Diseases

How to get rid of dandruff? – The definitive guide

Do you know enough about this extremely common condition that plagues the human race?

Story Highlights

  • Dandruff is the excessive shedding of dead skin cells from the scalp.
  • Propionibacterium and Staphylococcus bacterias are responsible for dandruff.
  • You won’t get dandruff just because your boyfriend/girlfriend has it.
  • Males are more prone to dandruff than females.
  • Usually, dandruff is not directly linked to hair-loss.

Imagine you are waiting in the lobby for a long awaited job interview. You look over to your shoulders and notice little white specks of dandruff all over the shoulders of your new black suit. You quickly brush it off with your hands and start stressing on what the interviewer will think about your dandruff issue. Does this sound familiar?

Dandruff is a scalp disorder that affects 50% of the post-pubescent population all over the world. The word ‘dandruff’ has an Anglo-Saxon origin that combines the words ‘tan’ meaning tetter (itch) and ‘druff’ meaning dirty. Dandruff is not life threatening in any way and usually limits its impact to aesthetics, itching and sometimes hair loss.

Dandruff is simply put – the excessive shedding/flaking of dead skin cells from the scalp. Everyone’s scalps shed dead cells at an approx. rate of 487,000 cells/sq cm. However, for some people, the rate goes up to 800,000 cells/sq cm. In a person without dandruff, this shedding of dead cells occurs one cell at a time and the average life span of the cell is 28 days. This makes it an invisible process just like how dead cells are discarded from a normal skin surface. However, for people with dandruff, due to the high turnover rate of the dead cells and various other factors, they cluster together, form lumps and are discarded from the scalp every 5-6 days. These are the visible dandruff flakes you see over your shoulders.

Overgrowth of microbes in the scalp is the primary reason for dandruff. This can be due to stress, hormones, too much oil in scalp, issues with immune system etc. For some people, the bi-products created by the microbes in the scalp causes irritation and triggers immune-response that eventually causes dandruff.

There are 3 fundamental factors that play a key role in dandruff formation.

Sebum – Everyone with a scalp in a normal condition produces sebum which is a mixture of oils that helps to protect skin and hair.

Scalp Microbiome – Everyone’s scalp houses a slew of microbes, some good and some bad. Previously, it was believed that a yeast called malassezia globosa was the primary cause of dandruff. However,  recent studies show that Staphylococcus bacteria is more closely linked to dandruff than malassezia globosa.

Acidic Bi-products – The Malassezia globosa/ Staphylococcus bacteria feeds on sebum oil and secretes acidic bi-products. Half of the human population’s scalp is sensitive to these acidic bi-products. Their body reacts by shortening the cell turnover (shedding of scalp cells) from 28 days to 5-6 days. This causes excessive shedding of dead skin cells in quick time causing dandruff.

Other reasons leading to dandruff are

  • Sensitivity to hair products that leads to scalp irritation and shortening of the cell renewal cycle.
  • Washing hair/scalp less frequently can cause sebum and flake buildup.

These are two very different conditions that have similar symptoms. When dry scalp gets misdiagnosed as dandruff, obviously the treatment will not help. Both the conditions lead to white flakes on your hair and shoulders. Lets have a look at how you can differentiate both.

Dandruff Dry Scalp
Characterized by larger, greasy and waxy flakes usually yellowish or grey Characterized by small white flakes of scalp
Caused by excess of sebum that is fed on by the micro biome in the scalp generating irritating acidic bi-products Caused by lack of lubrication by the sebaceous glands on the scalp
Itchy scalp Itchy scalp
Oily/Red/Scaly skin People with dry scalp often have dry skin in other parts of the body.
Dandruff treatments focus on removing the oil from the scalp and/or killing the fungus on your scalp. Can be cured by increasing the moisture level in the scalp by using a moisturizing conditioner.
Very common Very rare as scalp is the oiliest part of the body and hair helps to hold on to the moisture.

What is dandruff made of?

A dandruff flake is a cluster of corneocytes (dead scalp cells that form the uppermost layer of the scalp) that are tightly coupled together and have got detached from the scalp. The size and abundance of the flakes vary from one site of the scalp to another and over time.

Is dandruff bad?

Our society considers dandruff as unsightly. Having dandruff can affect a person’s social life and lead to low self esteem and reduced confidence. It also leads to socially adverse symptoms like itching, scalp redness and hair loss. However, it is not life threatening in any way.

Is dandruff contagious?

