Dandruff (White Specks on the Scalp)

What is dandruff?

Dandruff (seborrheic dermatitis) is a chronic skin condition characterized by itching and increased flaking (shedding of dead skin cells) from the scalp. Although seborrheic dermatitis can affect the skin on any part of the body, it is only known as dandruff when it occurs on the scalp. In babies, seborrheic dermatitis on the scalp is known as cradle cap. Dandruff is a common skin problem affecting people of any age group, sex or race. Most cases of dandruff can be easily managed with regular use of shampoo (non medicated and medicated). Complications are rare apart from the social embarrassment associated with the condition.

Dandruff Symptoms

Flakes and Scales

Whitish to yellowish skin flakes on the oily parts of the body namely, scalp, eyelids, eye brows, nasal creases, areas behind the ear even lips are the characteristic rash seen in seborrheic dermatitis. The skin flakes are often found on combs, dresses and pillow covers. Severity of dandruff fluctuates with season. During winter it worsens since the skin becomes very dry.


Itching and redness of the affected area may be present. The itching alone can sometimes be a very distressing symptoms. Although it is usually not severe enough to disturb sleep, constant scratching can be socially embarrassing. However, many people who suffer with dandruff may not experience itching. Burning or pain of the scalp in dandruff may be a sign of a secondary bacterial infection usually caused by excessive scratching and introduction of bacteria into the wounds.


In infants dandruff presents with typical features (thick yellow to brown scales on the scalp, usually without itching) known as cradle cap. Although symptoms may alarm the parents, the condition is usually harmless, non contagious, resolves on its own by the age of one year and there is no long term ill effect.

Causes of Dandruff

The outermost layer of the skin (epidermis) is continuously being replaced by new cells in a phenomenon known as cell turnover. It is a normal process where the older dead cells flake off over a 28 day period. In normal people the flakes are tiny so that it is not visible to the naked. In people with rapid cell turnover, like in dandruff patients, the process occurs over a much faster period like within 7 days. The skin flakes are shed in yellow to gray clumps known as dandruff.

There are several factors which are responsible for dandruff :

  • Dry skin along with skin of other body parts, scalp skin also become dry (mostly in winter, with overheating of rooms) leading to dandruff.
  • Excessively oily skin.
  • Psoriasis: skin disease where rate of cell turnover is increased.
  • Eczema: may sometimes be associated with dandruff.
  • Contact dermatitis: usually to cosmetic hair products (hair colors, dyes).
  • Fungal infection by Malassezia on the oily parts of the body (especially scalp). HIV infection (poor immune system) may cause overgrowth of fungus and precipitate dandruff.
  • Some neurological conditions namely Parkinson’s disease, stroke head injury may be associated with dandruff.

Risk factors

  • Age: Most commonly young adults are affected after puberty although dandruff can affect people of any age group.
  • Gender: both male and female are affected but males are slightly more commonly affected as male hormones are said to play some role.
  • Excessive oily skin: increased activity of the oil gland (sebaceous glands) favors fungal growth.
  • Poor nutrition.
  • Associated illness: Parkinson’s disease, stroke, HIV infection.

Dandruff Treatment

Management of dandruff is simple but requires regular and long term treatment.

  • Regular use of mild shampoos that are non-medicated. This ensures that the skin does not dry out excessively.If it fails then medicated shampoos can be used.
  • Zinc pyrithione shampoo which has both antibacterial and antifungal properties.
  • Tar-containing shampoo slows the cell turnover process and is also used for scalp psoriasis.
  • Salicylic acid shampoo.
  • Selenium sulfide based shampoo reduce fungal infection and slows cell death
  • Ketoconazole (antifungal) shampoo.

Severe cases of dandruff may require treatment with steroid lotion. The use of oral agents (drugs) is almost never needed unless of a secondary bacterial infection.

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