Why is it that something so natural, so commonplace, is still so embarrassing? The itchy, flaky truth is countless people deal with dandruff at some point or another, and it doesn't mean you've got bad hygiene habits and it certainly doesn't mean you're doomed to a live a life where you can't wear black.
"Dandruff is much more common than people realize; 13 million Americans have had it," said Dr. Francesca Fusco, a board-certified dermatologist at New York's Wexler Dermatology [1]. "According to a recent study conducted by Unilever, most consumers who have had dandruff have suffered long term, with 51 percent having had dandruff for more than two years."
What, Exactly, Is Dandruff?
Dandruff is a mild form of a skin condition called seborrheic dermatitis — also known as a red and itchy rash that causes scaly patches to form.
"Although most people think [dandruff] is a dry skin condition, it's the opposite," noted Dr. Gilberto Alvarez [2], a dermatologist who specializes in the treatment of skin conditions, including dermatitis. "This condition occurs in areas of the body that have many oil-producing glands, the scalp being the most common one. However, some people can get it in their eyebrows, chest, and upper back."
Although the cause is not completely clear, Dr. Alvarez said that the most accepted theory is that this excessive oil production results in yeast overgrowth, which in turn can cause inflammation.
Dandruff, therefore, can occur in someone who religiously washes their hair and follows hygiene protocol to a T. It shouldn't be confused with product buildup or dry skin, which are two separate issues that can be remedied via scalp hydration and anti-residue shampoos.
So What's the Best Treatment, Then?
First things first. A visit to the dermatologist will serve you well if you're dealing with dandruff. If you've already been, or you're simply searching for an over-the-counter remedy, you do have a few options.
"If someone has dandruff — or a pre-disposition to dandruff — the best way of controlling it is to cleanse the hair regularly with a product that has an ingredient like zinc pyrithione, which helps to clear and control the dandruff," noted Dr. Fusco. "I recommend Dove DermaCare Scalp Soothing Moisture Shampoo [3] ($5) and Conditioner [4] ($5) because both products contain zinc pyrithione, so you can shampoo and condition as you normally would, but treat dandruff at the same time. The other advantage of using a conditioner with ZP in it is that you won't wash out the ZP you just treated your scalp with when using a shampoo."
She also suggested using the conditioner as a deep conditioning mask. Simply heat it for 20 seconds in the microwave, or until it's tepid, and add in a drop or two of lavender essential oil for added moisture and a calming effect. Apply generously, cover with a shower cap, and let it set for about 20 minutes. This hydrates the scalp and it allows the ZP in the conditioner to have prolonged contact with the scalp.
Consistent usage of a ZP-infused shampoo and conditioner is key to treating and controlling dandruff, noted Dr. Alvarez. In fact, he recommended washing your hair about three to four times a week, or even daily if possible. Remember — dandruff is an oily scalp issue, not a dry scalp issue.
Prescription Options
"If someone's dandruff has become too severe or cannot be controlled with over-the-counter products, I individuate treatment for them with prescription medications," said Dr. Fusco. "This might include ketoconazole shampoo or cicloprox shampoo and a very limited application of a mild topical steroid for a few days."
Dr. Alvarez added, "There are also anti-inflammatory solutions, foams, and lotions that can help, and can be prescribed when there is moderate to severe itching or inflammation."
Bottom Line
If you've got dandruff, there's really no need to be embarrassed. The more we come to understand this skin condition, the less stigma we see associated with it.
"There was a time when people were concerned that having dandruff was an indication of poor hygiene or that it was contagious, but we know now that it is certainly not the case and anyone can get dandruff at any time," said Dr. Fusco.
Your best option for treatment is to consistently use products with zinc pyrithione, and to consult a dermatologist if you can't seem to get it under control on your own.