Dandruff may be dastardly, but in general, it is not a serious medical condition. Though people who have it may by frustrated by it, or even desperate for relief, doctors don’t get too excited when they see it. The flakes are not life threatening. They never require surgery. They are not contagious and, unlike flatulence, they don’t drive others away. But a bad case of dandruff makes people self-conscious, and thanks to decades of advertising, may even carry a social stigma.
Skin cells die and are sloughed off every day, all over the body. But on the scalp, they may clump together and form flakes that stick in the hair or fall to the shoulders, and are unpleasantly visible on a black polo shirt. If the flakes are especially large and numerous and the scalp is particularly itchy and red, a dermatologist might identify the problem as seborrheic dermatitis. This condition may also affect the face. In some people, patches of skin on the forehead (including the eyebrows), the sides of the nose, and the chin seem to be especially susceptible to developing reddish, itchy scales.
“I fought dandruff for 30 years. Even my eyebrows itched. I only bought light-colored clothing that wouldn’t show flakes.
My dermatologist recommended various shampoos that didn’t work. When I changed doctors, my new doctor said my “dandruff” was a yeast infection. She recommended Nizoral shampoo. I only have to use it about once a month and I have no more flakes or itching.
I know this story isn’t as dramatic as finding a cure for cancer, but solving an annoyance like this is truly liberating.”
Dermatologists usually distinguish between dandruff and seborrheic dermatitis, but researchers now believe that both conditions can be traced to the skin’s reaction to yeast that lives on its surface. This fungus, Malassezia globo and related species, sets up housekeeping, especially where the skin is secreting oils.166 The fungus then produces oils of its own, which irritate the skin.167 The resulting reaction is the excessive flaking typical of dandruff or the redness and itching on the scalp and face that characterize seborrheic dermatitis. Presumably, the big difference between dandruff and seborrheic dermatitis is the amount of irritation that results.
Malassezia yeast normally inhabit the skin; nobody seems to know exactly why some people are more irritated by Malassezia by-products than others. It might have something to do with hormones, or diet, or the activity of the immune system. Because dermatologists don’t know how to change individual susceptibility, the basic approach has been just to kill off as many of the yeastie beasties as is practical without hurting the scalp. This not only makes sense, it actually works most of the time. And it also explains why some dandruff shampoos seem to lose effectiveness over time. Presumably, the yeast can develop resistance.
Once in a while, people taking an oral anti-fungal drug for another problem report that it gets rid of their dandruff. But even for super-dandruff (aka seborrheic dermatitis of the scalp), an oral antifungal is too big a cannon to consider seriously. Why risk potentially serious side effects over dandruff?
Dandruff and seborrheic dermatitis both seem to result from a reaction to yeast that normally live on the skin. Scientists don’t know why some people react while others do not, nor are they sure why Malassezia yeast seems to grow more vigorously on some people’s skin than on others’. But research has shown that making life hard for the yeast usually controls the flaking and itching that are so bothersome. If any of these remedies make matters worse, stop the treatment right away and give your skin time to recover before you try anything else. When in doubt, check with a dermatologist!

  • Drench the scalp with Listerine original (amber) mouthwash before shampooing. The herbal oils and alcohol in Listerine discourage the growth of yeast on the scalp.
  • Smear some Vicks VapoRub on itchy, red, scaly spots. It contains many of the same antifungal herbal oils as Listerine. It can be very difficult to remove Vicks from hair, though.
  • Brew some herbal tea with sage or rosemary. Use it as a rinse after shampooing your hair.
  • Slather yogurt containing live cultures on the scalp. Leave it for 15 minutes before shampooing it out. Unlike the petrolatum in Vicks VapoRub, yogurt should be fairly easy to wash out.
  • Make a rinse with vinegar diluted at least two to one in water. Some people prefer apple cider vinegar, while others use the cheapest white vinegar.
  • Switch from one type of dandruff shampoo to another every 6 to 8 weeks. Don’t give Malassezia a chance to adapt.
  • Try using Nizoral A-D shampoo twice a week, then cut back and use it only as often as needed to keep flaking under control.
  • If none of this helps, check with your doctor. Perhaps your condition is not ordinary dandruff.
  • A prescription shampoo such as Loprox may help when other measures have failed.

