Is My Dandruff Severe?

Dandruff is itchy, flaky, and when it settles on your shoulders, you hope no one can see the evidence. Though you may feel like the only one in the room with this scalp problem, it's actually common.

For a few flakes here and there, an over-the-counter dandruff shampoo will usually solve your problem. If it doesn’t, you might have a severe case causing your scalp to feel raw and crusty.

You’ll want to take a different approach for stubborn dandruff. You might need to see a dermatologist, a doctor who specializes in hair, skin, and nail problems.

What Is Dandruff Exactly?

The condition causes little white or yellow flakes of dry skin, which rub off easily, to form on your body.

The official name is “seborrheic dermatitis.” If it’s on a baby’s scalp, you might hear it called “cradle cap.”

It usually affects your scalp, but it can happen on other parts of your body. You can have it on the sides of your nose, your ears, or your chest.

Dandruff Myths and Facts

Myths about dandruff may lead you to pick the wrong way to get rid of it.

For example, if you think of dandruff as a dry scalp problem, you may wash your hair less often to avoid drying out your scalp even more. In reality, not washing enough will only irritate your scalp and lead to more dandruff.

Here are some other dandruff myths and facts:

Myth: A dry scalp causes dandruff.

Fact: The reverse is true. If you have dandruff, it's because your scalp is oily. Yeast that live on your scalp feast on the extra oil and release substances that irritate your skin. The flakes you see are dead skin cells shedding from your scalp.

Myth: Dandruff can lead to serious health problems.

Fact: It doesn't do that. It also can’t make your hair fall out or cause baldness. But it can be itchy, unsightly, and embarrassing.

Myth: If you have dandruff, it means you're dirty.

Fact: A lot of different things can cause dandruff, and none of them have anything to do with how clean you are. These include:

You're more likely to get dandruff during your teenage years and after you’re 50 or older. It's also more common during winter when it’s cold and dry.

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Treatment

The best thing you can do is to wash your hair every day or every other day with an over-the-counter anti-dandruff shampoo. Look for ingredients on the label such as:

  • Ketoconazole (Nizoral A-D)
  • Salicylic acid (DCL Salicylic Acid Shampoo, Dermasolve, Neutrogena T/Sal, Selsun Blue Naturals Dandruff)
  • Selenium sulfide (Exsel, Head and Shoulders Intensive Treatment Dandruff Shampoo, Selsun Blue)
  • Sulfur (Some shampoos have sulfur as an ingredient in combination with other active ingredients.)
  • Tar (Denorex Therapeutic Protection Dandruff Shampoo, Pentrax, Neutrogena T-Gel)
  • Zinc pyrithione (Everday Clean Dandruff Shampoo, Head and Shoulders Dandruff Shampoo, Suave Anti-Dandruff Shampoo, Selsun Blue Salon Ultimate Daily Care 2 in 1 Shampoo)

How to use these shampoos: Massage a small amount into your scalp, beard, or other affected area. Don't scrub; you'll only irritate your skin more. Leave the shampoo in for 5 to 10 minutes (check the bottle label for exact instructions), then rinse.

Try different shampoos until you find one that works for you. Rotate your anti-dandruff shampoo with a regular moisturizing one to avoid getting a dry scalp.

If you've tried over-the-counter dandruff shampoos and are still fighting flakes, see a dermatologist.

You may need a stronger, prescription-strength shampoo or another treatment.

How to Manage Severe Dandruff

Sometimes even the best anti-dandruff shampoo won't get rid of a stubborn case.

Some things your dermatologist might try:

  • She might prescribe a steroid cream that you rub onto the affected area once or twice daily.
  • You may also need an antifungal medicine that you take by mouth or apply to your scalp or skin to get rid of the yeast.
  • You may need to apply an oil-based medicine and leave it on your scalp overnight under a shower cap, if the problem is on your head.

Is It Dandruff -- or Something Else?

Especially stubborn flakes may not be dandruff at all, but another skin condition that looks like it. Other scalp problems that can lead to flaking skin include:

Eczema: A group of conditions that irritate your skin and cause a scaly, itchy rash.

Psoriasis: A disease that leaves itchy, red, scaly patches on your skin, including your scalp.

Rosacea: Redness and irritation that usually affects the face but can also involve your scalp.

If your dandruff isn't going away with treatment, or you have scalp problems such as redness, pain, crusting, or pus, call your doctor.

You can't cure dandruff, but by finding the right treatment for your case, you can control it and live pretty much flake-free.

WebMD Medical Reference Reviewed by William Blahd, MD on November 02, 2016

Sources

SOURCES:

Johns Hopkins All Children’s Hospital, “Dandruff.”

Amy McMichael, MD, professor of dermatology at Wake Forest Baptist Medical Center.

American Osteopathic College of Dermatology: "Seborrheic Dermatitis."

University of Michigan Health Service: "Dandruff."

Nemours Foundation: "Dandruff."

Cleveland Clinic: "Seborrheic Dermatitis."

Ferri, F. Ferri's Clinical Advisor 2012, 1st ed. Mosby Elsevier; 2011.

Habif, T. Clinical Dermatology, 5th ed.  Mosby Elsevier, 2009.

American Academy of Dermatology: “Why see a dermatologist.”

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