Dandruff and Scalp Concerns

Dandruff and scalp problems are extremely common, with nearly half of the world’s population affected. While dry, itchy or inflamed skin conditions can vary in their severity and duration, herbal and natural remedies may help to nourish and relieve the scalp and promote healing.

What are the symptoms of scalp problems?

The symptoms of scalp conditions depend on the cause – with the most readily identifiable symptoms linked to dandruff and seborrheic dermatitis. Second to these, psoriasis of the scalp is also relatively common, with its own set of uniquely identifiable symptoms.

What is the difference between dandruff and seborrheic dermatitis?

Dandruff and seborrheic dermatitis are often considered to be the same condition, but at opposing ends of severity. Either scalp condition is commonly characterised by a scaling (known as hyperkeratosis) where the outermost layer of skin (known as the stratum corneum) clumps together. People reporting dandruff often actually have seborrhoeic dermatitis, but other skin conditions such as psoriasis or eczema can also be mistaken for dandruff.

Dandruff and seborrheic dermatitis are rare between infancy and puberty, but are prominent in infants up to three months as well as in adults.

What are the symptoms of dandruff?

Dandruff (also known as pityriasis capitis) is the most common and mildest form of seborrheic dermatitis. It is characterised by a series of common symptoms, including:

  • Excess flaking of fine, white or grey scales isolated to the scalp
  • Scaling of dandruff (where the outermost layer of the skin clumps together) producing large clumps of dry scales that form in several isolated, roundish patches. Loose skin cells eventually fall out, shedding small flakes
  • Dandruff scaling often leads to itchy scalp (known as pruritus), skin irritation, and a tight or dry feeling of the scalp.

What are the symptoms of seborrheic dermatitis?

Seborrheic dermatitis is a more severe form of skin condition. It is similar to and sometimes occurs in patients with eczema. Scaling of the skin is typically marked by greasy, yellowish scales that form around the scalp, face, nasal folds and eyebrows, and can extend to the ear canal, armpits, upper chest, pubic area and groin region. The scaling may be contained in patches, or spread across the surface of the scalp and skin.

Similar to dandruff, seborrheic dermatitis can lead to irritation, a feeling of tightening caused by dryness, and inflammation.

Cradle cap is a form of seborrheic dermatitis that typically occurs in infants in the second to tenth week of life, peaking at three months of age. It appears as thick, greasy scales on the vertex (centre) of the scalp. Scales typically appear as large white, off-white or yellow flakes.

What are the symptoms of psoriasis?

Psoriasis is a chronic inflammatory condition that affects 2% of the population worldwide, with roughly half of all cases involving the scalp.

On the scalp, psoriasis of the scalp typically presents itself as clearly defined scalp plaques, which look like raised, red patches covered with a silvery white build up of dead skin cells. Itchy scalp and burning may typically follow the appearance of lesions.

What causes dandruff and scalp problems?

The scalp protects the head through its dense follicular structure and high rate of sebum production (which is responsible for its natural oiliness). These characteristics also create an ideal environment for microorganisms to flourish, making the scalp prone to surface-level fungal infections, parasite infestation and inflammatory skin conditions.

While the causes of dandruff and seborrheic dermatitis are not completely understood, the various forms of seborrheic dermatitis can be linked to several causal factors, including changes in hormone levels, fungal infections, nutritional deficiencies and issues related to the nervous system.

Scalp conditions such as psoriasis may also be exacerbated by friction and injury. Heated styling elements such as blow dryers and hair straighteners in particular can irritate and aggravate the scalp.

Fungal infection

Dandruff and seborrheic dermatitis have been linked to a type of fungal infection from the Malassezia species, a species of yeast that feed off lipids (fatty acids) found in sebum.

Malassezia settle in those areas of the body that are high in sebaceous glands where they metabolise neutral fats, producing oleic acid. In turn, the oleic acid can penetrate the outer layer of the skin and disrupt its normal barrier functions, ultimately triggering an inflammatory response that causes skin cells to split and flake.

Allergy

Dandruff and seborrheic dermatitis are known to flare up in response to allergies. There may also be links to the change of seasons, as it sometimes worsens in winter.

