Dandruff Triggers and Treatment

Amber, I keep seeing you scratching and brushing, and you'll look back and ... so I think you should get that taken care of.

A conversation that could only take place between friends. Co-workers who've shared a cozy office for a decade.

Why do you keep putting it off, Amber?

They're afraid to seek help for something that's quite common and actually can be easy to treat.

Yeah, I think you should see one of our doctors, and I think they'll give you a prescription for that.

Finally, with the nudging of her co-worker, she made an appointment with her dermatologist.

It's been going on for about a year; a little over a year, since I had my last child that I've just been having a lot of the flaking.

I can definitely see here. Some other conditions can look similar to seborrheic dermatitis, which is a common cause of dandruff. So we want to just make sure there's any other signs that can appear in the nails and elbows.

It is important to know that not all dandruff is caused by the same thing. So there are things anywhere from a fungus on the scalp, to true psoriasis on the scalp, to eczema or an allergic reaction. So if your dandruff is not improving, that's the time to seek the care of your doctor.

So what are you in here for today?

I just have a lot irritation and, you know, different itching and I wanted to make sure it wasn't any type of rash.

Let's have a quick look. I don't see any thick, scaly plaques that look like psoriasis. I'm just going to check your lymph nodes. Sometimes there's a sign of fungal infection.

One of the masquerading events in patients of color, in African-Americans, about 20% of the time the flaking of the scalp is not seborrhea but is actually tinea capitis. It's a different condition. It's actually caused by a different type of fungus called a dermatophyte.

Believe it or not, as common as dandruff is, we don't know 100% what causes it. But there's a couple factors that we know play a role. So there's increased oil production on the scalp, and additionally, there is probably overreactivity to some normal yeasts that we have on the scalp as well.

Like any condition you can have mild, moderate, severe.

Other factors we can't help that may trigger dandruff:

Is this something new that's been going on or is this something you've been dealing with for a while?

Umm, I remember when I was, you know, in high school it started, my parents have it.

Do you see any correlation to weather? Or activity or stress level at all?

Well, I'm a tennis player, so sometimes when I get really hot, or in the cold when my skin gets pretty dry.

What the typical reason is as you very well know, you've mentioned your parents have it so that's not uncommon that this is a condition that will present in families. There are different times of the year when this can get a little bit worse. For example when it's cold outside. Also when you're perspiring a lot.

So, you have dandruff. What do you do about it?

Part of the art of medicine is finding the right combination of shampoos, topical steroids that are going to keep the condition under control.

Some may be over-the-counter and others may need a prescription.

I love when patients come because although it may be an embarrassing issue up front, it is very manageable. And there are so many ways to achieve control that you don't have to deal with these embarrassing flaking on the shirt or jacket or dress.