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  1. CF
    Reply

    Thank you.
    I tried Listerine as a rinse AFTER shampooing… although it helped….sure did make my scalp raw. Using before sounds definitely better.
    Will try the vinegar spray, that good old vinegar is good for so many things.
    Lately the relief I have could stem from being reliable in taking fish oil, probiotics, and using Tree oil shampoo and Cond. from Trader Joes.
    If I get a lumpy patch, I use straight Tea Tree Oil, on tip of finger, directly on the spot, gives relief, and 2-3 apps, seem to eliminate the spot.
    Being somewhat addicted to whites- like sugar and flour –I do agree, a huge problem also.

  2. BHO
    Reply

    I developed Seborrheic Dermatitis several years ago and at times it has been severe spreading to my eyelids, ears and around my nose. Nothing helped- I tried shampoos and prescription medicine from my doctor. Then I tried two things that have worked for me.
    I began to spray my hair with white vinegar which I keep in a spray bottle in my shower. I spray my hair after washing (trying to get the vinegar to my scalp) and leave this on, then towel dry and style. I started the vinegar treatment first and it helped but did not completely get rid of the dandruff.
    Then I started drinking cranberry juice/seltzer water daily. I add about 3/4 to 1 cup juice to 1 and 1/2 cups seltzer water. I have been drinking this for several months.
    My dandruff is now almost completely gone. I don’t know why but this solution has worked for me. Doing the vinegar hair rinse and the cranberry water drink together has been effective. I am posting this hoping this might help others looking for a solution.

  3. Jean
    Reply

    I have discovered that one of the benefits of fish oil is reduction in dandruff!

  4. CF
    Reply

    Am anxious to go down the list to find which one works for me. Did try Listerine on front half of head and seemed to help: relief, not cure. Must try few more times.
    I never had any problem ever in my life! Since yeast generally (have read) loves sugars and white flours it possible this elimination will speed process, or do not bother?
    I traveled to the Amazon 1 year ago. A ‘medicine man’ whacked me on the head w/some dried palm type branches while, I assume, praying.
    Since after this trip the problem started (never, ever had ANY dandruff in 65 years!)–what is the likelihood a jungle bug decided to take up residence ?

  5. Marcus
    Reply

    Head and Shoulders works great for me…

  6. Megan
    Reply

    I have been trying to figure out what my scalp condition is for years now. I have a mildly itchy scalp and little to no actually loose flakes. What I do have it LOTS of oily build up. When I do scratch my scalp, underneath my finger nails will be full with oily ‘white’ stuff! Also it will very quickly hurt and sometimes bleed, from very little scratching?!?!? It also seems to ‘flare’ up. I think it is worse in the winter time. Somethings I read on the internet lead me to think it could be scalp psoriasis? I have tried most of the dandruff shampoos and they seem to help but only for about 2 weeks or more before they stop working.

  7. JE
    Reply

    I have been using pine tar shampoo, seems to work, are there any long term effects from using it?, I don’t know.
    PEOPLE’S PHARMACY RESPONSE: WE HAVE NOT READ OF ANY.

  8. Lucy
    Reply

    Dandruff shampoos don’t work for me, but I have been getting some relief from Aveeno shampoos and conditioners. They are very gentle and help to keep the flakes down for me.

  9. LE
    Reply

    I have very itchy scalp, but no dandruff. Is there any otc I can get to help besides shampoos, which I have tried already with no luck. Could there be a relationship to the fact that I color my hair?
    PEOPLE’S PHARMACY RESPONSE: PERHAPS YOU HAVE DEVELOPED A REACTION TO THE HAIR COLORANT. YOU MIGHT WANT TO ELIMINATE THE CHEMICALS IN IT, PREFERABLY STEPWISE, SO YOU WILL BE ABLE TO IDENTIFY A CULPRIT.

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