Dandruff and Hair Loss – Causes and Treatments

With at least 50% of the world’s population effected by dandruff, it’s no wonder that so many anti-dandruff products are currently available on the market (1).

From shampoos and conditioners to peels and scalp creams, the treatment of dandruff is a multi-million dollar industry.

While everyone is desperate to rid themselves of the white flakes commonly associated with the disorder, those with a susceptibility to hair loss may be dealing with much more urgency.

This is because dandruff can lead to hair thinning and may even cause damage to the follicles and hair roots.

So, what can a dandruff sufferer do to treat the root cause of the condition, while simultaneously protecting against hair loss?

I aim to answer this very question below.

First, I’ll explain exactly what dandruff is, including the main cause and symptoms.

Second, you’ll learn of common dandruff treatments on the market, from ketoconazole to zinc.

Finally, I’ll outline the steps you need to take to treat the problem while also preventing hair thinning and perhaps even promoting healthy growth.

What is Dandruff?

Dandruff is a scalp condition, characterized by white flakes and itching (2). It’s clinically known as Pityriasis Capitis, and it’s a disorder that can negatively impact the lives of sufferers.

Dandruff is an extremely common condition that affects upwards of 50% of people worldwide (1).

This is a condition known to appear around the pubertal age, though it can extend to 50 years of age and beyond.

There is a similar condition that is seen in infants and known as cradle cap, though it’s temporary and typically resolves on its own (3).

What Causes Dandruff?

While many believe that dandruff is simply a case of dry scalp, the cause goes much deeper than that.

According to a 2014 research study, the culprit appears to be a species of fungus, known as Malassezia (4).

The researchers found that 84% of individuals with clinical dandruff have levels of Malessezia present in their scalps.

This is in comparison to healthy individuals, with only 30% having the fungus present in their scalps.

Malessezia is also believed to be the cause of seborrheic dermatitis, a more serious version of dandruff, and has also been found to be linked to increased levels of hair fall (5). Dandruff and seborrrheic dermatitis are a continuous spectrum of the same disease. Dandruff is the mild version and seborrheic dermatitis is the severe form consisting of severe inflammation secondary to Malessezia.

What are the Symptoms of Dandruff?

For those who’re suffering from itchy scalp, it may be difficult to distinguish between general irritation and a clinical diagnosis of dandruff. Here’s a list of symptoms that, when combined, may indicate that you suffer from more than just scalp itch.

• Intense itching, requiring constant scratching
• White or yellowish scale flakes found on the scalp and shoulders
• Red patches on the scalp (in extreme cases)
• Sore and tingly scalp
• Scaly rash on the scalp

Additionally, you may feel a tightness or dryness of the scalp, leading to further irritation and itching.

Conditions Similar to Dandruff

Aside from seborrheic dermatitis, which is a more severe form of dandruff, other scalp conditions are similar to dandruff. These conditions, however, are not caused by the same mechanisms and, therefore, require different treatments.

One such condition is scalp psoriasis. This is a chronic and immune-related condition that is marked by silver-colored scaling on the scalp and surrounding areas (6).

Unlike dandruff, which is linked to an overgrowth of fungus, psoriasis is caused by a faulty mechanism that enables skin cells to be produced at an accelerated rate.

This leads to rough, thick scales that are dry, itchy, and sometimes painful.

Seborrheic dermatitis is another condition often mistaken for dandruff but it is essentially a severe form of dandruff.

Seborrheic dermatitis can also be found almost anywhere on the body where there is sebaceous glands (face, scalp, upper trunk, external auditory meatus, and anogenital area).

Seborrheic dermatitis is marked by “well-delimited erythematous plaques with greasy-looking, yellowish scales of varying extents. (7)” These can be found anywhere that sebaceous glands are present.

Interestingly, dandruff and seborrheic dermatitis aren’t completely separate conditions. Instead, they exist on opposite ends of the spectrum, with dandruff being a mild presentation and seborrheic dermatitis being a severe one.

Is Dandruff Linked to Hair Loss?

Dandruff is not a direct cause of hair loss. Instead, those who suffer from dandruff may experience hair thinning and excessive shedding due to the constant scratching of the scalp.

This is because frequent rubbing of the scalp can dislodge hair, especially in individuals who are already susceptible to hair fall.

Additionally, as mentioned above, those with a known Malassezia infection are more likely to experience some degree of thinning. This isn’t a direct result of the fungal infection, but instead a side effect.

Common Methods Used for Treating Dandruff

As dandruff is such a common occurrence, there are some treatments that have been scientifically researched over the years. Each of the treatments will vary in effectiveness, and some may also come with less-than-desirable side effects.

Zinc

Zinc pyrithione is a common ingredient in shampoos, and may be a successful treatment method for those with dandruff (8).

Used in a variety of anti-dandruff shampoos, zinc may also be an anti-androgenetic (9). A topical solution of 1% zinc pyrithione was shown to induce hair growth (10).

