Learn about symptoms and causes of dandruff, self help treatment options, medication and when to seek medical help.

What is Dandruff?

Dandruff is a scalp condition which involves a shedding of small, white or yellowish flakes of dead skin from the scalp.  This is usually harmless and does not spread from person to person. However, it can be embarrassing and hard to manage. Approximately half of the adults in the world are affected by it. It is most common among adults around the age of 20 years and less common in those aged 50 and above.

What are the possible causes of this condition?

The exact cause of dandruff is not fully understood. However, the following are believed to be the common causes of dandruff:

• Excessive oil production. Some factors such as hormonal imbalance may lead to oily scalp which can cause the buildup of dead skin cells and dandruff. 
• Dry skin. While not as common as oily scalp, dry skin can also result in dandruff as dead skin cells shed more readily. 
• Poor hygiene. A lack of regular hair washing and scalp care can result in more dead skin cells and oil which leads to dandruff. 
• Yeast overgrowth. Dandruff is often associated with an overgrowth of the yeast-like fungus Malassezia furfur on the scalp which can lead to inflammation and an increased rate of skin cell shedding. 
• Skin sensitivity. Individuals who have an increased sensitivity to certain hair products or harsh chemicals may develop scalp irritation. This condition is known as contact dermatitis and it may cause dandruff too. 
• Underlying medical conditions such as: 
  - Eczema (dry, itchy skin and rashes)
  - Psoriasis (scaly and itchy skin resulting from rapid buildup of cells on the skin surface)
  - Seborrhoeic dermatitis (red and oily skin with flaky white or yellow scales on the scalp)  

What are the symptoms of dandruff?

The symptoms of this condition may include the following:

• White or yellowish skin flakes on the scalp, hair and clothing
• Dry or oily scalp
• Itching and redness on the scalp 
• Smelly hair or scalp

What can I do to treat dandruff?

You can approach your pharmacist to get the following medications to treat dandruff:

• Ketoconazole shampoo 
  • Ketoconazole is an antifungal medication that treats the growth of fungi, including Malassezia furfur. It can also reduce scalp inflammation, thus providing relief from itchy and flaking symptoms. 
• Zinc pyrithione shampoo 
  • Zinc pyrithione is effective at slowing the growth of Malassezia furfur. It can also normalise oil production on the scalp as excessive oil production may increase the growth of Malassezia furfur and lead to dandruff. It also reduces scalp inflammation, thus providing relief from dandruff-related discomfort such as itching and redness of the scalp.
• Coal tar-based shampoo 
  • Coal tar can slow down the rapid growth of skin cells on the scalp, relieving itchiness and flaking. Coal tar has an unpleasant smell and it may darken or stain the skin and hair, especially light-coloured and bleached hair. If you use coal tar shampoo, avoid going under the sun. You may protect your scalp from sunlight by wearing a cap or hat.  
• Selenium sulphide shampoo 
  • Besides reducing the growth of Malassezia furfur, selenium sulphide can also reduce the growth of skin cells on the scalp, thus reducing dandruff. Do note that it may discolour hair, especially blond, grey or dyed hair. Rinse your hair and scalp thoroughly after use to minimise this effect.

When do I need to see a doctor?

If you have tried a medicated shampoo for at least a month and your condition does not get better or worsens, you should see a doctor. You should also see a doctor if you experience any of the following:

• Your dandruff condition is causing a lot of discomfort or your scalp is very itchy 
• Experience unusual symptoms such as bleeding, pain and any discharge on your scalp
• Flaky, itchy skin on your face, ears or other parts of your body
• Your dandruff condition keeps coming back after you have stopped using medicated shampoos

What else can I do to manage this condition?

Other than using medications to treat the condition, dandruff can also be managed or prevented by the following methods:

• Engage in stress-reduction activities like yoga, meditation and deep breathing, as stress may worsen dandruff.   
• Wash your hair regularly with a gentle shampoo to prevent the buildup of oils and dead skin cells.
• Massage your scalp gently to remove dead skin cells and improve blood circulation.
• Avoid hot water and use lukewarm or cool water instead when washing your hair as hot water can wash away natural oils on your scalp. This leads to dry scalp which can be prone to dandruff. 
• Avoid or minimise using harsh hair products like hair gels, hairsprays or styling products that can irritate your scalp.  
• Maintain a healthy and balanced diet as a lack of certain nutrients may contribute to dandruff.
• Clean your combs, brushes and hair accessories regularly to prevent the buildup of oils and skin cells on these items. 

Disclaimers

This article is jointly developed by members of the National Medication Information workgroup. The workgroup consists of cluster partners (National Healthcare Group, National University Health System and SingHealth), community pharmacies (Guardian, Unity and Watsons) and Pharmaceutical Society of Singapore. The content does not reflect drug availability and supply information in pharmacies and healthcare institutions. You are advised to check with the respective institutions for such information.

 The content above is solely for informational purposes only and is not intended as a substitute for the advice provided by your physician, pharmacist or other healthcare professional. You should not use the information for diagnosing or treating a health problem or disease, or prescribing any medication or other treatment. Always speak with your physician, pharmacist or other healthcare professional before taking any medication or supplement, or adopting any treatment for a health problem.