Is It Dandruff or Dry Scalp?

dandruff or dry scalp

Story at-a-glance -

  • By the age of 20, nearly 50 percent of the world has had one bout of dandruff and nearly 20 percent of Americans will suffer from the condition; however, not all flaking scalp skin is the result of dandruff
  • Flaking dead skin cells from dandruff results from a fungal infection producing oleic acid, which in turn increases the rate of skin shedding from your scalp
  • Simple dietary changes such as reducing carbohydrates and increasing healthy fat have a significant impact on treatment of flaking skin, whether from dry skin or reducing the effects of a fungal infection
  • Natural remedies for dandruff that are healthier for you and the environment include patchouli oil, tea tree oil, coconut oil, apple cider vinegar and garlic

By Dr. Mercola

By age 20, nearly 50 percent of the worldwide population, and 20 percent of Americans, will have suffered from dandruff.1 While a small amount of flaking on your scalp is normal, some people experience an unusually large amount, either chronically or as the result of specific triggers. If you have experienced problems with flaking scalp, then you're likely familiar with the embarrassment it brings.

Flecks of dead skin on your shoulders, in dark hair and on your clothes may result from giving in to an uncontrollable urge to scratch an itchy scalp or from flaking occurring with brushing and combing. However, some scalp flaking is merely the result of a dry scalp. By understanding the difference between dandruff, seborrheic dermatitis and dry scalp, you can choose the right strategy to reduce or eliminate your symptoms.

What Causes Those White Flakes?

Dandruff is a common term used for those pesky white flakes deposited on your clothing from your scalp. However, there are several different ways your scalp may become irritated and begin to shed dead skin cells. Dry skin is one common cause. In this case, you likely notice dry skin on other areas of your body as well, often on your trunk and extremities. When skin flakes are the result of dry skin, the flakes are often smaller and less oily than those from other causes.2

Dry skin is frequently a sign of a deficiency in animal-based omega-3 fat. This is easily treated from the inside out by eating small fatty fish such as sardines, anchovies or wild-caught Alaskan salmon. These fish have lower amounts of pollution and are a healthy source of the omega-3 fats DHA and EPA. Another option is a high-quality supplement such as krill oil sustainably sourced from the Antarctic.

Omega-3 fat helps normalize your skin fats and prevent dehydration in your skin cells. Keeping your skin cells moist and strong will decrease flakiness. Omega-3 fat also has an anti-inflammatory effect, which may help soothe irritated skin, including on your scalp.

A second cause for dandruff flakes is a fungal infection from Malassezia fungus.3 Many have this fungus living on their heads without problems, but external factors may cause the oils metabolized by the fungus to create a byproduct of oleic acid. The acid penetrates your skin and triggers skin cell shedding. A recent study has linked the presence of Staphylococcus bacteria with Malassezia fungus with an increased severity of dandruff and scalp irritation.4

The study also found a higher number of Propionibacterium could help suppress the effects of the fungal growth, suggesting future treatments for subduing the effects of dandruff may lie in reducing the growth of Staphylococcus and encouraging colonies of Propionibacterium.

Seborrheic Dermatitis May Increase Scalp Flakes

Although symptoms are slightly different, seborrheic dermatitis can produce white skin flakes common to dry skin and dandruff. The cause of the condition is poorly understood, but has been associated with areas of the skin producing large amounts of sebum.5 Many sufferers appear to have an abundant growth of the same fungus associated with dandruff, Malassezia. The condition is characterized by the appearance of scaly patches, red skin and stubborn dandruff.6

Sometimes called seborrheic eczema or seborrheic psoriasis,7 seborrheic dermatitis may be the single most common inflammatory skin condition affecting humans, aside from acne.8 The condition affects people of any age and ethnicity9 but certain risk factors increase your potential for suffering from the condition. Stress, fatigue, pollution, obesity and other medical conditions such as Parkinson's disease or stroke increase your risk.10

Although the condition is sometimes confused with psoriasis, there are differences between them. If you suffer from seborrheic dermatitis affected areas will appear yellow and greasy. Symptoms are sometimes triggered by external factors, such as changes in the weather, your hormone levels or in personal care products you use, such as soaps, detergents and shampoos.11

Personal Habits May Increase Your Risk of Dandruff

A couple of personal habits are known to increase your risk of a dry scalp and of irritating your skin. Many scalp problems may be resolved by reducing the number of times you shampoo. The function of a shampoo is to remove excess oil and product buildup.

