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As the skin is constantly renewing itself, the skin cells on the scalp are usually shed invisibly. If for some reason the cells are being shed too quickly or clump together, it can show up on dark hair or clothes as dandruff.
The causes of dandruff aren't really understood, but people with greasier skin and hair do tend to be more prone. The growth of Pityrosporum ovale1 also appears to be much greater, although it's not clear if the fungus causes the dandruff, or the dandruff gives the fungus a happier home. Most of the more successful treatments have an anti-fungal effect though.
Whilst not exactly being a life threatening condition, dandruff can have quite an effect on a person's lifestyle by undermining self confidence. Sometimes treatment can be as straightforward as the television ads imply: simply buying a bottle of brand X shampoo may well stop those little white flakes affecting daily life, but what happens if that doesn't work?
Don't despair! There are several different treatments available, each using different active ingredients - it may just be trial and error to find the one that works. It's also worth looking beyond the supermarket shelves - only the mildest medicated shampoos can be sold this way. Stronger formulations are available from the chemist, stronger still from doctors, on a prescription. Visit the doctors anyway, if there is any redness, inflammation, weeping, bleeding, crusting or persistent, intense itching. Dandruff isn't the only cause of flaky scalps, and many of the other causes will require prescription treatment to help, seborrheic dermatitis and scalp psoriasis among them.
Shampoos will be based upon one or more of the following ingredients:
- Coal tar - Slows down cell reproduction rate, contains a natural anti-fungal agent, but long term use can stain fair hair orange2.
- Zinc pyrithione - Slows down cell reproduction, as does selenium sulphide. Both of these also have an anti fungal effect.
- Salicylic acid - Helps the skin shed the cells more easily while being washed. Sulphur works in the same way by slightly irritating the scalp.
- Ketoconazole - This is an anti-fungal shampoo available from the chemist or doctor.
Shampooing Tips and Tricks
- Work the shampoo into a lather with your hands before applying to the hair.
- Rub through vigorously, but not with fingernails, to dislodge as many flakes as possible.
- Leave the lather in the hair for about five minutes before rinsing3.
- Rinse thoroughly.
- Try only applying conditioner to the ends of the hair, but always rinse out thoroughly.
- Medicated shampoos should be used at least twice a week, shampooing daily helps keep the flakes down though. Try alternating medicated and a mild shampoo.
- The effects of a medicated shampoo may start to diminish after a couple of months. Once this happens, switch shampoos, reverting to the original once the effects diminish again.
There are other treatments that don't involve dandruff shampoos. These may be worth trying on milder dandruff.
- Use a beer rinse after shampooing, but don't rinse out4.
- Dissolving an aspirin in water and using this as a final rinse. Aspirin is a type of salicylic acid, an ingredient often used in dandruff shampoos.
There are also herbal remedies that can be quite effective for some, these are usually based on natural antiseptics, such as tea tree oil. For mild dandruff try lavender or rosemary oil - a few drops of each oil to about a third of a pint of distilled water and 2 teaspoons of cider vinegar. Shake well and massage this mixture into the scalp a few times a week.