Dandruff

Hanna Rutkowski is a freelance writer for the medical team.

More about the experts All content is checked by medical journalists.

Dandruff (mediz .: Squama) trickles onto the shoulders of many people. Most of them are harmless and can often be eliminated with anti-dandruff shampoos, lotions, and tonics for the scalp. 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 do dandruff come from? What are the possible causes? Which remedies help against the annoying dandruff? When is it advisable to see a doctor?

Brief overview

• Formation: Dandruff occurs when larger associations of dead skin cells are shed
• Causes: often hereditary, but skin diseases (such as psoriasis), hormone fluctuations, incorrect hair care, certain climatic conditions, stress are also possible
• What helps? Many people affected can help themselves, e.g. 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 In the case of persistent or recurring dandruff, if a skin disease is suspected, in the event of hair loss, redness, inflammation, itching and / or oozing of the scalp.

What helps against dandruff?

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

Dandruff: The doctor does that

For psoriasis, in particular, which often manifests itself in annoying dandruff, there are various therapy options for the dermatologist:

• Salicylic acid: It dissolves dandruff and makes the skin underneath more receptive to the following active ingredients in medicinal ointments. Salicylic acid shampoos or washable ointments should only be used for a few days. Caution: Salicylic acid is not suitable for babies!
• Vitamin D3 analogues: These are derivatives of vitamin D that have anti-inflammatory effects. 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 attack, the dermatologist can use antifungal agents as dandruff shampoo. These contain active ingredients such as ketoconazole or clotrimazole.

Dandruff: You can do that yourself

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

• Use anti-dandruff shampoo correctly: Dandruff shampoos can prevent dandruff from forming again. They often 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 relieving it. Use them only one to three times a week and no longer than a month.

• Proper care for a dry scalp: Don't wash your hair every day. After washing, rinse the hair thoroughly with clean water. Avoid using a hot blow dryer to prevent a dry scalp from developing in the first place. In general, you should use mild shampoo for dry, sensitive scalps.

• Proper care for an oily scalp: Daily hair washing, long blow-drying and drying shampoos are also unfavorable for oily scalps - they promote the sebum production of the scalp. 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, mousse, hairspray and hair gel can also irritate the scalp and promote dandruff. You should therefore only use a few hair care products and then only use those that are coordinated with one another.

• Olive oil: For a supple scalp, you can massage in a small amount of olive oil, leave it on for a while (for example overnight) and then wash it out. This is good for dry scalp, which is often stressed by shampooing.

• Sun protection: You can prevent excessive sun exposure on your head with light, airy headgear. However, sun in moderation is not harmful to skin and hair.

• Proper nutrition: Alcohol, wheat flour, sugar and coffee are unfavorable because they promote the food supply for microorganisms on the skin. Also, avoid high fat diets as 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 help with dandruff.

How do dandruff develop?

First of all: everyone produces dandruff. The top layer of skin (medical epidermis) consists of skin cells that are 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 surface of the skin. If this process proceeds normally, the small, flaked skin cells cannot be seen with the naked eye.

Only larger associations with a number of around five hundred cells or more 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 from using an aggressive shampoo or washing and blow-drying too often.

Most of the time, the scales trickling down 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 dandruff

Dandruff can be divided into two categories:

Dry dandruff: The dry, white dandruff is mainly caused by a dry scalp, heated air in winter, drying shampoos and care products, blow dryers or hot, dry climates. This affects women just as often as men. Dry dandruff also occurs in certain diseases, for example psoriasis (psoriasis vulgaris).

Greasy dandruff: Yellow, greasy dandruff is caused by increased sebum production. These are usually larger than dry flakes and feel oily. Also, because they're sticky, they won't peel off as quickly as the dry flakes. This favors the growth of the Malassezia furfur yeast. It is part of the normal skin flora, but in this case it has a negative effect: the slightly inflamed scalp promotes the development of greasy dandruff.

Dandruff: causes and possible diseases

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

• Hormone fluctuations: The production of sebum 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 flakes on the scalp. Dry dandruff, on the other hand, is often a symptom accompanying menopause in women.
• Incorrect hair care: Frequent hair washing with harsh shampoos and hot blow-drying can lead to dry scalp and dandruff.
• unfavorable climate: heat and dry air cause a dry scalp, which promotes itching and the formation of small, white flakes. Greasy flakes, on the other hand, are more likely to develop in high humidity.
• Hereditary predisposition: Experts assume that heredity also plays a role in the development of dandruff. In fact, dandruff occurs more frequently 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. The skin cells of the epidermis keratinize in psoriasis within three to five days and are also increasingly reproduced. This results in the typical, circular scale surfaces.
• Malassezia furfur: The yeast is part of the normal skin flora and feeds particularly on fatty acids in sebum-containing skin. If the scalp produces more sebum, it can grow by leaps and bounds and cause inflammation. Itchy scalp and oily dandruff are typical symptoms. Bacteria can also lodge in the scratched areas of the skin.
• Atopic eczema: The disease, also known as neurodermatitis, often occurs in early childhood. It manifests itself in scaly, very itchy rashes. Atopic eczema can also only affect the head and neck in an atypical variant and lead to dandruff formation due to the severely itchy scalp.
• Seborrheic eczema: This non-contagious, chronic inflammatory rash particularly affects the face and scalp. Typical symptoms are itching and yellowish scales.
• Contact allergies: Some people react to ingredients in hair care or cosmetic products with itching, flaking, scabbing 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 got under control with anti-dandruff shampoos, proper hair care and a healthy diet without medical help. However, you should go to a dermatologist in the following cases:

• Dandruff that has lasted for more than a month or keeps coming back
• severe itching, redness, or swelling of the scalp
• Hair loss
• Burning or inflammation of the scalp
• oozing or crusted areas on the scalp

Initial consultation and examinations

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

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

Then he looks at the skin of your body. Changes in the skin in other parts of the body can provide the doctor with decisive clues. Skin diseases often manifest themselves differently on the scalp than on the less hairy parts of the body.

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

Once it is clear what is causing the dandruff, the doctor can suggest an appropriate therapy.

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