Dandruff is the flaking and itching of the scalp that most people notice as white or yellowish scales in the hair and on the shoulders. Seborrheic dermatitis is the same problem in a more inflamed form, where the scalp also becomes red and greasy scales stick to the skin, and where the eyebrows, the sides of the nose, the area behind the ears, the beard and sometimes the chest can be affected as well. Both are linked to a yeast called Malassezia that lives normally on everyone's skin. The trouble starts when the oil on the skin, the amount of this yeast and the individual's own immune reaction fall out of balance, causing the surface skin cells to shed too quickly. It is not caused by dirt, and it is not a sign of poor hygiene.
This is one of the most common scalp conditions seen in clinical practice, and in Jaipur the climate makes it worse in both directions. Dry, dusty winters crack and irritate the scalp, while the heat, sweat and humidity of the monsoon months encourage the yeast to grow, particularly under helmets, caps and turbans. Many people delay proper treatment because they assume the flaking is simple dryness and respond by applying more oil, which often feeds the problem, or by using an anti-dandruff shampoo for a week, stopping when it improves, and being surprised when it returns. Untreated dandruff also matters for the hair itself. Constant itching, scratching and inflammation around the follicles increases hair shedding, so people frequently arrive worried about hair fall when the real problem sitting under it is an inflamed scalp. Seborrheic dermatitis is a long-term, relapsing condition. It can be brought under good control and kept there, but it tends to come back when treatment stops completely.
Signs & Symptoms
- White or yellowish flakes fall from the scalp onto the hair, shoulders and clothes.
- The scalp itches, often more when you sweat or when a few days have passed since the last wash.
- Greasy yellowish scales stick firmly to the scalp instead of falling off freely.
- The scalp looks red or pink in patches under the hair.
- Flaking and redness also appear on the eyebrows, the sides of the nose, behind the ears or in the beard.
- The ear canal or the centre of the chest becomes scaly and itchy in some people.
- More hair comes out during combing and scratching than before.
- The scalp feels sore, burning or tender after scratching, and symptoms worsen in winter, during stress or after illness.
Causes & Triggers
- An overgrowth of, or an exaggerated reaction to, Malassezia yeast that normally lives on the skin.
- An oily scalp with active oil glands, which is why the condition often starts around puberty and in young adults.
- Hot, humid or sweaty conditions, and long hours under helmets, caps or turbans that trap heat and moisture.
- Cold, dry winter air and dust, which irritate the scalp and increase flaking.
- Washing the hair too infrequently, or the opposite pattern of harsh shampoos and frequent chemical treatments that irritate the scalp.
- Heavy oil applied to the scalp and left on for long periods, which can worsen the yeast overgrowth in people already prone to it.
- Stress, poor sleep and general illness, and more severe or stubborn disease in people with weakened immunity or with conditions such as Parkinson's disease.
Diagnosis & Treatment
The first job in the clinic is to be sure that the flaking really is dandruff or seborrheic dermatitis, because several other conditions look similar. Scalp psoriasis produces thicker silvery scale that often extends slightly beyond the hairline. Fungal infection of the scalp, which is common in children, causes scaling with broken hairs and bald areas. Contact allergy to a hair dye or product causes sudden redness, swelling and severe itching. Some scarring scalp conditions begin with scaling and must not be missed. So the doctor will look at the scalp, the hairline, behind the ears, the eyebrows, the face and the chest, ask about products used, wash frequency, oiling habits and how the problem changes with season and stress, and use a magnified examination of the scalp where needed. Tests are not usually necessary, but a scraping or other investigation may be advised if an infection or another diagnosis is suspected.
Treatment is built around medicated shampoos containing specific active ingredients, used in a proper schedule and left in contact with the scalp for the recommended time rather than rinsed off immediately like a regular shampoo. Topical preparations that reduce the yeast and calm inflammation may be added for the scalp and for affected areas on the face or chest, and short courses of oral medication are occasionally advised for severe or very widespread disease. Where indicated, in-clinic treatment may be suggested after examination. Most people notice that itching settles within one to two weeks and that flaking reduces substantially over about two to four weeks. The important part is what comes next. Because this is a relapsing condition, an active course is usually followed by a maintenance routine, such as using the medicated shampoo once or twice a week even when the scalp looks clear, so that the problem does not simply return in a month.
