Flaky scalp Dr Rob Hicks Dandruff is the most common cause of a flaky scalp, but it's not the only one.

In this article

What causes it? What's the treatment

How can it be prevented? When should I see my GP?

Every day we lose dead skin cells from our scalps. When more are lost than normal, they clump together forming the white or grey flakes called dandruff.

Dandruff can form when the scalp is too dry or too oily. A fungus called pityrosporum ovale, which lives naturally on the scalp, has been implicated in the development of dandruff. Excess production of sebum, the natural oil secreted from glands in the skin, fuels the growth of this fungus. This helps to explain why dandruff often starts in puberty when hormone changes occur and why people with oily scalps suffer more.

Dandruff is believed to run in families. Diets that are too salty, spicy or sugary and accompanied by too much alcohol make it worse, as can stress and changes in climate.

Nutritional deficiencies, such as a lack of essential fatty acids or vitamin B, may cause dandruff.

Seborrhoeic eczema causes itchy and flaky patches on the scalp. This tends to be more severe than simple dandruff because the skin and glands become inflamed. The flakes are often greasier and more yellow in colour and can also affect the eyebrows, ears, face and upper body.

Anti-dandruff shampoos are the mainstay of treatment for simple dandruff. It's usually trial and error finding the one that works for you.

For more stubborn dandruff or seborrhoeic eczema, selenium, zinc, coal tar in coconut oil or salicylic acid can be successful. Scalp preparations contain various combinations of these. Be careful when using tar, however, as it can discolour fair hair and bed linen.

Antifungal shampoos containing ketoconazole work well for dandruff and seborrhoeic eczema. They need to be used a few times a week. Be patient: they can take up to six weeks to work.

All these treatments are available from the pharmacist without a prescription.

When shampooing, massage your scalp and don't scratch it. Rinse your hair well, ideally twice with every shampoo. The scalp is very sensitive, so take care with hair products that can dry and irritate it.

Alternate your usual shampoo with a dandruff shampoo. If you find the flakes make an unwelcome return, don't panic. This often happens, just switch to a new shampoo.

Make sure your diet contains enough vitamins E, B6 and B12, selenium and zinc. Flaxseed oil is also said to help prevent dandruff and can be taken in liquid or capsule form.

It's a myth that dandruff is:

• Infectious
• Makes you go bald sooner
• Only affects dark-haired people
• Means you don't wash your hair enough

If your scalp isn't getting better with these treatments, or if it's red, inflamed or painful, a different treatment may be needed.

Steroid lotion or mousse is used for severe seborrhoeic eczema. It's also used to treat psoriasis, which not only affects the elbows and knees, but also the scalp.

Psoriasis occurs when new skin cells are made too quickly. The build up of these cells creates red areas covered with thick, scaly, silvery-looking patches, which can be very uncomfortable and itchy.

This article was last medically reviewed by Dr Rob Hicks in April 2008