Genetic conditions

Scalp conditions such as psoriasis are known to have some genetic link. A genetic predisposition to psoriasis or a link to family members with the condition may play a part in its occurrence.

In traditional Chinese medicine (TCM), symptoms of dandruff and seborrheic dermatitis, including dry, itchy skin and inflammation, are often associated with an energetic imbalance in which there is excess Dampness in the body, often followed by excess Wind and/or Heat.

Scalp problems that are caused by Damp-Heat commonly exhibit redness, inflammation and swelling (such as seborrheic dermatitis and dandruff), while scalp problems involving Damp-Wind tend to be itchy and irritable (such as psoriasis).

Natural therapies for dandruff and scalp problems

The impact of dandruff is purely cosmetic in nature; dandruff is not harmful or contagious and if left untreated does not lead to more serious conditions. Seborrheic dermatitis, on the other hand, can be more difficult to treat. Several treatment options may help the scalp to soothe and heal and alleviate symptoms of both conditions.

Traditional Chinese herbs for scalp conditions

In traditional Chinese medicine (TCM), the internal treatment of dandruff and scalp conditions often involves the use of herbs with cooling properties that dispel excess Wind and Dampness, such as Fang Feng, Dong Quai, White Peony and Fallopia Multiflora.

  • Fang Feng (also known as Wind Protector) and Tribulus are used to relieve excess Damp-Heat, itching and pain
  • Dong Quai and White Peony are employed to strengthen, cleanse and invigorate the blood, which in turn nourishes the skin
  • Fallopia Multiflora (Phytofol®) works to tonify and nourish the (Liver and Kidney) blood and replenish Liver and Kidney energy to revitalise the scalp.

Burdock, traditionally regarded to improve skin conditions by supporting detoxification, purifying the blood purifier and aiding metabolic waste elimination, is also used to cool and dispel excess Heat.

Zinc assists dandruff and scalp problems

Zinc may assist in the management of mild-to-moderate dermatitis, and the alleviation of minor wounds often attributed to dermatitis - such as scratching and abrasions. Zinc and vitamin C contribute to the healthy functioning of the immune system, and in assisting the body to maintain and repair healthy skin cells and fight infection.

Natural antiseptics Aloe Vera and Echinacea calm itchy skin

Topical applications of natural antiseptics such as aloe vera, tea tree oil and golden seal have been traditionally used to soothe and calm itchy and inflammatory skin conditions such as dermatitis. Echinacea may also enhance the resistance of the body to infection, promoting the healing of wounds and new tissue formation.

Diet and lifestyle tips to improve dandruff and scalp problems

Dandruff and scalp conditions may also be attributable to diet and nutritional deficiencies, but as yet there is no clear link. In managing seborrheic dermatitis, there are several things you can do to reduce inflammation, relieve itching and the negative effects of scaling, including:

  • Try not to scratch – while this can be extremely difficult, dandruff and scalp psoriasis may be made worse by rubbing and scratching. Ensure you shampoo gently and apply shampoo treatments with care
  • Avoid irritating the skin – similar to the above, picking at dandruff and psoriasis scales may cause them to flare up. Remove scales gently to avoid scalp irritation
  • Stress – stress is believed to contribute to the severity of dermatitis symptoms. From regular exercise to meditation and relaxation techniques, there are many ways to reduce stress and increase wellbeing
  • Diet – eating an anti-inflammatory diet and reducing your intake of fatty red meats, dairy products, processed foods and refined sugars, may help to relieve inflamed skin exhibited by psoriasis.

When should you see your doctor or health professional about dandruff and scalp problems?

  • In some instances, severe cases of psoriasis can lead to a form of hair loss called telogen effluvium or pattern hair loss.  Any sudden or unusual hair loss should be investigated by your healthcare professional in order to rule out underlying disease or problems with your prescribed medicines
  • Some prescribed medicines may increase the tendency for dandruff to develop. Talk to your doctor or pharmacist if you are concerned you may be affected.

For more information treating dandruff and scalp problems, visit our hair health concerns page.