Since dandruff is caused mainly due to a person’s scalp micro-biome and intrinsic factors like age, physiological factors, hormonal balance etc, it is not contagious. That is, you won’t get dandruff just because your boyfriend/girlfriend has it.

Inflation is when you pay fifteen dollars for the ten-dollar haircut you used to get for five dollars when you had hair.
– Sam Ewing

What are the risk factors?

The below factors make you more susceptible to dandruff.

Being male – Seems the male population is more susceptible to dandruff thanks to their hormones.

Oily scalp – Since one of the major factor causing dandruff is oil in the scalp, people with an oily scalp are more susceptible to dandruff.

Age – Dandruff is more prevalent in the early teens to middle age.

Climate – Winters are known to aggravate dandruff. So living in areas of long winters make you more prone to dandruff.

Stress – Stress is a trigger for dandruff. If you are prone to stress, you are more likely to get dandruff.

What are the symptoms of dandruff?

  • Itching is the first symptom of dandruff.
  • Hair loss/thinning of hair, if dandruff is left untreated for long.
  • Scaly scalp.
  • Visible and greasy white/yellow flakes of dead skin on hair and shoulders. It may worsen during winter due to skin dryness.
  • Itchy flaking can appear on scalp, eyebrows, around the hairline, ears, nose, center of chest or back.
  • Dryness and Redness of scalp.

Hair Loss and Dandruff

Dandruff is not directly linked to hair-loss. However, in rare situations where dandruff is left untreated for long, can lead to inflammations in the scalp. This can lead to other underlying medical conditions which may result in hair loss.

The medications used to treat hair loss could irritate the scalp/dry out the scalp and cause dandruff. This is one reason why hair loss and dandruff are wrongly linked together.

Dandruff and weather

The severity of dandruff varies with seasons and usually gets worse during winter. Hot and humid summers are known to reduce the intensity of dandruff.

Can dandruff be cured?

There is no known cure for dandruff. However, it can be effectively treated and controlled with specialized shampoos and other natural remedies.

How does the current treatment options fight dandruff?

The existing treatment options using shampoos focus on fighting the major three factors that contribute to dandruff – the flakes, oil in scalp and the scalp microbiome.

  1. Removal of oil from the scalp – Shampooing helps remove the excess oil from the scalp and deprives the scalp microbiome of its energy source.
  2. Attack the microbes – Almost all of the Anti-Dandruff shampoos focus on killing the microbes on the scalp.
  3. Clear off flaky skin – Some shampoos also contain special ingredients that helps in removing the dead flaky skin.

The active components in Anti-Dandruff shampoo and their role in fighting dandruff

shampooBelow are the active components used in Anti-Dandruff formulations. Some brands combine these active ingredients to make the formulations more effective.

Pyrithione zinc (Active ingredient: Zinc pyrithione) – It is an anti-microbial drug that kills the harmful fungus and bacteria in the scalp and also helps in normalizing the sebum production. No major side effects reported. 1

Selenium Sulfide (Active ingredient: Selenium sulfide) – Effective against malassezia fungus and harmful bacteria in the scalp. It also slows the death of scalp cells. Possible side effects include increased level of hair loss, hair discoloration, unusual oiliness or dryness of hair and scalp. 2

Ketoconazole (Active ingredient: Ketoconazole) – Ketoconazole depicts antimicrobial and anti inflammatory properties. It kills the fungus and bacteria that causes dandruff. 3. Topical application of Ketoconazole is generally safe with very mild side effects if any. 4

Salicylic acid (Active ingredient: Salacid) – Reduces the cohesion/bonding between the scalp and the dead cells. This helps to removes scales from the scalp before it can start flaking. For some people, salicylic acid can dry out the scalp and increase flaking. 5

Coal tar (Active ingredient: Coal tar extract/Solubilized coal tar/Coal tar solution/Whole coal tar/Coal tar/Coal tar solution/Polytar) – Slows the growth and shedding of scalp cells. Possible side effects include hair discoloration. Coal tar is considered as a carcinogenic substance. There are no significant proof that coal tar applications lead to cancer, however more targeted studies need to be conducted. 6 Coal tar and cancer related studies – 7 8

Sulphur (Active ingredient: Sublimed sulfur, Sulphur) – Acts as a Keratinolytic agent which helps in loosening the bonding between the dead cells and the scalp. This helps to removes scales from the scalp before it can start flaking. 9

Ciclopirox (Active ingredient: Ciclopirox) – Effective against malassezia fungus and also helps in decreasing inflammation in the scalp. It also has anti-bacterial properties that prove useful against the Staphylococcus bacteria that has been found to be the primary cause of dandruff. There are no adverse side effects reported and its topical application is considered safe. 10

Clobetasol (Active ingredient: Clobetasol) – Helps reduces inflammation in the scalp that eventually reduces swelling, redness and itching.