A few common mistakes keep people stuck in a cycle. Stopping everything the moment the scalp looks clear almost guarantees a relapse. Using a medicated shampoo like an ordinary shampoo, with a quick lather and rinse, gives the active ingredient no time to work. Buying a steroid lotion or cream from a chemist and using it on the scalp or face for weeks may give quick relief but can thin the skin, cause redness and visible vessels on the face and make the condition harder to control later. Scratching with nails or the tip of a comb breaks the skin and invites infection. Kitchen remedies such as lemon juice, vinegar and curd often irritate an already inflamed scalp. Also worth saying plainly is that dandruff is not caused by not washing your hair enough, though regular washing does help remove scale and oil. Wash as advised, keep helmet padding clean and dry, avoid leaving heavy oil on overnight while the scalp is inflamed, and come back for review if there is no clear improvement in about a month.
When to See a Doctor
- Flaking and itching have not improved after three to four weeks of using an over-the-counter anti-dandruff shampoo correctly.
- The scalp is red, painful, swollen, crusted, oozing or has a bad smell, which suggests infection.
- Flaking comes with bald patches or broken hairs, particularly in a child, which may indicate a fungal infection needing oral treatment.
- Thick silvery scale is spreading beyond the hairline onto the forehead, behind the ears or elsewhere on the body.
- You have been applying a steroid cream or a fairness cream to the face or scalp for the flaking, or an infant has thick, spreading scaling.
Common Questions
Is dandruff contagious? Can it spread through combs, towels or pillows?
Ordinary dandruff and seborrheic dermatitis are not contagious. The yeast involved lives normally on almost everyone's skin, and the problem is your skin's reaction to it, not something caught from another person. Sharing combs and towels is still not a good idea, because true fungal infections of the scalp, which are a different condition, can spread that way.
Does dandruff cause hair fall?
Dandruff does not directly destroy hair follicles, but ongoing itching, scratching and inflammation around the follicles can increase shedding, and hair often looks and feels worse during a flare. Many people find that their hair fall reduces once the scalp is treated and settles. If thinning continues after the scalp is clear, there is usually a separate cause such as pattern hair loss or a deficiency that needs its own assessment.
Will dandruff be cured permanently?
It can be controlled very well, but it is a relapsing condition, so it is more accurate to talk about long-term control than permanent cure. Most people do well on an active course followed by a light maintenance routine, often just a medicated shampoo once or twice a week. Flares are still possible in winter, during stressful periods or after an illness, and those are usually settled quickly if you act early.
Should I stop oiling my hair, and how often should I wash it?
You do not have to give up oil forever, but heavy oil left on an inflamed, flaky scalp for long hours can make things worse, because the yeast involved grows well in oil, so it is usually best to avoid overnight oiling of the scalp during active treatment. Once the scalp has settled, a light application on the hair lengths, kept away from the roots and washed off the same day, is generally fine if it suits you. Most people with dandruff also do better with regular washing than with washing rarely. In Jaipur's hot months, and especially if you wear a helmet daily, more frequent washing usually helps.
What does treatment cost?
A clinic consultation in Vidyadhar Nagar is Rs 300 and an online consultation is Rs 500, with shampoos and medicines charged separately. Most dandruff treatment involves a small number of products used correctly rather than an expensive package. Consultations are available in Hindi and English.
Get this looked at properly.
In-clinic consultation ₹300 · Online consultation ₹500. Consultations in Hindi and English with Dr. Pradeep Agarwal, MBBS, MD (Dermatology, Venereology & Leprology).
Related conditions
This page is general information, not a diagnosis. Conditions that look similar can need very different treatment, so please do not self-treat based on what you read here.