Standing in the shampoo aisle staring at the many many brands of dandruff shampoo should make you realize one thing: you are not alone in your struggle with dandruff. Some estimates have it affecting half of all adults. You might ask then, If it affects so many people, can it be a reason to go see a doctor? Yes, in fact, it can. That’s because dry, itchy flakes on your scalp can be caused by a few different things, some more serious than others. And frankly, sometimes those shampoos just won’t cut it.

What is dandruff?

Dandruff is the condition of having white or gray flakes in varying amounts in your hair–sometimes those flakes fall to your shoulders. In mild cases, this may simply be caused by the natural exfoliation of skin on your scalp or dry skin.

Dandruff can also be caused by contact dermatitis, an allergic reaction or sensitivity to hair products like shampoos, gels, mousses, or hairsprays. If you have a sudden onset of red, itchy, flaky skin on your scalp, take note of any new products you have started using and try cutting them out to see if your symptoms clear up.

Dandruff is in some cases thought to be caused by a yeast-like fungus called malassezia, found to some degree on most people’s scalps. For unknown reasons, in some it irritates the scalp, causing an increase in the growth of skin cells. Malassezia is targeted by the anti-dandruff chemical zinc pyrithione, found in some dandruff shampoos.

This 2018 study explains in depth how this chemical acts on malassezia by inhibiting cellular function and enzyme production. Increasingly, scientists are also making the connection between dandruff and disruption to the scalp microbiome.

A rashy scalp with flakes that appear to be more greasy and yellow in color may be a sign of a condition called seborrheic dermatitis. In infants this is called cradle cap. According to the American Academy of Dermatology, patches form in places the skin is oily, like the scalp, but also eyebrows, eyelids, armpits, and around the ears. It is associated with stress, an overgrowth of yeast, and a genetic predisposition.


Most cases of dandruff can be treated at home. Sometimes the only thing that is needed is a more regular regimen of hair washing, conditioning, and combing to remove the flakes. Dandruff shampoos are also recommended and contain a variety of active ingredients, including:

  • Zinc pyrithione
  • Salicylic acid
  • Ketoconazole
  • Selenium sulphide
  • Coal tar

It is not uncommon for people to alternate between different shampoos as one loses effectiveness. Make sure to follow the instructions on the bottle as some recommend leaving the product on the scalp longer than others. Shampoos with coal tar may cause discoloration if you have blond or white hair.

When to see a doctor

If you have tried dandruff shampoos for at least a month and your flakes persist, it is a good idea to see a doctor. There are other skin conditions that can also cause an itchy, flaky scalp, including ringworm (tinea capitis), eczema, and psoriasis, which are different than dandruff and should be diagnosed by a doctor.

Certain medications can also cause dandruff, as can neurological conditions like Parkinson disease, and a compromised immune system. You should also consult a doctor for particularly severe cases of dandruff, or the presence of redness and swelling. Depending on your diagnosis, treatment may include prescription dandruff shampoo, topical creams, steroids, or other medications.

If you are concerned about an itchy, flaky scalp or any other medical condition, contact our office and schedule an appointment today. You don’t have to suffer, and you certainly don’t have to go it alone.