Various studies shows Ciclopirox shampoos (1%) 11 are the most effective (and safe) option for dandruff treatment. 12 The next most effective and safe anti dandruff component is Ketoconazole.

Controlling dandruff and hair loss through nutrition

Zinc – Deficiency of Zinc can cause flaking of scalp. This is because the turnover of scalp cells in the scalp increases. Including a good source of Zinc in your daily diet can help you control dandruff from the inside. Sources of Zinc in our diet can be from animal proteins (beef, shellfish, poultry, crab meat, shrimp and pork), wheat-grass, wheatgerm, cheddar cheese, kidney beans, flax seeds, squash seeds and various kinds of nuts like peanuts, almonds and cashews, milk, spinach. Read our definitive article on Zinc micro nutrient.

Magnesium – Magnesium helps the body absorb other nutrients like calcium. In the absence of Magnesium, calcium is not absorbed into the bones and ends up clogging arteries and causes calcium deposits in hair follicles which eventually leads to flaking and dandruff. Even hard water causes calcium buildup in scalp. Massaging Magnesium oil on the scalp is good to dissolve these calcium deposits. Green leafy vegetables, legumes, nuts, seeds and whole grains are good sources of Magnesium.

Vitamin B2 -Promotes healthy skin/scalp health, healthy hair and prevents dandruff by keeping the scalp well oxygenated. Almonds, Asparagus, Avocado, Broccoli sprouts, Fish, Kale, Meats etc. are good sources of Vitamin B2 (Roboflavin).

Vitamin B6 – There are studies that found that people with low B6 levels are more prone to have dandruff. The deficiency of B6 makes the scalp dry and flaky. Fish, organ meat and starchy vegetables are good sources of B6 (Pyridoxine).

Vitamin B7 – Biotin (B7) aids in healthy hair growth. Organ meats, Barley, Avocado, Broccoli, Mushroom, Nuts etc. are good sources.

Vitamin E – Helps reduce the dryness in the scalp. Almond, Avocado, Wheatgerm, Spinach, Sweet potato, Sunflower seeds etc. are good sources.

Vitamin B12 – Deficiency of B12 makes the scalp dry and and increase scaling on the scalp. Food sources include Meat, Poultry , Milk, Egg, Fish etc.

Vitamin C – Supports better blood circulation and skin, scalp health. Orange, Grape fruits, Lemons, Strawberry, Kiwi etc. are great sources of Vitamin C.

Omega 3, 6 Fatty acids – Omega 6 helps the body produce prostaglandins which stabilizes the over active oil glands in the scalp and eventually controls sebum production, which is a leading cause of dandruff. Omega 3 helps in preventing inflammation and dry scalp conditions.

Allicin – Garlic, Onion and Shallots are great sources of Allicin. Allicin is an anti microbial and helps keep bacterial and fungi at bay and eventually helps maintain a healthier micro biome in the scalp. 13

Foods to avoid

sugar-cubesAvoid food allergens – Certain food allergies can cause dandruff. You can use an elimination diet to figure out what triggered the allergic reaction. Once the food is identified, make sure you stay away from the same.

Sugar – High intake of sugar leads to increased blood sugar and may trigger dandruff in some people. High sugar affects the microbiome in the scalp, depletes the body of B Vitamins which is a key component of an anti-dandruff diet and also reduces the amount of antioxidants Vitamin C and E in the body.

Does drinking alcohol cause dandruff?

Alcohol has a diuretic effect. i.e. it causes kidneys to remove excess water from the body along with nutrients and electrolytes. This dries out the scalp as well. This may cause flaking worse.

Does caffeine cause dandruff?

Caffeine is a diuretic, just like alcohol and dries out the scalp.

Recent Scientific Studies and Findings

A recent Chinese study found out that unlike earlier assumption that fungi was a main cause of dandruff, bacteria seems to be more directly linked to dandruff. The study which was carried out in China (in 2015) focused on the inter and intra association of dandruff, physiological conditions and host demographics (gender, age, region, scalp microbiome). Below are the major findings.

