Diseases & Conditions

Dandruff

Dandruff is a common chronic scalp condition, which is marked by itching and flaking of the skin on your scalp. Although dandruff isn't contagious and is rarely serious, it can be embarrassing and sometimes difficult to treat.

The good news is that dandruff can usually be controlled. Mild cases of dandruff may need nothing more than daily shampooing with a gentle cleanser. More stubborn cases of dandruff often respond to medicated shampoos.

For most teens and adults, dandruff symptoms are easy to spot: white, oily looking flakes of dead skin that dot your hair and shoulders and an itchy, scaling scalp.

A type of dandruff called cradle cap also can affect babies. This disorder, which causes a scaling, crusty scalp, is most common in newborns, but it can occur anytime during infancy. Although it can be alarming for parents, cradle cap isn't dangerous and usually clears up on its own by the time a baby is a year old.

When to see a doctor
Most cases of dandruff don't require a doctor's care. But if you're still scratching your head after several weeks of experimenting with over-the-counter (OTC) dandruff shampoos or if your scalp becomes red or swollen, see your doctor or dermatologist. You may have seborrheic dermatitis or another condition that resembles dandruff. Most often, your doctor can diagnose the problem simply by looking at your hair and scalp.

Dandruff can almost always be controlled, but dandruff treatment may take a little patience and persistence. In general, mild dandruff can often be helped by daily cleansing with a gentle shampoo to reduce oiliness and skin cell buildup.

When regular shampoos fail, over-the-counter (OTC) dandruff shampoos may succeed. But dandruff shampoos aren't all alike, and you may need to experiment until you find one that works best for you. Dandruff shampoos are classified according to the medication they contain:

• Zinc pyrithione shampoos (such as Selsun Salon, Head & Shoulders). These contain the antibacterial and antifungal agent zinc pyrithione, which can reduce the fungus on your scalp that can cause dandruff and seborrheic dermatitis.
• Tar-based shampoos (such as Neutrogena T/Gel). Coal tar, a byproduct of the coal manufacturing process, helps conditions such as dandruff, seborrheic dermatitis and psoriasis by slowing how quickly skin cells on your scalp die and flake off.
• Shampoos containing salicylic acid (such as Ionil T). These "scalp scrubs" help eliminate scale, but they may leave your scalp dry, leading to more flaking. Using a conditioner after shampooing can help relieve dryness.
• Selenium sulfide shampoos (such as Selsun Blue). These shampoos slow your skin cells from dying and may also reduce malassezia. Because they can discolor blond, gray or chemically colored hair, be sure to use them only as directed and to rinse well after shampooing.
• Ketoconazole shampoos (such as Nizoral). Ketoconazole is a broad-spectrum antifungal agent that may work when other shampoos fail. It's available over-the-counter as well as by prescription.

Try using one of these shampoos daily until your dandruff is controlled, then cut back to two or three times a week. If one type of shampoo works for a time and then seems to lose its effectiveness, try alternating between two types of dandruff shampoos. Be sure to leave the shampoo on for at least five minutes — this gives the ingredients time to work.

If you've shampooed faithfully for several weeks and there's still a dusting of dandruff on your shoulders, talk to your doctor or dermatologist. You may need a prescription-strength shampoo or more aggressive treatment with a steroid lotion.