry and itchy.
Skin is in a constant state of shedding and being replaced, and the skin on your scalp is no exception. If you don’t have dandruff, the shed dead skin on your scalp simply gets washed away when you shampoo your hair without you even noticing.
However, according to the NHS, dandruff can develop when this cycle of skin shedding and renewal speeds up, leading to patches of dead skin forming on the scalp. And that, say some hair experts, can happen when the normal balance of bacteria and other micro-organisms on the scalp is disrupted.
Many things are thought to create an imbalance of bacteria on your scalp, including the following
Changing hormone levels
Certain weather conditions (dandruff can be worse in cold or dry weather)
Illness and certain skin conditions (see Seborrhoeic dermatitis, below)
How is it treated?
Most people who have dandruff can treat it themselves with an anti-dandruff shampoo that you can buy over the counter without a prescription. The NHS recommends looking for a shampoo that contains zinc pyrithione, salicylic acid, selenium sulphide (or sulfide), ketoconazole or coal tar.
Follow the advice on the label on how to use the shampoo carefully, making sure that you leave it on as long as the manufacturer recommends. You may not see any change in your scalp for a month, so don’t think the shampoo isn’t working if your dandruff doesn’t disappear straight away.
That said, you may have to try a few different shampoos with different ingredients before you find the one that works best for you. But when you do find one that works, keep using it from time to time, even when your dandruff has gone - as it may come back if you stop using the shampoo completely.
Some people may need a stronger shampoo that’s only available on prescription from their GP if they’ve tried several anti-dandruff shampoos and none of them have cleared their dandruff. These shampoos and mousses often contain steroid medication, so follow your GP’s instructions when you use them.
Meanwhile, you may also want to see your GP about dandruff if the flakes and itching are very severe or your scalp is red or swollen. People with a compromised immune system should also consult their doctor about dandruff.
There are several skin conditions that can cause a flaky scalp, including seborrhoeic dermatitis. This can cause itchy, greasy-looking yellowish flakes on the scalp and in your hair - in other words, dandruff - sometimes with a red, scaly and weeping rash.
However, seborrhoeic dermatitis can affect other parts of the body too, including the face, where it often appears on the eyebrows and around the edges of the nose. It can cause red, swollen and flaky eyelids too, and some people find it affects their ears (either inside the ear canal, in the outside part of the ear or behind the ear).
You may also get seborrhoeic dermatitis on your chest and/or on your upper back, between your shoulder blades, where it causes patches of pink or red skin with mild scaling. It’s often found in areas where there are folds of skin too, such as under the breasts, under the arms and in the groin.
How common is it?
According to the British Association of Dermatologists, seborrhoeic dermatitis affects around four percent of the population and can start at any time after puberty. It’s also thought to affect slightly more men than women, and is more common during winter than in the summer.
Experts think it’s caused by an overgrowth of a yeast that lives normally in the skin, or an over-reaction to the yeast by the immune system. This harmless yeast is called Malassezia, and nobody really knows why it causes a problem in some people. However, experts believe things like tiredness and stress can trigger seborrhoeic dermatitis flare-ups in those who are affected.
How can you treat it?
There are treatments that can help you manage seborrhoeic dermatitis, but there’s currently no cure. This means if you treat your skin then stop using the treatment, the problem is likely to come back, and you’ll have to treat it again.
If you have seborrhoeic dermatitis of the scalp, the most common treatment is an anti-yeast (or antifungal) shampoo that contains ketoconazole. You should normally use this shampoo two or three times a week, leaving it on for about five minutes before rinsing (or follow the instructions on the label).
Other anti-dandruff shampoos can be used too, including those that contain zinc pyrithione or coal tar, if your scalp condition is mild. Your doctor may also prescribe a scalp lotion that contains steroid medication, or a course of antifungal tablets if your skin isn’t clearing up with other treatments. In severe cases, phototherapy using ultraviolet B light may be recommended.
Seborrhoeic dermatitis that affects parts of your skin other than your scalp is usually treated with an antifungal cream, with a steroid or other type of cream prescribed if necessary.
Meanwhile, there are some other skin conditions that cause flaky skin on the scalp, including eczema, psoriasis, allergic contact dermatitis (caused by an allergy to scalp and hair products, for example) and tinea capitis (a fungal infection also called scalp ringworm).
Cradle cap in babies
Seborrhoeic dermatitis can also affect babies. If their scalp is affected, the condition is usually referred to as cradle cap. This causes dandruff-like scales that can be large, greasy, yellow or brown. You may also notice flakes on your baby’s clothing and bedding. Thankfully, it’s not thought to be itchy, and most babies with cradle cap don’t suffer any discomfort.
This harmless condition often affects babies during their first couple of months and usually clears up by itself by the time they’re six months to a year old. However, unlike seborrhoeic dermatitis of the scalp in adults, it’s short-lived and not a chronic condition in babies. But according to the NHS, babies who had cradle cap are more likely to develop dandruff when they grow up than those who aren’t affected.