  • Secretion of sebum in the scalp is negatively correlated to dandruff.
  • Water content in the scalp is negatively correlated to dandruff.
  • Severity of the dandruff is closely associated with the interaction between the host and micro-organisms. Propionibacterium and Staphylococcus are the two most prominent bacteria residing in the scalp. The study found that in scalps with more Propionibacterium population exhibited lower severity of dandruff, however the scalps with more Staphylococcus population exhibited higher severity of dandruff. The study suggests that enhancing Propionibacterium and suppressing Staphylococcus might be a potential solution to dandruff.

How often should you use shampoo treatment?

Shampoo once or twice weekly for 4 weeks when you start off with your dandruff treatment. After 4 weeks, you can choose to shampoo once in 1 or 2 weeks to prevent relapse thereafter. 14

The right way to use an Anti-Dandruff shampoo

Anti dandruff shampoo serves 2 main purpose – medicates the scalp, remove flakes and excess sebum. It is critical that you shampoo correctly in order to get the benefits of shampooing.

During a shampoo session, you need to lather and rinse your scalp twice. Lather well and make sure the scalp is well coated with shampoo. Use your fingers or a scalp scrubber to rub the shampoo into the scalp. Preferably avoid the hair shafts while shampooing as shampoos are harsh for the hair. Try to limit the application on the scalp area.

Step 1: Removing excess sebum/flakes – You could use a normal shampoo at this point along with a scalp scrubber to effectively remove flakes, dirt and excess sebum. The scalp scrubber will help dislodge the flakes and gets your scalp ready for the second round of shampooing. Rinse well.

Step 2: Use the medicated shampoo for the second lather and let the shampoo stay in your scalp for 5 minutes. Rinse out the shampoo.

Another thing to note is to rotate the medicated shampoo every couple of weeks. i.e. if you are using a shampoo with active ingredient as Zinc pyrithione this week, use a one with Selenium sulfide next week.

How to get rid of dandruff using 11 home remedies

Here are 11 wonderful natural remedies that works. You can choose to mix and match as its compounds the anti-dandruff properties and gives better results.

Salt – The abrasiveness of salt can be made use to dislodge flakes from your scalp before you go with any of the below remedies. This is a good pre-cursor step when you go for any natural remedies or even before shampooing. You could choose to mix salt with an oil base (like coconut oil or diluted tea tree oil) to make it easily applicable and reap the benefits of the anti-dandruff properties of the oil.

Tea Tree oil – “Terpenes” in tea tree oil fight many types of harmful bacteria including Staphylococcus which is the primary cause of dandruff as per studies. The oil also acts as a great moisturizer, anti-inflammatory, anti-fungal, anti-bacterial and anti-septic. 15 Make sure the oil is diluted with other base oils like coconut oil before applying to the scalp.

Baking Soda – Baking soda helps the scalp at multiple levels. It helps to remove excess sebum and oil from the scalp. Being a natural antiseptic, it helps clean up the microbiome in the scalp. 16 It also help with PH balancing and helps stabilize the sebum production. Yes, it seems to hit dandruff from all sides! You can add 2-3 tablespoons of baking soda to a cup of lukewarm water, mix well and apply to your scalp. Scrub your scalp with your fingers or a scalp scrubber to dislodge the flakes. Leave the paste on your scalp for 2-3 minutes before rinsing.

You can choose to substitute water with Apple cider vinegar (good for PH balancing and a good anti microbial), Lemon (great antimicrobial properties),  Olive oil (retains moisture), Coconut oil (great anti-fungal, anti-bacterial, moisturizing properties), Tea tree oil (great anti microbial properties).

Baking soda may make your hair look bad and dry after first wash. However, hair quality will improve after a couple of washes.

Coconut Oil – Coconut oil is a great moisturizer and has anti microbial properties 17 that helps fight dandruff. Heat the oil to make it lukewarm and apply it to your scalp. Leave it on the scalp for 15 minutes before washing it off with natural soaps or shampoo.

Apple Cider Vinegar – Its anti-inflammatory and anti-microbial properties 18 helps fight dandruff. Mix 1 teaspoon of Apple cider vinegar in one cup water and apply it to your scalp. Leave it for a couple of minutes before rinsing.

Lemon – Helps in PH balancing and maintain a good microbiome because of its anti-microbial properties. You can mix 1 teaspoon lemon with i cup water and apply it to your scalp. Leave it for a couple of minutes before rinsing. 19

Garlic – Mix crushed garlic with an oil base such as coconut oil to multiply the benefits. The great anti microbial properties of garlic helps in curing dandruff. 20 Note that some people have adverse allergic reactions to Garlic and may induce dermatitis.

