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Dandruff: causes, symptoms, therapy

by Josephine Andrews
Published: Last Updated on 383 views

Dandruff (medicinal: squama) trickles onto the shoulders of many people. They are usually harmless and can often be eliminated with anti-dandruff shampoos, lotions and scalp tonics. However, dandruff is not always a purely cosmetic problem – it can also be a side effect of skin diseases that should be treated by a doctor. Here you can read everything you need to know about the topic: Where does dandruff come from? What are the possible causes? What remedies help against the annoying dandruff? When is a doctor’s visit advisable?

quick overview

  • Formation : Dandruff forms when larger clusters of dead skin cells are shed
  • Causes : often hereditary, but skin diseases (such as psoriasis), hormonal fluctuations, improper hair care, certain climatic conditions, stress are also possible
  • What helps? Many of those affected can help themselves, for example with anti-dandruff shampoos, proper hair care and a healthy diet and sun protection. In the case of underlying diseases, however, treatment by the doctor may be necessary (e.g. with medication).
  • When to the doctor? For stubborn or recurring dandruff, suspected skin disease, hair loss , redness, inflammation, itching and/or weeping of the scalp.

What helps against dandruff?

There are several products that have proven themselves in the fight against dandruff. Some of these can only be prescribed by a doctor, while others are over-the-counter. In order to find the right remedy for the individual case, the reason for the dandruff must be known. In principle, however, there are, for example, the following options for getting dandruff trickling under control.

Dandruff: The doctor does that

Especially against psoriasis , which often manifests itself in annoying dandruff, there are various treatment options for the dermatologist:

  • Salicylic acid : It dissolves scales and makes the skin underneath more receptive to the active ingredients of the medicinal ointments that follow. You should only use salicylic acid shampoos or washable ointments for a few days. Attention: Salicylic acid is not suitable for infants!
  • Vitamin D3 analogues : These are derivatives of vitamin D that have an anti-inflammatory effect. They also slow down and normalize the process of dandruff formation. The preparations are suitable for long-term therapy of up to one year.

In the case of greasy dandruff and fungal infestation , the dermatologist can use antifungal agents as a dandruff shampoo. These contain active ingredients such as ketoconazole or clotrimazole.

Dandruff: You can do this yourself

The light-colored scales are mostly harmless, but annoying to uncomfortable. Many sufferers can help themselves with the following “anti-dandruff measures”:

  • How to use anti-dandruff shampoo : Dandruff shampoos can prevent dandruff from forming again. Often they also contain fungicidal agents (e.g. zinc pyrithione). But be careful: dandruff shampoos are usually not suitable for daily or long-term use. Otherwise you can dry out the scalp and then increase dandruff instead of alleviating it. Apply only 1-3 times a week and no longer than a month.
  • Proper care for dry scalp : Do not wash your hair every day. After washing, rinse the hair thoroughly with clear water. Do not use a hot blow-dryer to prevent dry scalp from developing in the first place. In general, you should use a mild shampoo for dry, sensitive scalps.
  • Proper care for greasy scalp : Daily hair washing, long blow-drying and drying shampoos are also unfavorable for greasy scalps – they promote the scalp’s sebum production. If you cannot or do not want to do without blow-drying, you should at least choose a cooler setting and blow-dry your hair as short as possible.
  • Hair care products : Conditioners, mousses, hairspray and hair gel can further irritate the scalp and promote dandruff. Therefore, only use a few hair care products and then only those that are coordinated with each other.
  • Olive oil : For a supple scalp, you can massage in a small amount of olive oil, leave it on for some time (for example overnight) and then wash it out. This is good for dry scalps, which are often heavily stressed by shampooing.
  • Sun protection : You can prevent excessive sun exposure on your head with a light, airy headgear. Sun in moderation does not damage skin and hair.
  • Proper nutrition : Alcohol, wheat flour, sugar and coffee are unfavorable because they promote the supply of food for microorganisms on the skin. Also, avoid high-fat diets because they can increase the skin’s sebum production. Instead, your diet should provide adequate amounts of the “skin vitamins” vitamin A , vitamin E , and biotin . These ensure beautiful skin and hair from the inside and can thus help with dandruff.

How are dandruff formed?

First things first: Everyone produces dandruff. The top layer of skin (medical epidermis ) consists of skin cells arranged in several layers. Within four weeks, the cells migrate through the various layers of the skin (from the inside out), ultimately die and are shed on the skin’s surface. If this process is normal, the small, shed skin cells cannot be seen with the naked eye .

