Dandruff (White Flakes on the Scalp)


Excess production of sebum results in oily skin and other conditions like flakes and scaly patches. This condition is known as seborrheic dermatitis and it causes flaking of the skin and itching on the scalp. Dandruff is the term for the whitish flakes of skin that usually occur on the scalp. In severe cases, dandruff might also be seen on the eyebrows, ears, beard, and the sides of the nose. Dandruff is one of the most common skin conditions that affects the general population and teens and adults in particular. It is not contagious.


The exact cause of dandruff is not known. Increased production of sebum (natural oil of the skin) leads to oily skin and excessive skin growth and shedding. This seems to be tied in with an increased growth of skin yeasts that naturally occur on human skin.

  • Poor hygiene precipitates dandruff but is not the cause.
  • An impaired immune system may also result in dandruff. Severe dandruff is frequently reported in patients with a weak immune system (like in HIV/AIDS) or in those suffering from chronic diseases such as Parkinson’s disease.
  • Common triggers of dandruff include oily scalp, sweating, hot and humid weather conditions, infrequent shampooing, bacterial or fungal skin infections, and mental stress.
  • Skin disorders like psoriasis and eczema also cause accumulation of dead skin cells, which develop into scales.
  • Sensitivity to certain ingredients (like paraphenylene diamine) in hair care products like shampoos, conditioners, gels and hair dyes can result in red, itchy, and scaly scalp.


The common symptoms of dandruff are:

  • White flakes visible on the back and shoulders.
  • Itchy or oily scalp with dry flakes.
  • Dry facial skin.
  • Eyebrow and beard dandruff.
  • Recurrent rashes on eyebrows, nose, and ears.
  • Chest rash with dry flakes and red spots (less common)


There is no treatment for dandruff, but it can be controlled with various measures. It often resolves on its own but tends to recur in a person who is at risk.

Home care

  • Daily washing of the hair with over-the-counter shampoos specifically for dandruff is effective in most cases. All the areas affected with dandruff should be washed thoroughly.
  • Mild hydrocortisone creams applied to the affected areas helps in decreasing skin inflammation.
  • Oil-based skin products, closely fitted headgears and tight clothes should be avoided.
  • For eyelid dandruff, gentle washes with baby shampoo are recommended.
  • Itching and skin inflammation can be controlled by massaging the scalp with clobetasol solution.


  • Anti-bacterial cleansers (like sulfacetamide), anti-fungal shampoos (containing ketoconazole, ciclopirox), and anti-inflammatory lotions and creams are recommended for difficult-to-treat dandruff cases.
  • Oral corticosteroids like prednisone anti-fungal pills are recommended only in severe cases.

Skin Care

  • For mild dandruff, wash the scalp with ketoconazole or ciclopirox shampoo daily and avoiding the use of hair conditioner on the scalp.
  • For moderate dandruff, wash the scalp daily with ketoconazole or ciclopirox shampoo. Avoid the use of hair conditioner and massage the scalp daily with fluocinonide or clobetasol for relief from itching.
  • For severe dandruff, washing scalp daily with a tar shampoo, salicylic acid shampoo and then with ketoconazole or ciclopirox shampoo respectively. Use of hair conditioner on the scalp should be avoided.

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