However, a simple rinse with water will remove most of these and the excess can be washed away with shampoo every second or third day. More frequent shampooing increases your risk of drying out your hair and scalp by stripping away oils your body uses to nourish your hair and keep it strong.12

Conditioning your hair and scalp is another way to help protect and prevent dry skin. Consider making a simple conditioner at home using combinations of mayonnaise, egg whites, avocado and apple cider vinegar. While over-the-counter products advertise they add vitamins and nutrients back into your hair shaft, natural ingredients do a better job without the chemicals.

Ignoring obvious signs of a dry scalp, dandruff or seborrheic dermatitis may only make the problem worse. Don't let dry flaky skin persist — below I’ll provide natural strategies to address the problem.

Dandruff Products Going Chic

Many manufacturers are jumping at the chance to produce high-end shampoo and conditioner products to treat scalp problems as consumers have a rising interest in using natural and organic goods. In some cases, the word “scalp” appears on the bottle instead of “dandruff” in order to create a more chic appearance and address the issue surreptitiously.13

However, while many of these products contain some natural and organic ingredients, they often use active ingredients found in most drugstore brands, including salicylic acid, pyrithione zinc or coal tar. These active ingredients are then mixed with natural oils and conditioners and sold in fashionable department stores and boutiques, often starting at about $20 per bottle.14

Formulas may contain a combination of natural oils, such as ginger, rosemary, eucalyptus or tea tree oil in order to make the treatment feel more like a spa treatment. While this feels indulgent, and definitely cost more than what you can purchase at the drugstore, the product may also contain chemicals that are dangerous to your health and to the environment.

Your Exposure to Toxins Increases With Each Shampoo

Although you might be tempted to reach for a medicated shampoo if you suffer from dandruff, the popular chemicals used to control your condition is not a cure. Once you stop using shampoo, the dandruff is likely to return, which is why many end up using it at least a few times a week to stay dandruff-free.

Some shampoos contain ketoconazole, an antifungal, which often irritates your skin if you use it more than once a week. One study found shampoos containing ketoconazole leave your hair harder to control and frizzier than shampoos containing pyrithione zinc.15 Coal tar is another common ingredient and works by slowing the growth of skin cells on your scalp.

You may suffer less flaking, but coal tar is a known carcinogen and likely something you don't want to rub onto your skin, as your skin is highly permeable, allowing direct access for toxins into your bloodstream.16

In 1985, a study of those working with coal tar for 40 years found nearly half had developed skin cancer. However, the American Academy of Dermatology has suggested there is no cancer danger using coal tar to treat skin.17 Despite the U.S. Food and Drug Administration’s insistence coal tar used over-the-counter is safe, the European Commission’s Scientific Committee on Cosmetic Products and Non-Food Products Intended for Consumers stated:18

“Refined coal tar by bi-distillation present at a maximum concentration of 5 percent in rinse-off products cannot be used safely as it contains polycyclic aromatic hydrocarbons which are genotoxic carcinogens and it may represent an unacceptable high risk of skin cancer.”

Even common over-the-counter commercial shampoos expose you to a greater number of chemicals with every wash. Several years ago it was learned Johnson & Johnson's Baby Shampoo contained chemicals such as formaldehyde and 1,4-dioxane.19 In response to consumer outcry, Johnson & Johnson agreed to remove some of these toxins from their products as of 2015. However, many questionable chemicals still remain in popular shampoos.