Only larger associations from a number of about five hundred cells are visible as scales. They form when the skin sheds the flakes too quickly and they clump together. A typical sign is an itchy scalp. It indicates that the scalp is irritated, for example by an aggressive shampoo or washing and blow-drying too often.

Most of the time, the falling scales are harmless and are only perceived as aesthetically unattractive, especially on dark clothing. But dandruff can also be an indication of a disease such as psoriasis or neurodermatitis.

Dry and greasy scales

Dandruff can be divided into two categories:

Dry dandruff: The dry, white dandruff is mainly caused by a dry scalp, heating air in winter, drying shampoos and care products, blow-drying or a hot, dry climate. Women are affected by this just as often as men. Dry dandruff also occurs in certain diseases, for example in psoriasis (psoriasis vulgaris).

Oily scales: Yellow, oily scales appear as a result of increased sebum production. These are usually larger than dry scales and feel oily. Also, because they’re sticky, they don’t shed as quickly as dry scales. This favors the growth of the yeast Malassezia furfur. Although it is part of the normal skin flora, it has a negative effect in this case: the slightly inflamed scalp promotes the formation of greasy dandruff.

Dandruff: causes and possible diseases

Most of the time, the causes of dandruff are harmless. But there can also be illnesses behind it. Common dandruff triggers include:

  • Hormone fluctuations : sebum production is influenced by hormones and can become an annoying problem during puberty, for example. The skin becomes oily, which promotes the formation of blackheads and pimples, as well as yellow, stuck scales on the scalp. Dry dandruff, on the other hand, is often an accompanying symptom of menopause in women.
  • Improper hair care: Frequent hair washing with aggressive shampoos and hot blow-drying can lead to a dry scalp and dandruff.
  • unfavorable climate : heat and dry air cause a dry scalp, which promotes itching and the formation of small, white scales. Greasy scales, on the other hand, are more likely to develop in high humidity.
  • Heredity : Experts believe that heredity also plays a role in the development of dandruff. In fact, dandruff is more common within some families, which supports this thesis.
  • Stress : Mental stress affects the metabolism of the cornea – dandruff is the result. Since the skin’s defense barrier is also disturbed, skin fungi can also settle more easily.
  • Psoriasis : Scalp psoriasis is a subtype of psoriasis that is difficult to treat. In psoriasis, the skin cells of the epidermis keratinize within three to five days and are also increasingly reproduced. This results in the typical, circular scale surfaces.
  • Malassezia furfur : The yeast fungus is part of the normal skin flora and feeds particularly on fatty acids in skin containing sebum. When the scalp’s sebum production increases, its growth can skyrocket and cause inflammation. Itchy scalp and greasy dandruff are typical symptoms. Bacteria can also settle in the scratched areas of skin.
  • Atopic eczema : The disease, also known as neurodermatitis, often occurs in early childhood. It manifests itself in the form of scaly, severely itchy rashes. In an atypical variant, atopic eczema can also only affect the head and neck and lead to dandruff formation due to severely itchy scalp.
  • Seborrheic eczema : The face and scalp are particularly affected by this non-contagious, chronic inflammatory skin rash. Typical symptoms are itching and yellowish scales.
  • Contact allergies : Some people react to ingredients in hair care or cosmetic products, for example, with itching, flaking, scabs and crusting of the skin.

Dandruff: When do you need to see a doctor?

Dandruff is a cosmetic problem for many sufferers, but it can usually be managed without medical help with anti-dandruff shampoos, proper hair care and a healthy diet. In the following cases, however, you should see a dermatologist:

  • Dandruff that lasts more than a month or keeps coming back
  • severe itching, redness or swelling of the scalp
  • hair loss
  • Burning or inflammation of the scalp
  • weeping or crusted patches on the scalp

Initial consultation and examinations

In order to get to the bottom of the cause of the dandruff, the doctor will first discuss your medical history (anamnesis). For example, he asks:

  • How long have you had dandruff?
  • Have you already tried different means (e.g. anti-dandruff shampoo)? With what success?
  • Do you suffer from severe itching?

Then he looks at the skin of your body. Skin changes on other parts of the body can provide the doctor with crucial clues. Skin diseases on the scalp often express themselves differently than on the less hairy parts of the body.

It is also important to distinguish whether it is dry or greasy dandruff. Especially in the case of an inflamed scalp, a pathogen detection can show whether a fungal infestation, a bacterial infection or a parasite infestation is present. If necessary, the dermatologist can also take blood and/or tissue samples.

Once it is determined what is causing the dandruff , the doctor can suggest a suitable therapy.

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