DermatologicalICD-10: L21.0Affects up to half of adults at some point

Dandruff

Also known as: Seborrhea of the scalp, Flaky scalp, Pityriasis capitis

Dandruff is a common, non-contagious scalp condition that causes flaking of the skin and, often, itching. It is a mild form of seborrheic dermatitis and is linked to an overgrowth of a normally present yeast (Malassezia), excess oil, and individual sensitivity. While harmless, dandruff can be persistent and embarrassing. It is usually well controlled with medicated shampoos and good scalp care.

Symptoms

White or yellowish flakes of skin in the hair and on the shoulders
Itchy scalp
Oily or scaly patches on the scalp
Worsening in dry, cold weather or with stress
Mild redness of the scalp in some cases

Causes

  • Overgrowth of Malassezia yeast on the scalp
  • Excess oil (sebum) production
  • Individual sensitivity to yeast byproducts
  • Dry skin
  • Infrequent or irritating hair washing

Risk Factors

  • Oily scalp and hair
  • Age (most common from adolescence through middle age)
  • Male sex
  • Stress
  • Certain neurological conditions (e.g., Parkinson's) and weakened immunity

Diagnosis

  • Visual examination of the scalp and flakes
  • Distinguishing dandruff from dry scalp, psoriasis, or eczema
  • Rarely, skin evaluation if the diagnosis is unclear

Treatment

  • Medicated shampoos with zinc pyrithione, ketoconazole, selenium sulfide, or coal tar
  • Salicylic acid shampoos to reduce scaling
  • Regular, thorough washing to reduce oil and yeast
  • Leaving medicated shampoo on the scalp for several minutes before rinsing
  • Rotating shampoo types if one stops working

Prevention

  • Wash hair regularly with a gentle or medicated shampoo
  • Manage stress
  • Limit hair products that build up on the scalp
  • Get a little sunlight (may reduce yeast growth), with skin protection

When to See a Doctor

  • Dandruff doesn't improve with over-the-counter medicated shampoos
  • The scalp is very red, swollen, or painful
  • Flaking extends to the face, eyebrows, or chest (seborrheic dermatitis)
  • You suspect psoriasis or another scalp condition

Frequently Asked Questions

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