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Dealing with Dandruff

Many people like to wear black because they believe, rightly or wrongly, that dark clothing makes them look thinner and more elegant. Millions spoil the stylish image they seek, though, when white flakes of dandruff show up on their shoulders.

We hear from readers who have struggled with dandruff for decades. In addition to the unsightly flakes, they frequently complain about their itchy scalp. Scratching in public is almost as embarrassing as brushing off snowy shoulders.

Dandruff is caused by an inflammatory skin response to yeast that live on skin. Dermatologists keep discovering new species and new links between these Malassezia organisms and skin conditions such as dandruff, seborrheic dermatitis, folliculitis, eczema and psoriasis (Clinical Microbiology Reviews, Jan., 2012).

Scientists haven’t yet figured out why this fungus may get out of control for some people while others don’t even notice they have such organisms thriving on their skin. They have found that inflammation can trigger an immune response that interrupts the normal process of shedding dead skin cells. Instead of getting rid of one cell at a time, imperceptibly, large groups of cells clump together and fall off at once, making visible flakes. Histamine released as part of the inflammatory process may be responsible for the typical itch associated with dandruff and its nastier cousin, seborrheic dermatitis.

Common approaches to treating dandruff utilize chemicals such as zinc pyrithione, found in Head & Shoulders and other dandruff shampoos. This compound disrupts the metabolism of the scalp fungus (Antimicrobial Agents and Chemotherapy, Dec., 2011).

Repeated use of the same compound may result in the yeast developing resistance, which could explain why a shampoo that worked at first loses efficacy. That’s why we often recommend rotating different types of dandruff treatments, switching from a zinc-based product to a selenium-based shampoo after a few weeks. We have included details on how to follow this regimen in our Guide to Hair and Nail Care.

Readers tell us that dandruff treatments that work for one person don’t always work for everyone else. That may be due to individual differences in the reaction to Malassezia fungi, as well as differences in the particular species. Some day dermatologists may have an easy way to determine which species predominate on a patient’s scalp, but for now we are stuck with trial and error.

Luckily, many readers have done some of that trial and error for all of us and have found some fascinating home remedies for flakes and itching. One says: “I happen to have long hair and issues with yeast-based dandruff. I use a mixture of amber Listerine and cider vinegar when the itchies act up. I haven’t had any problems with my hair drying out as a result.”

You will find many more home remedies for dandruff at www.peoplespharmacy.com.

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies..
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