Holy basil/Neem – Neem is a wonder herb that is used extensively in Ayurveda treatments. 21 It has anti fungal, anti bacterial, anti inflammatory properties and helps relieve itching and maintains a healthy microbiome. you can choose to purchase dried neem leaves in case fresh neem leaves are unavailable. Use 2 handful of neem leaves or 2 table spoons of neem tea and mix it with hot water. Leave it for 4-6 hours before applying on the scalp. Rinse after 15 minutes.

aloe-veraAloe Vera – Aloe vera has a soothing and nourishing effect on the scalp thus relieving itching. It also helps in reducing inflammation in the scalp. It is also known for its anti-microbial properties and keeps a check on the micro biome. Use aloe vera gel on its own or mix with an oil base to enhance the benefits. 22

Ginger – Ginger has anti-inflammatory 23 and anti microbial 24 properties that helps fight dandruff. You can chose to mix garlic paste with honey and apply to the scalp. Massage for 5 minutes before washing off.

Honey – Honey has great therapeutic and anti microbial effects 25 Honey can be diluted with water and applied to the scalp. Massage for 5 minutes before washing off.

Summary

Dandruff has been a problem for humans right from the beginning of civilization. Even though it is incurable, there are effective ways to control and treat dandruff nowadays. Studies show that bi-products excreted by the microbiome on the scalp is responsible for dandruff. Shampoos usually focus on cleaning up the microbiome, controlling sebum production and removing visible flakes.

References


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  11. Altmeyer P, Hoffmann K. Efficacy of different concentrations of ciclopirox shampoo for the treatment of seborrheic dermatitis of the scalp: Results of a randomized, double-blind, vehicle-controlled trial. International Journal of Dermatology. 2004;43(S1):9-12. doi:10.1111/j.1461-1244.2004.02381.x.

  12. Ratnavel R, Squire R, Boorman G. Clinical efficacies of shampoos containing ciclopirox olamine (1.5%) and ketoconazole (2.0%) in the treatment of seborrhoeic dermatitis. Journal of Dermatological Treatment. 2007;18(2):88-96. doi:10.1080/16537150601092944.

  13. Ankri S, Mirelman D. Antimicrobial properties of allicin from garlic. PubMed – NCBI. 1999. Accessed November 15, 2017.

  14. Shuster S, Meynadier J, Kerl H, Nolting S. Treatment and Prophylaxis of Seborrheic Dermatitis of the Scalp With Antipityrosporal 1% Ciclopirox Shampoo. Archives of Dermatology. 2005;141(1). doi:10.1001/archderm.141.1.47.

  15. Carson C, Hammer K, Riley T. Melaleuca alternifolia (Tea Tree) Oil: a Review of Antimicrobial and Other Medicinal Properties. Clinical Microbiology Reviews. 2006;19(1):50-62. doi:10.1128/cmr.19.1.50-62.2006.

  16. Drake D. Antibacterial activity of baking soda.PubMed – NCBI. 1997. Accessed November 15, 2017.

  17. Shilling M, Matt L, Rubin E et al. Antimicrobial Effects of Virgin Coconut Oil and Its Medium-Chain Fatty Acids on Clostridium difficile. Journal of Medicinal Food. 2013;16(12):1079-1085. doi:10.1089/jmf.2012.0303.

  18. Johnston CS, Gaas CA. Vinegar: Medicinal Uses and Antiglycemic Effect. Medscape General Medicine. 2006;8(2):61.

  19. Fisher K, Phillips C. The effect of lemon, orange and bergamot essential oils and their components on the survival of Campylobacter jejuni, Escherichia coli O157, Listeria monocytogenes, Bacillus cereus and Staphylococcus aureus in vitro and in food systems. Journal of Applied Microbiology. 2006;101(6):1232-1240. doi:10.1111/j.1365-2672.2006.03035.x.

  20. Petrovska BB, Cekovska S. Extracts from the history and medical properties of garlic. Pharmacognosy Reviews. 2010;4(7):106-110. doi:10.4103/0973-7847.65321.

  21. PD S. Herbal Treatment for Dermatologic Disorders. PubMed – NCBI. 2011. Accessed November 15, 2017.

  22. MR F. Aloe vera in dermatology: a brief review. PubMed – NCBI. 2009. Accessed November 15, 2017.

  23. Ginger. University of Maryland Medical Center. 2017. Accessed November 15, 2017.

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  25. Al-Waili N. Mixture of Honey, Beeswax and Olive Oil Inhibits Growth of Staphylococcus aureus and Candida albicans. Archives of Medical Research. 2005;36(1):10-13. doi:10.1016/j.arcmed.2004.10.002.

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