Why do babies get it?
Experts don’t really know what causes cradle cap. But some believe that overactive sebaceous (oil) glands in the skin could be to blame. Some babies have their mothers’ hormones circulating in their bodies for a while - months in some cases - after they’re born. And it’s thought that these hormones affect the babies’ oil glands. Another theory is that the Malassezia yeast may have something to do with it.
Since the condition is usually very mild, there’s no need for any treatment for cradle cap. But there are a few things you can do if your baby is affected:
Use a baby shampoo that’s formulated to relieve cradle cap (these shampoos are available over the counter).
Apply some olive oil or white petroleum jelly to your baby’s scalp and leave overnight, then wash it off gently using a baby shampoo the next morning. This can help to loosen and remove the scales.
You can also loosen scales by using a soft brush to gently brush your baby’s scalp after they’ve had their bath.
Use a moisturising lotion called an emollient on your baby’s scalp - these products are also available over the counter.
If your baby’s scalp becomes very red and inflamed you may need to see your doctor for advice (your GP may prescribe a mild steroid cream or an antifungal cream to use on the affected area).
Can diet help?
While there’s no hard and fast evidence to suggest what you eat could cause - or treat - dandruff, many hair experts believe it’s a good idea to check your diet is healthy if you have a flaky scalp. Making sure you get at least five portions of fruit and vegetables every day is a good place to start, but here are some other things you could try:
Eat less sugar
It’s widely thought that a diet high in sugar can cause inflammation in the body, so cutting back on the sweet stuff could help if you have a red or swollen scalp as well as dandruff flakes. While adding less sugar to your food and drinks, try to eat fewer high-sugar foods such as refined carbohydrates (white rice, bread, pasta etc) and alcohol too.
Go for healthy fats
Foods rich in omega-3 essential fatty acids may help fight inflammation as well as support healthy hair and skin. Try to eat two portions of oily fish each week – choose from salmon, fresh tuna, sardines, mackerel, herring and pilchards, or get plenty of healthy plant-based fats in your diet by eating avocados and nuts (such as walnuts), and by drizzling extra virgin olive oil over your salads.
Fill up on fermented foods
Eating foods such as live yoghurt, sauerkraut, kimchi (spicy fermented cabbage, similar to sauerkraut), kefir (a yoghurt-like drink), tempeh (made from soya beans) and raw pickled vegetables may help maintain an healthy balance of bacteria and other micro-organisms in your digestive system and skin.
Add some garlic
Foods such as garlic, onions, ginger and oregano are thought to have anti-fungal properties, so may be useful if you have dandruff caused by seborrhoeic dermatitis.
Some nutritionists also think dandruff may be a symptom of food intolerances, so you may notice that when you eat a lot of a certain type of food, your dandruff gets worse. If this is the case, it’s a good idea to find a nutritionist who can help you pinpoint exactly what may be causing the problem and to suggest suitable alternatives so that you don’t miss out on any important nutrients in your diet.
Natural remedies for dandruff
The use of both aloe vera cream and tea tree oil shampoo have been suggested as ways of relieving the symptoms of mild dandruff. Other ways to relieve dandruff naturally include taking nutritional supplements, such as the following:
If you have a red, dry, itchy scalp, a fish oil supplement may be useful, thanks to the fact that the omega-3 fatty acids found in fish oils are widely believed to have anti-inflammatory properties.
Many natural health practitioners recommend vitamin E - both as a nutritional supplement and a topical oil treatment - for dandruff. Not only is vitamin E thought to help boost blood circulation, including to the blood vessels in the scalp, it may also help keep the scalp moisturised. Having good circulation in the scalp may help keep the skin healthy and prevent dryness (poor circulation, claim some experts, may be a contributing factor in the development of dandruff). You can also top up your vitamin E levels by eating more nuts, seeds, green leafy vegetables, eggs and wheat germ.
While some hair health experts claim shampooing too often can lead to dandruff - thanks to the way detergent ingredients may irritate the scalp - others believe dandruff may, in some cases, be an allergic reaction to excessive use of hair styling products. In this instance, taking a natural supplement containing anthycyanidins may be useful.
Compounds belonging to the flavonoid family of plant chemicals, anthocyanidins are antioxidants that many believe help suppress the body’s allergic responses. These compounds are found naturally in the skin of dark and richly coloured fruit, such as blueberries, blackberries, raspberries and red grapes.
While tackling dandruff may be difficult, this guide might be the first steps towards managing it. For more information on how to support your overall health, feel free to visit our health library.
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Disclaimer: The information presented by Nature's Best The Pharmacy is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.
Christine Morgan has been a freelance health and wellbeing journalist for almost 20 years, having written for numerous publications including the Daily Mirror, S Magazine, Top Sante, Healthy, Woman & Home, Zest, Allergy, Healthy Times and Pregnancy & Birth; she has also edited several titles such as Women’ Health, Shine’s Real Health & Beauty and All About Health.