The exact cause of dandruff, also known as scurf or Pityriasis simplex capillitii is unknown.

So, what are the factors that may contribute to dandruff?

Not enough hair brushing

People who do not comb or brush their hair regularly have a slightly higher risk of having dandruff - this is because they are not aiding the shedding of skin that combing or brushing provides.

Yeast

People who are sensitive to yeast have a slightly higher risk of having dandruff, so it is logical to assume that yeast may play a part. Yeast-sensitive people who get dandruff often find that it gets better during the warmer months and worse during the winter. UVA light from the sun counteracts the yeast. Some say, that during winter the skin is drier because of cold air and overheated rooms (exposure to extreme temperatures), making dandruff more likely. So, it is sometimes not that easy to know whether it is yeast or just dry skin.

Dry skin

People with dry skin tend to get dandruff more often. Winter cold air, combined with overheated rooms is a common cause of itchy, flaking skin. People with dandruff caused by dry skin tend to have small flakes of dandruff; the flakes are not oily.

Seborrheic dermatitis (irritated, oily skin)

People with seborrheic dermatitis are very prone to dandruff. Seborrheic dermatitis affects many areas of the skin, including the backs of the ears, the breastbone, eyebrows, and the sides of the nose, not just the scalp. The patient will have red, greasy skin covered with flaky white or yellow scales.

Certain skin conditions

People with psoriasis, eczema and some other skin disorders tend to get dandruff much more frequently than other people.

Some illnesses

Adults with Parkinson’s disease and some other neurological illnesses are more prone to having dandruff and seborrheic dermatitis. Patients recovering from heart attacks and strokes and some people with weak immune systems may have dandruff more often than other people.

Reaction to hair or skin care products

Some people react to some hair care products with a red, itchy, scaling scalp. Shampooing too often may cause dandruff as it can irritate the scalp.

Malassezia

Malassezia is a fungus that lives on everybody's scalp. Generally, it will cause no problems at all. However, it can grow out of control. It feeds on the oils our hair follicles secrete. When this happens, the scalp can become irritated and produce extra skin cells. These extra skin cells die and falloff; they mix with the oil from the hair and scalp, and turn into what we see as dandruff.

Diet

Some experts say that people who do not consume enough foods that contain zinc, B vitamins, and some types of fats are more prone to dandruff.

Mental stress

Studies have shown that there is link between stress and many skin problems.

HIV

This study found that 10.6% of people with HIV have seborrheic dermatitis.

Diagnosis of dandruff

You do not need a doctor to diagnose dandruff. You can do this yourself. If you see the characteristic white flakes on your scalp, you have dandruff.

If you still want to see a doctor, no special preparations are needed to help the doctor diagnose dandruff. Diagnosis will be confirmed by looking at the scalp and skin. Anybody who has started using some new hair care product may find it useful if they bring the bottles with them.

If your dandruff gets no better after some weeks of self-treatment, you should then consider seeing your doctor, especially if there are red, swollen patches on the scalp.

How can I treat dandruff?

Two factors should be considered when you treat dandruff:

• Your age

• The severity of your dandruff.

Your aim will be to stop the dandruff by slowing down the reproduction of skin cells, or counteract the yeast production that might be the cause.

Shampoos and scalp preparations

Shampoos and products for the scalp are available OTC (over-the-counter, no prescription needed) at most stores and pharmacies. It is important to remember that seborrheic dermatitis can be controlled, but not cured with these products.

Before using an anti-fungal shampoo see if you can remove any scaly or crusty patches on your scalp - do this with care. If you manage to remove them, the shampoo will be more effective.

If you have dandruff on your beard, you can use dandruff shampoo on it.

Most anti-dandruff or anti-fungal shampoos contain at least one of the following active ingredients:

▪ Zinc pyrithione - an ingredient which slows down the production of yeast.

▪ Selenium sulphide - this reduces the production of natural oils your scalp glands produce.

▪ Coal tar - this has a natural anti-fungal agent. If your hair is dyed or treated remember that long-term coal tar usage can stain the hair.

▪ Ketoconazole - a very effective anti-fungal. Most people who use this are pleased with the results. Experts say shampoos with this ingredient can be used with young and elderly people.

▪ Salicylic acids - these help your scalp get rid of skin cells. They do not slowdown the reproduction of skin cells. Many "scalp scrubs" contain salicylic acids. Some people find salicylic acid treatments leave their scalps dry and eventually make the flaking of the skin worse.

▪ Tea-tree oil - A growing number of shampoos now include tea-tree oil as one of its ingredients. It has been used for centuries as an anti-fungal, antibiotic, and an antiseptic. However, some people are allergic to it.

▪ Green Tea potential - Researchers from the Medical College of Georgia, USA, found that green tea may have potential for the treatment of dandruff and psoriasis.

Ideally, select a shampoo that has one of the above ingredients and shampoo your hair with it every day until your dandruff is under control. When that happens, use them less frequently. You may find a particular shampoo stops being so effective after a while, if this occurs switch to one that has another ingredient.

Make sure the shampoo has time to stay on your scalp before you rinse it off - perhaps about five minutes. If you rinse it off too quickly, the ingredient will not have enough time to work.

If after several weeks of treating yourself you still have dandruff, you should consider seeing your doctor or a dermatologist (skin specialist).

What are the possible complications of dandruff?

A person with dandruff or seborrheic dermatitis will hardly ever experience complications. If one were to occur, it would more likely be caused by one of the dandruff treatments. If you find one of your dandruff shampoos or scalp treatments is causing irritation, stop using it and ask your pharmacist to suggest another one.

Bacteria can get in under your skin if there is a break on the skin of the scalp. If this happens, and you feel unwell, or that area of skin is red, tender and swollen, go and see your dermatologist.