Few things are as universally frustrating as dandruff, the white flakes that refuse to leave your shoulders alone. For some, it's an occasional annoyance. For others, it's a chronic battle that no "anti-dandruff" shampoo seems to win. But dermatologists now agree that dandruff is not just about dryness or hygiene. It's a medical condition with multiple causes. Known clinically as seborrheic dermatitis (in more severe cases) or pityriasis capitis, dandruff affects up to 50% of the global adult population, according to research published in the Journal of Clinical and Investigative Dermatology (2019).
In India, where humidity, air pollution, and frequent hair oiling are common, dermatologists report that dandruff tends to flare up seasonally, particularly during winter and post-monsoon months.
Understanding dandruff means knowing how your scalp works, and why sometimes, it overreacts. Here's the science behind scalp flakes, why anti-dandruff shampoos don't always deliver, and what dermatologists say actually works to restore scalp health and confidence.
Dandruff is not about "dirty hair"
Despite popular belief, dandruff has little to do with hygiene. It stems from an overgrowth of a yeast-like fungus called Malassezia globosa, which feeds on scalp oils (sebum). As it breaks down these oils, it produces oleic acid, which irritates some people's scalps, leading to flaking, redness, and itching. (NIH)
"The key trigger is scalp sensitivity, not uncleanliness," says a 2023 Indian Journal of Dermatology review. "Over-washing or under-washing can both make it worse. The goal is balance - keeping the scalp clean, but not stripped of its natural oils."
Stress, hormones, and weather all play a role
Why does dandruff appear out of nowhere? Stress and hormonal changes increase sebum production, creating a favourable environment for Malassezia. That's why dandruff often peaks during teenage years and young adulthood, when oil glands are most active.
Cold, dry weather worsens flaking by dehydrating the scalp, while heat and humidity boost oil secretion, worsening fungal growth. Studies show that people living in tropical or urban environments (like India) are more prone to persistent dandruff due to humidity, air pollution, and frequent sweating.
The oil paradox: Why "nourishing" oils can make it worse
Hair oiling, a deeply rooted Indian tradition, can sometimes backfire. "When you apply heavy oils like coconut or mustard oil to a dandruff-prone scalp, you're feeding the yeast," says dermatologists from AIIMS in an IADVL consensus statement (2021). "This can lead to more inflammation, itching, and scaling."
Instead, use lightweight, medicated formulations or antifungal scalp serums prescribed by dermatologists. Avoid leaving oil overnight if you have dandruff, as it traps heat and moisture, encouraging fungal growth.
Medical treatments that actually work
Dermatologists recommend antifungal shampoos containing ketoconazole, zinc pyrithione, selenium sulfide, or ciclopirox olamine, which are proven to reduce Malassezia populations.
A 2022 review in the Journal of Cosmetic Dermatology found that rotating between two active ingredients prevents resistance and helps maintain long-term results.
Other proven ingredients include:
- Salicylic acid or coal tar: Exfoliate dead cells and reduce scaling.
- Tea tree oil (5%): Natural antifungal properties, though it may cause irritation in sensitive scalps.
- Topical corticosteroids: Used briefly for severe seborrheic dermatitis under medical supervision.
Consistency is crucial. Most antifungal shampoos need at least 4-6 weeks of regular use (2-3 times weekly) before improvement.
Your diet and stress levels matter
Emerging research links dandruff to internal inflammation and gut microbiome imbalance. A 2020 Frontiers in Microbiology study found that people with chronic dandruff often have lower bacterial diversity in their gut and higher systemic inflammation markers.
Dermatologists now recommend a balanced diet rich in zinc, B vitamins, omega-3 fatty acids, and antioxidants to support scalp health. Avoiding excessive sugar, processed foods, and alcohol can reduce oil production and oxidative stress.
Managing stress through exercise, meditation, or adequate sleep also helps. Chronic stress not only increases cortisol (which triggers oil secretion) but also suppresses immune function, giving Malassezia an upper hand.
When dandruff may signal something more
If you have redness extending beyond the scalp, on your eyebrows, behind the ears, or on the chest, it might be seborrheic dermatitis, a more severe inflammatory form of dandruff. Persistent itching with thick crusts could also indicate psoriasis or eczema. In such cases, over-the-counter shampoos won't help as a dermatologist's evaluation is essential.
Dandruff may not be dangerous, but it's more than a cosmetic nuisance. It's your scalp's way of saying something's off. Whether triggered by fungal imbalance, stress, hormones, or lifestyle, it's manageable with science-backed care and consistency.
Skip the random home remedies, stop over-oiling, and reach for evidence-based treatments. As dermatologists remind us, healthy hair begins with a healthy scalp, and that means listening to what those flakes are trying to tell you.
Disclaimer: This content including advice provides generic information only. It is in no way a substitute for a qualified medical opinion. Always consult a specialist or your own doctor for more information. NDTV does not claim responsibility for this information.
