Dandruff (Seborrheic Dermatitis)

If you've ever had dandruff, with its telltale white flakes, you probably know that it can be a little embarrassing. This is especially true for kids and teenagers, who may already be self-conscious about their looks.

Fortunately, dandruff is harmless and can almost always be controlled, often with simple over-the-counter remedies.

About Dandruff

Dandruff is another name for a condition called seborrheic dermatitis, or seborrhea, specifically seborrhea that occurs on the scalp. It's a very common condition in kids and adults alike, regardless of age or race.

Dandruff causes flaky, white, or yellowish skin to form on the scalp and other oily parts of the body. Other areas that can get seborrhea include the eyebrows, eyelids, ears, crease of the nose, back of the neck, armpits, groin, and bellybutton.

In some cases, dandruff can cause redness in the affected area and may appear crusty and start to itch, sometimes pretty badly. On rare occasions, dandruff can even lead to hair loss if it isn't treated. Any lost hair should grow back once the dandruff is treated, though.

Dandruff is not contagious or an indication of poor hygiene, and it often can be controlled by daily shampooing with a gentle shampoo. In more severe cases, a doctor may recommend a medicated shampoo or cream.

Causes

The exact cause of seborrhea isn't known, although some researchers believe it can be caused by an overproduction of skin oil (sebum) in the oil glands and hair follicles. A type of yeast (fungus) called malassezia can grow in the sebum along with bacteria. This may be another factor in the development of seborrhea. Seborrhea happens in people (like teenagers) with high hormone levels, which also may play a role.

The flakes associated with dandruff sometimes can be caused by conditions other than seborrhea, including:

• dry skin, such as the kind caused by cold, dry winter air
• other skin conditions like eczema, acne, or psoriasis that can cause dead skin cells to build up on the scalp
• shampooing too often or not often enough
• using hair-care products or hair dye that leave a dry, flaky residue or having a bad reaction to these products

Dandruff often runs in families. Men are a little more likely than women to get it. Other things can also make dandruff more likely, like having oily skin, stress, a neurological condition such as Parkinson's disease, or a condition like HIV (human immunodeficiency virus) that harms the body's immune system.

Symptoms

Often, the first symptom someone with dandruff will notice are white flakes of dead skin in the hair or on the shoulders. The scalp may also become itchy and scaly.

Other signs of seborrhea:

• dry, flaky skin that gets worse in cold weather
• dry skin on the face, forehead, ears, or eyebrows
• flaky skin on the chest or other parts of the body that have hair
• greasy or oily areas of skin on the scalp or other parts of the body
• mild redness in the affected area
• temporary hair loss

When to Call the Doctor

Most cases of dandruff won't require a doctor's visit and can be treated with special dandruff shampoos available without a prescription.

Sometimes the dandruff is particularly hard to treat, or the rash is coming from a completely different problem. If your child's dandruff doesn't get better after a few weeks of using dandruff shampoo, or if the skin becomes red, swollen, or drains fluid, you should contact your doctor. Also call if your child's seborrhea gets worse, spreads to other parts of the body, or causes hair loss.

Treatment

Many cases of mild dandruff can be treated just by shampooing every day with a gentle shampoo. This will reduce oiliness and keep dead skin cells from building up.

Moderate cases of dandruff usually can be treated with an over-the-counter dandruff shampoo. Many types are available and not every one works for every person, so you may need to experiment until you find the one that works for your child.

The different types of dandruff shampoos include:

• Selenium sulfide shampoos. These help slow the rate at which skin cells die and may fight the fungus that can cause seborrhea.
• Tar-based shampoos. Made from coal tar, these also slow down the rate at which skin cells die and flake off.
• Zinc pyrithione shampoos. These tackle the fungus on the scalp that can cause seborrhea.
• Salicylic acid shampoos. These help remove flaky skin from the scalp but may leave it dry, which can lead to more flaking.
• Ketoconazole shampoos. These antifungal shampoos, available in stronger doses with a prescription, are designed to reduce fungus on the scalp.

At first, kids with dandruff may need to use one of these shampoos every day to get their dandruff under control. After that, most can cut back to once or twice a week.

Have your child massage the shampoo into the scalp and let it sit for at least 5 minutes before rinsing it out. After rinsing, kids can use regular shampoo or conditioner if they want, as the treatment shampoos tend to be a little smelly.

If over-the-counter dandruff shampoos don't improve your child's dandruff, or if seborrhea develops in places other than the scalp, talk to a doctor. You may need to get your child a prescription-strength shampoo, an antifungal lotion, or cream containing steroids.

After treatment, some people will notice that areas of skin that had seborrhea will be lighter in color than the rest of their skin. This is more common in those with darker skin. This color difference will fade over time and the skin's color will eventually return to normal.

Dandruff is a chronic condition, meaning it can't be cured, but it can almost always be kept under control. Once it's under control, it's usually impossible to detect and will go from being a problem to something that's barely on your child's mind.