Dr. Tariq Jagnarine
Family Medicine/ Endocrinology

Dandruff is related to Seborrheic Dermatitis (SD), which causes itchy and flaky skin, but it occurs only on the scalp. It’s so common that it affects about half of the global adult population.
Most people focus on the flakes. Itching, on the other hand, may be the most uncomfortable side effect.

Many factors can contribute to the development of dandruff, so pinpointing the exact cause of the itchy, flaky scalp can be difficult. Here are a few likely culprits:

* Secretions from the sebaceous glands
* Fungal colonization on the surface of the skin
* Not shampooing enough, which may cause skin cells to accumulate and create flakes and itching; or, alternatively, over-shampooing and over-drying the scalp.
* Over-brushing the hair on the head creates too much friction with the sensitive skin on the scalp
* A yeast called Malassezia, which aggravates the scalp and causes excess skin cell growth
* Different personal care products may cause contact dermatitis, which makes the scalp red and itchy
* Too much exposure to sunlight
* Excessive pressure on the scalp from hats
* Eating habits
* Exposure to dust or dirt
Some people may be more predisposed to dandruff than others, for reasons that are unknown. However, it’s known that men develop dandruff more frequently than women.
People who tend to have oilier hair or live with certain illnesses (such as Parkinson’s disease or HIV) are also at higher risk.

Flakes and an itchy, scaly scalp are the main symptoms of dandruff. White, oily flakes typically accumulate in the hair and on the shoulders, and often get worse during the fall and winter months, when the air is dry. Additional symptoms can include:
* Erythema, which are red patches on the skin of the scalp, and sometimes on the face
* Eyebrow dandruff
* Hair loss
* Dry flakes on the skin of the face

Getting rid of dandruff can consist of taking medications that can be obtained both through prescriptions and over the counter. There are also some home remedies.
The best way to get rid of dandruff is to use dandruff shampoo and scalp treatments. The American Academy of Dermatology Association (AAD) recommends taking the following steps:
Follow instructions. Since there are many different types of dandruff treatment shampoos, and each comes with its own instructions, it’s important to carefully read and follow the directions of the product of choice.
Different skin and hair types require different care. African American people may need to wash only once a week with a dandruff shampoo. Asian American people and those who are white may need to alternate between different dandruff shampoos that contain different ingredients in order to achieve the best results.
Shampoos for dandruff can be medicated (which requires a prescription to purchase) or available over the counter. Usually, this means that the amount of the medication in medicated shampoos is just higher.
Typical ingredients include ketoconazole, selenium sulfide, coal tar, and zinc pyrithione. These ingredients usually loosen the dandruff flakes from the scalp, or fight the overgrowth of the Malassezia fungus, which may play a role in the development of dandruff.

Common dandruff shampoo brands
Some specific products you may see on the shelves include:
* Head & Shoulders and Jason Dandruff Relief, which contain zinc pyrithione, an antibacterial and antifungal. Dandruff is not caused by a fungus, but these shampoos can help to slow the production of excess skin cells.
* Neutrogena T/Gel, which is a tar-based shampoo. Coal can ease conditions from dandruff to psoriasis by slowing how quickly the scalp’s skin cells die and flake off. This type of shampoo can discolour hair.
* Neutrogena T/Sal, which has a dose of salicylic acid and may lessen the amount of scale on the head. It can leave the scalp dry, however. If the scalp is particularly dry, follow up with a moisturizing conditioner.
* Selsun Blue, which has the power of selenium sulfide. It can slow the death of skin cells and also reduce Malassezia. This type of shampoo may discolour lighter shades of hair.
* Nizoral, a ketoconazole shampoo, meaning: it contains a broad-spectrum antifungal. This type of shampoo can be found over the counter or by prescription.
However, the AAD warns about using coal tar shampoo. This kind of shampoo can discolour light hair and make the scalp more sensitive to the sun.

Some natural remedies before the use of medicated solutions include the following options:
* Baking soda. Gently rub it into the scalp in the shower, and rinse after a few minutes.
* Apple cider vinegar. Mix 1/4 cup with a 1/4 cup of water. Apply to the hair for 15 minutes to 1 hour, and then rinse out. Do this twice a week.
* Coconut oil. Rub 3–5 teaspoons into the scalp and leave for 1 hour. Then shampoo the hair and wash it out.
* Lemon juice. Rub 2 teaspoons into the scalp and rinse out. Then rub one more teaspoon mixed with 1 cup water. Do this every day.
* Aloe Vera. Rub into the scalp before you wash the hair.
* Olive oil. Rub 10 drops into the scalp. Cover the head with a shower cap and leave overnight. Shampoo and wash the hair in the morning.

Here are some tips to avoid dandruff:
* Practise good hygiene. Do your best to resist the urge to touch the scalp, especially if it’s already itchy. Scratching can increase irritation and lead to a vicious cycle. By scratching, you can also introduce dirt into the mix, which can make dandruff worse.
* Find the right shampooing balance for the scalp. The shampoo is often enough to keep oils at bay, but don’t use too many products in the hair, as that can irritate the scalp.
* Reduce stress. Stress can aggravate or even worsen dandruff for some individuals. While Malassezia is not introduced to the scalp by stress, it can thrive if the immune system is compromised, which is exactly what stress does to the body. Do the scalp a favour and relax. Try taking a restorative walk or practising yoga.
* Breathe fresh hair. Research shows that including regular exposure to the outdoors, especially where the air is fresher, can help reduce oil buildup on the scalp.
* Massage the scalp. This may also help prevent dandruff symptoms.
* Brush those locks. Brush the hair when it’s damp (not wet) at least twice daily.
* Limit friction. Limit the wearing of hats and scarves, especially those of synthetic materials.
The good news is that many cases of dandruff can be treated effectively with over-the-counter (OTC) shampoos and other lifestyle measures. That being said, dandruff isn’t the only reason for an itchy scalp. If the dandruff is particularly stubborn or itchy, it may be psoriasis, eczema, or true fungal infection. The doctor can help.