Even though the results were less than those shown in the Minoxidil group, the hair growth was maintained throughout the 26-week study thanks to continued use of the zinc treatment.

Tar-based Shampoos

While not one of the most popular treatments, mainly due to its odor and mess, there have been studies performed that show that tar-based shampoos are just as effective at treating dandruff as other methods, such as salicylic acid 11, 12).

One study found that more than 70 percent of participants approved of the results they say when treating their dandruff with a coal tar shampoo (13).

Selenium Sulfide

An ingredient found in popular anti-dandruff shampoos, like Head and Shoulders and Selsum Blue, there’s no doubt that selenium sulfide is an effective treatment for dandruff.

However, the ingredient has been linked to hair loss, even going as far as to damage the roots of the hair (14).

For individuals with androgenetic alopecia or other forms of hair loss, then, selenium sulfide is one treatment to be avoided.

Ketoconazole-containing Products

Hair products, such as nizoral shampoo contain the active ingredient ketoconazole.

A proven promoter of hair growth, ketoconazole has also been shown to reduce the levels of Malassezia fungus on the scalp, especially when used in conjunction with zinc pyrithione (15, 16).

Salicylic acid

For more than 2,000 years, salicylic acid has been used to treat a variety of skin disorders (17). These include acne, scarring, and wrinkles, though it’s also been proven effective in the treatment of dandruff. Now it’s also used in shampoos.

How to Prevent Hair Loss Caused by Dandruff

As previously discussed, dandruff is not a direct cause of hair loss. However, the constant scratching and overall inflammation can certainly contribute to thinning.

Let’s look at a few steps to take if you want to prevent hair loss that may occur as a result of dandruff.

1. See a Doctor

To ensure that you’re treating the right problem, it’s important to see a doctor and get a diagnosis before treatment.

As mentioned above, there are many numerous conditions similar in appearance and symptoms to dandruff. These include seborrheic dermatitis and scalp psoriasis.

But as each of the conditions has a different cause, it’s important to know which one if affecting you.

Your physician may diagnose you, or they may refer you to a dermatologist. They’ll perform a physical examination of the scalp, and ask you questions such as when the symptoms first appeared and what methods you have tried to treat it.

Once dandruff has been diagnosed, they can help you to come up with a successful treatment plan.

2. Use Medicated Shampoos

As dandruff is a fungal issue, you’ll likely need to add a medicated shampoo to your hair care routine at least for the present time. This may be one prescribed by your doctor or one that you found over-the-counter.

It’s important to follow your doctor’s instructions or the directions on the package.

During the first few weeks of treatment, you’ll likely need to use this shampoo every time that you wash your hair throughout the week. The number of times will vary based on the doctor’s recommendations and/or the shampoo you’re using.

However, once the dandruff is under better control, you may be able to reduce usage to once per week or even once per month.

3. Moisturize Your Scalp

When it comes to fighting dandruff, there’s no such thing as too much moisture.

Moisturization of the scalp is a process that enables you to add oils back to the environment but, even more importantly, keep them trapped within the skin.

When you suffer from dandruff, and as you introduce medicated shampoos to your routine, the scalp loses its natural oils at an irregularly fast rate. You must moisturize, then, to preserve the equilibrium and ensure a healthy environment in which your hair can grow.

The easiest way to moisturize the scalp is with a carrier oil, such as coconut or jojoba. These can be applied directly to the scalp and left in overnight to absorb.

This is especially important if you use a particularly drying ingredient in the treatment of your dandruff, such as salicylic acid.

4. Avoid Overstyling

Gel, mousse, hairspray, and heat – these are common tools used in the daily hair care routine.

But for someone with an already sensitive scalp, the use of these products can cause further irritation and may even worsen the condition.

Gels, mousses, and hairsprays are very likely to contain alcohols, which are incredibly drying. They may also contain ingredients that clog the hair follicles and sweat glands which can cause further issues.

Heat styling tools – such as curling wands, straightening irons, and blow dryers – can also dry out the scalp. And inadvertent burns, which can sometimes happen when you use a tool that regularly heats to over 300 degrees Fahrenheit, may have a difficult time healing if dandruff is already present.

5. Soak Up Some UV Rays

You’ve heard that unprotected exposure to the sun and its ultraviolet rays can cause premature aging. This is true.

However, a little bit of sun regularly may be just what you need to keep your dandruff under control (18).

You don’t want to expose yourself to the sun for long periods, but a few minutes every day may be enough to benefit your dandruff. Just be sure to apply sunscreen to your face and body, and wear a hat or use an umbrella after your short sun session.

Conclusion

While dandruff is not a direct cause of hair loss, it can negatively impact the lives of those affected and make hair fall more likely to occur. This is due to the actions of said sufferers – namely, scratching – and can lead to the dysplasia of fragile hair.

This is why it’s important to work with a qualified medical professional and consider all of the treatment options available to you.