How to treat dandruff and an itchy scalp

Your skin reveals a lot about you. It flushes when you’re nervous and breaks out in goosebumps when you’re scared. Every four weeks, it renews itself completely, with old skin cells dying and falling off you on a microscopic scale. It is difficult to say just how much dander this translates into exactly, but estimates say we lose about ten grammes of dander each day. Purely mathematically, this translates to 3,650 grammes of dander a year – or roughly the weight of a newborn.

This is totally normal. But if dandruff suddenly starts raining from your hair in white flakes and your scalp starts to itch, something’s wrong. Oftentimes, the culprit is simply an irritated scalp. However, diseases such as scalp psoriasis can also be behind it. Dr Philipp Schrüfer, dermatologist and plastic surgeon at Skinmed in Lenzburg, explains the causes and treatment of itchy scalp and dandruff.

Itchy scalp – what’s behind it?

An itchy scalp is a sign that your body’s natural production of moisture and fat is out of balance. Frequent hair washing with degreasing shampoos, blow-drying with hot air, air from the heater in winter, fine dust in big cities, the pollen count as well as hormonal changes (e.g. during puberty) all disturb the acid mantle of the scalp. As a result, the skin dries out, tightens, itches and let’s in more pathogens, pollutants and allergens.

Normally, the acid mantle protects and cares for the roughly two square metres of skin you have from head to toe. It has a slightly acidic pH and is composed of amino acids, fatty acids, the serum from the sebaceous glands as well as lactate secreted during sweating. All these acid protection components form the skin barrier that protects against bacteria colonising the skin.

«The most common reason for an itchy head is excessively dry skin,» explains Schrüfer. However, there are a number of other triggers: «In childhood, lice can be behind the itching, as well as various skin diseases such as atopic dermatitis, psoriasis, seborrheic eczema or fungal diseases.»

For example, Pityrosporum ovale yeast can spread particularly well if the acid mantle is disturbed. It’s a natural part of the scalp flora, but can spread faster in favourable conditions and trigger itching and dandruff. «Why there may be a sudden outbreak of this yeast fungus is not definitively clear,» says the dermatologist. «The theory is that the fungus, which is part of the normal flora, can spread too quickly, overgrow on the skin, and its metabolites then irritate the skin.»

Studies speculate that possible triggers include certain allergens, for example the mould Aspergillus fumigatus. However, the authors emphasise the need for more research on the exact causes.

A question of genetics – oily or dry dandruff?

An itchy scalp can not only be very demoralising; it might not be the prettiest to look at either, as it’s often accompanied by skin irritation and dandruff in particular. There are two types of dandruff: oily and dry.

With dry dandruff, the skin lacks sebum or moisture. With oily dandruff, the opposite is true: the scalp produces too much sebum, resulting in thick, greasy dandruff. Whether your skin tends to be too dry or too oily is hereditary. «A distinction is made between atopic and seborrheic dermatitis,» says Dr Schrüfer. «Atopic eczema – or neurodermatitis – is characterised by dry, fine scales. Seborrheic dermatitis, on the other hand, results in a greasy head and face, and therefore oily dandruff.»

Environmental influences reinforce whichever predisposition you have. Dry dandruff is often the result of a stressed scalp due to incorrect care, allergens or excessively dry air from the central heater. Dandruff is white, small and easily tumbles down from your head.

Oily dandruff, on the other hand, is more likely to be the result of hormonal changes or yeast overgrowth. Larger, white-yellowish pieces will detach from the scalp and remain adhered to the hair. Whichever the case, there are certain things you can change in your skincare routine to improve the situation.

Treat dandruff and itching – (home) remedies to help your scalp

The scalp care you should use depends only to a certain extent on whether your skin is too dry or too oily. Dr Schrüfer emphasises that the treatment of oily and dry dandruff differs only minimally. In both cases, you should take care not to further dry out your scalp, instead building up moisture through moisturising agents.

It’s also important to listen to your body’s warning signs and rule out any potential scalp conditions like psoriasis or bacterial infections. «Redness, open wounds on the scalp or hair loss are warning signs of more severe inflammation and should be investigated.»