Some of these chemicals include endocrine disruptors, chemicals known to interfere with development and reproduction, and cause serious neurological and immunological system effects. These include sodium lauryl sulfate, phthalates, methylisothiazolinone and parabens.

In one study it was suggested parabens from antiperspirants and other cosmetics appear to increase your risk of breast cancer.20 The researchers identified where breast tumors were appearing and determined higher concentrations of parabens were found in the upper quadrants of breast and axillary areas where antiperspirants were usually applied.

Medicated Shampoos Flush More Toxins Down the Drain

Researchers have also detected fungicides used in dandruff shampoos in water already processed through wastewater treatment plants.21 These fungicides are still bioactive and may be killing algae, harming growth of larger plants, and impacting fish and other marine life. The researchers concluded:22  

“Emerging pollutants such as personal care products can reach the environment via effluents from wastewater treatment plants (WWTPs) and digested sludge. Only recently, the antidandruff agent and antimycotic climbazole was detected for the first time in a WWTP effluent with concentrations up to 0.5 µg/L.”

The risk of fungicides persisting in waterways have an immense impact on the environment. Unless these chemicals are removed from personal care products, it is clear more effective wastewater treatment is necessary. Supporting this assertion is a report by the International Joint Commission,23 in which 10 years of data showed many of the 42 compounds analyzed were not being effectively removed.

The authors expressed concern about the effect even low levels of contaminants would have on the environment and human health long-term. EcoWatch warns there are at least five toxic ingredients you want to avoid when picking out a shampoo or conditioner. Unfortunately many of these chemicals are found in most over-the-counter shampoos. The toxic ingredients include sulfates, parabens, fragrance, triclosan and polyethylene glycol.24

Address the Underlying Causes of Dandruff

Effective treatment for your dandruff or dry scalp necessitates addressing the underlying causes and not just the symptoms. As discussed previously, one of the best ways to address dry skin, be it your body or scalp, is to increase your intake of animal-based omega-3 fat. However, dandruff is caused by a yeast infection, thus one of the best way is to solve this problem is to cut down on the nutrient intake required by the fungus, namely sugars and carbohydrates.

As you reduce your carbohydrate and sugar intake, increase the amount of healthy fat in your diet. Since your body has the metabolic flexibility to burn both fat and carbohydrates for fuel, using a cyclical ketogenic diet may help reduce inflammation in your body, support healing in your scalp and skin and support optimal health and longevity. You can read more about the process and why it is critical to your overall health in my previous article, “Health-Conscious Public Increasingly Embraces Ketogenic Diet.”

It will be important to switch to a low carbohydrate and no- or low-grain diet to fight the underlying cause of dandruff. This strategy helps to address the nutrient intake of the yeast. Your flaking scalp may also be the result of sensitivity to hair products. This can lead to contact dermatitis and red, itchy and scaly scalp.

Chemicals found in permanent hair dyes may also result in this condition. Even if you haven’t had a reaction to the shampoo you're using, you may be shampooing your hair too often, irritating your scalp and increasing the potential for a yeast infection. Using too many styling products can cause a similar issue and these products can build up on your scalp, making it more prone to flaking.

Natural Remedies Are Healthier for You and the Environment

Creating your own dandruff shampoo at home has a number of benefits, as your version will not contain toxic chemicals or pollute the environment. Homemade products are also typically far more economical. Salicylic acid is what is used in many dandruff shampoos to loosen flakes and make them easier to wash away in the shower. Aspirin tablets are salicylic acid. Try crushing two tablets and mixing with your regular shampoo in the palm of your hand just before washing your hair.

Let the mixture sit on your head for one or two minutes before rinsing and repeating with regular shampoo.25 However, using medicated shampoos are far from your only option. Dandruff may be naturally resolved using the simple home remedies you find in my previous article, “Home Remedies for Dandruff.” You likely have some of the ingredients at home, such as coconut oil, tea tree oil, lemon and garlic, along with sun exposure.

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