(Contributed by Dermveda)

Dandruff refers to itchy, flaking skin on the scalp, with the most common cause being seborrheic dermatitis of the scalp.1 This scalp condition is common in a range of ages and consists of white or yellowish greasy scaling accompanied with skin redness and itching.

 In infants, scalp seborrheic dermatitis is called “cradle cap” and usually resolves within 12 months. In adults, dandruff commonly presents in teenagers, with males being more commonly affected than females. In older adults, certain illnesses, such as Parkinson’s disease, are associated with seborrheic dermatitis. Dandruff can be an embarrassing and uncomfortable condition for many people, since the scalp itches and flakes onto clothing. 

What Causes Dandruff?

It is not yet known what exactly causes dandruff. Extensive research has shown that overgrowth of normally residing skin yeast species called Malassezia may contribute to dandruff.1 In addition, it is thought that excessive oil production of the scalp may worsen dandruff by promoting Malassezia metabolism of oil to promote irritation and inflammation.2 In people with dandruff, the connections between scalp skin cells appear to be weakened, which makes the skin barrier weak and less able to maintain moisture.3

 There are several dermatological conditions affecting the scalp that could cause an itchy and flaky scalp:

  • Scalp seborrheic dermatitis (the most common cause of “dandruff”)
  • Psoriasis
  • Dermatitis

 Table 1 – Conditions Causing an Itchy and Scaling Scalp


Scalp Condition


“Dandruff” or scalp seborrheic dermatitis1

Most classic cause for dandruff; causes itchiness and persistent greasy flaking from the scalp.

Scalp Psoriasis4

Psoriasis causes well-demarcated pinkish plaque-like areas that appear scaly but are thicker than scales in seborrheic dermatitis.

Contact Dermatitis5

Itchy, red, and scaling skin usually caused by exposure to an irritating chemical in hair products.

Dandruff Symptoms

Dandruff, or scalp seborrheic dermatitis, is a condition when the skin of the scalp becomes inflamed, flaky, and extremely itchy. In some people with seborrheic dermatitis, skin around the central face including the eyebrow area and creases around the nose are affected. Even the chest can be involved in some cases. When this happens, the affected skin appears bright pink or red with fine white to yellowish scaling.

 For some people, proper hair hygiene and treatment can clear up dandruff.  However, for many, dandruff may be a persistent and recurrent lifelong problem for those who are prone to it.

Risk Factors


Seborrheic dermatitis (“dandruff”) appears to occur in three main phases of life. It is common in newborns, referred to as “cradle cap,” and usually resolves by age one. The prevalence of dandruff spikes again in teenage years, males more than females, most likely as a result of androgen hormone induced increases in oil production. Lastly, prevalence is increased in adults over age 50 as sebaceous gland (oil gland) activity declines.6

Psychiatric Diseases

There is an increased risk for seborrheic dermatitis in people with certain psychiatric conditions, such as depression.1

Neurologic Diseases

There is a higher prevalence of seborrheic dermatitis in people with Parkinson’s disease and dementia.1

Immune System Weakness

People with HIV or who have had an organ or bone marrow transplant and are on immune suppression medications are at increased risk for developing dandruff. It is thought that Malassezia yeast species are able to overgrow in people with a weakened immune system.7


In some people, sun exposure triggers dandruff flares.8 This is an important consideration because people with sun-sensitizing skin conditions, such as lupus, may also develop scalp scaling after sun exposure.

 Winter time can be especially troublesome for people who are prone to dry skin, as the cold outside air and heated indoor air may lead to increased scalp irritation and scaling.9


In people prone to dandruff, it is essential to carefully evaluate the ingredients in shampoo, conditioner, hair gel, hair dye, and any other hair products that come into contact with the scalp. Products may trigger dandruff for a variety of reasons, including over-shampooing leading to dryness and irritation, accumulation of products that lead to oil buildup and scalp flaking, or even allergy to specific chemicals.


Psychological stress can be a major exacerbating factor for people with scalp seborrheic dermatitis.10


Treatment Approaches

 Table 2 – Treatment Approaches in Dandruff1

Pathogenic Factor or Symptom in Dandruff

Typical Treatment Approach

Malassezia overgrowth

Antifungal shampoos

Inflammation and Itch

Decrease inflammation

Scaly scalp

Scale removing shampoo

Oily Scalp and Hygiene

Hair washing 2-3 times per week to prevent scalp oil build up

Chemical Induced Irritation

Limit shampoo frequency and use of hair products; seek evaluation for allergy work-up if irritation persists




  1. Borda LJ, Wikramanayake TC. Seborrheic Dermatitis and Dandruff: A Comprehensive Review. J Clin Investig Dermatol. Dec 2015;3(2).
  2. Ro BI, Dawson TL. The role of sebaceous gland activity and scalp microfloral metabolism in the etiology of seborrheic dermatitis and dandruff. J Investig Dermatol Symp Proc. Dec 2005;10(3):194-197.
  3. Turner GA, Hoptroff M, Harding CR. Stratum corneum dysfunction in dandruff. Int J Cosmet Sci. Aug 2012;34(4):298-306.
  4. Eberle FC, Bruck J, Holstein J, et al. Recent advances in understanding psoriasis. F1000Res. 2016;5.
  5. Redlick F, DeKoven J. Allergic contact dermatitis to paraphenylendiamine in hair dye after sensitization from black henna tattoos: a report of 6 cases. CMAJ. Feb 13 2007;176(4):445-446.
  6. Cotterill JA, Cunliffe WJ, Williamson B, Bulusu L. Age and sex variation in skin surface lipid composition and sebum excretion rate. Br J Dermatol. Oct 1972;87(4):333-340.
  7. Tragiannidis A, Bisping G, Koehler G, Groll AH. Minireview: Malassezia infections in immunocompromised patients. Mycoses. May 2010;53(3):187-195.
  8. Moehrle M, Dennenmoser B, Schlagenhauff B, et al. High prevalence of seborrhoeic dermatitis on the face and scalp in mountain guides. Dermatology. 2000;201(2):146-147.
  9. Pierard-Franchimont C, Pierard GE, Kligman A. Seasonal modulation of sebum excretion. Dermatologica. 1990;181(1):21-22.
  10. Park SY, Kwon HH, Min S, et al. Clinical manifestation and associated factors of seborrheic dermatitis in Korea. Eur J Dermatol. Apr 1 2016;26(2):173-176.

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