If neither the itching nor dandruff disappears after four to six weeks of at-home treatment, you should consult a dermatologist, advises Dr Schrüfer.

1. Washing your hair – urea and ketoconazole to combat scalp itchiness and dandruff

You can start off by adapting your hair washing routine. «Washing your hair two to three times a week is perfectly sufficient,» says the dermatologist, adding, «It’s best to use a mild, pH-neutral shampoo without additives.»

When buying shampoo, look out for silicones, too. They’re added to many shampoos to create more shine and softness. But they hinder the skin breathing, says Dr Schrüfer. The result is increased itchiness and dandruff. After washing your hair, you should take care not to blow-dry it using too high heat. Or, better yet, skip the hair dryer entirely for a while.

For oily dandruff, Dr Schrüfer also recommends special anti-dandruff shampoos with the active ingredient ketoconazole, a drug for the prevention and treatment of fungal diseases of the skin.

Another ingredient that works for both dry and oily dandruff is urea. «Uric acid binds water to the skin, builds moisture and helps loosen the dandruff from the scalp,» says Dr Schrüfer.

2. Hair lotion and tonic – soothing and moisturising

Urea is available as a shampoo, but also as a lotion. You can use lotions and soothing tonics in addition to shampoo to help your scalp. It’s important to rely on lipid-replenishing scalp care, emphasises Dr Schrüfer: «Stay away from alcohol-based lotions, because alcohol additionally dries out the scalp.»

Tonics developed specifically for dry, itchy scalps are available without a prescription. The fact that they don’t have to be rinsed out of the hair will save you an additional hair wash – a good thing if your scalp is irritated.

3. Conditioners with herbal extracts against itchiness

For your hair conditioner, you can harness the power of nature. Studies have shown that thyme essential oil has an antifungal, antibacterial effect and is therefore particularly suitable for oily dandruff. But thyme can also help with atopic, dry skin. Similar positive effects on dandruff and skin health have been noted with nettle extract and other essential oils such as tea tree, rosemary and eucalyptus.

No matter which herb you choose, pour boiling water over a handful of dried leaves and let everything steep for 15 minutes. Wait until the liquid has cooled down, and rinse your hair with it after washing. Apple cider vinegar is also antibacterial and antifungal, but only when undiluted – so showed a study, though its authors emphasise the need for further research.

4. Oil masks against scalp itchiness

Another home remedy to fight dandruff and stop itchiness is oil. It soothes the scalp, frees dandruff and relieves itchiness in a gentle and natural way. Olive oil, sesame oil, sunflower oil and jojoba oil are especially suitable – ideally, unadulterated and organic to avoid pesticide residues. Spread a few drops of the oil on your head, massage it into your scalp and leave it in overnight.

Because of its antifungal properties, coconut oil is also said to help, especially in the case of oily dandruff. A recent study demonstrated this effect, especially against Malassezia globosa yeast, with a positive effect found on general scalp health.

«While oil can be helpful to soothe the scalp and especially to loosen dandruff, oil is not lipid-replenishing,» warns Dr Schrüfer, and continues, «You’ll also have to wash your hair more often, which is actually counterproductive against dandruff.»

5. Sea salt against dandruff and itchiness

Finally, a change of scenery – to the sea – can also work wonders for dandruff and an itchy scalp. Not only salt water can promote skin health and help to rebalance the acid mantle, even the sea air can, too. It’s not without reason that the Dead Sea in Israel (with a salt content of over 30 per cent) is the global heartland for sufferers of skin conditions. In one study, six weeks of bathing in a Dead Sea salt solution was shown to improve skin – a result attributed mainly to the solution’s high magnesium content.

If you don’t have a seaside vacation planned, you can bring the sea to your home: mix three tablespoons of coarse sea salt with two tablespoons of olive oil and massage the mixture into your hair. After five minutes, wash your hair as usual. Alternatively, you can order Dead Sea bath salts here:

Bath salts + Bubble baths

Bonneville Dead Sea Bath Salts

Bath salts

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Bath salts + Bubble baths

Bonneville Dead Sea Bath Salts

Bath salts

19