A few unsightly white flakes may be nothing more than harmless dandruff.
Dandruff is the most common scalp condition, affecting 50 per cent of the population at some point in their lives.
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But if you’re seeing inflammation, blood, or colour in your flakes, it may be a more severe scalp condition that can at worse lead to hair loss and at best, leave you self-conscious.
What’s more, it’s easy to provide the ideal breeding grounds for these scalp issues – are you guilty of going to bed with damp hair or using dry shampoo more frequently than you’re meant to?
To understand the differences between dandruff and the more severe scalp conditions, we spoke to the experts…
Dandruff and the clear signs of it
We’ve all seen those famous adverts and are aware that white or grey flakes on the scalp, in the hair or on the shoulders are the telling sign of dandruff.
The cause has nothing to do with poor hygiene, but stress, hormonal changes, diet and even weather can all play a role.
Trichologist (aka a hair and scalp specialist) Annabel Kingsley says: “It’s commonly thought of as a dry skin problem, but dandruff is more often associated with oily skin.”
The excess oil and a combination of yeasts called Malassezia, which live harmlessly on our skin, multiply, causing accelerated skin cell turnover, which appears as these flakes on the scalp, Annabel explained.
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How to treat dandruff
“Wash your hair frequently! Every other day is a good balance,” says consultant trichologist Eva Proudman.
“With dandruff, the oil and yeast on the scalp are all the time building up and if you’re only washing once or twice a week it will just continue to build up.”
The trichologists agreed that a shampoo containing piroctone olamine, an anti-microbial ingredient, is highly effective in treating dandruff.
You’ll find plenty of affordable finds on the high street like Head and Shoulders Bare Pure Clean Anti-Dandruff Shampoo (£9.99, Boots), Neutrogena T/Gel Anti-Dandruff Shampoo for oily scalps (£6.10, www.lookfantastic.com).
And for a more luxe formulation, you can try Philip Kingsley Flaky/Itchy Scalps Shampoo (£27, Sephora).
When to see a GP
It may be time to head to your GP, dermatologist or trichologist for help if your scalp is:
- Itchy
- Red
- Swollen or sore
- You have bumps that bleed, weep or crust, or they look yellow, silver or red
Annabel says: “If the condition of your scalp hasn’t improved after a month of using an anti-dandruff shampoo or is accompanied by tightly-packed scales with underlying redness or bleeding you should consult your GP or see a trichologist.”
When dandruff is a sign of something else
Your GP or trichologist will need to see your scalp in person, as many of the most common scalp problems and conditions have similar or identical symptoms.
Let’s break down the most common scalp conditions seen in clinics so you know what to look out for…
1. Seborrheic dermatitis
What does it look like?
Ranges from flaky white or yellow sticky crusts to red, weeping patches.
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What causes it?
Seborrheic dermatitis is a relapsing inflammatory or chronic scalp condition that can be very itchy.
In its more severe form, it can also affect other body parts like the eyebrows, nasal folds and top lip.
“It’s not contagious. You cannot catch it from another person,” advises Eva.
“It’s the result of environmental and genetic factors.”
Like dandruff, stress, hormonal changes and weather can all cause the Malassezia to overgrow leading to this fungal infection she told us.
Yet, some medications and medical conditions like HIV or Parkinson’s disease can also be triggers.
It could also be down to your family’s genes.
2. Scalp psoriasis
What does it look like?
Thick, dry, rough silvery scales, accompanied by redness and inflammation.
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What causes it?
Often found at the nape, around the hairline and behind the ears. It can be very itchy, tight, and uncomfortable, and picking and scratching leads to bleeding.
“Scalp psoriasis is an autoimmune condition where the skin reproduces five times faster than it should, causing a build-up of skin cells called psoriatic plague,” explains Eva.
Scientists have found that psoriasis runs in families, so if a member of your family has it, you have a higher chance of getting it too.
Triggers vary from person to person but include stress, infections, weather, and lifestyle choices, to name a few.
3. Folliculitis
What does it look like?
From small red bumps that look like acne to yellow/brown weeping sores.
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What causes it?
“Folliculitis is an inflammation and infection of the hair follicle,” explains Eva.
The hair follicle is the pore that surrounds the root of the hair. “It starts when the hair follicle is damaged or blocked.”
This can happen after shaving or clipping hair, as well as scratching an itchy scalp.
It can then become infected with (staph) bacteria which leads to crusty, weeping and bleeding sores.
How to treat common scalp conditions
Not only can these scalp conditions be uncomfortable, sore or even painful, but they can also affect how we feel, leading to social embarrassment and anxiety.
And left untreated, constant itching and picking combined with the stress of the conditions can lead to hair loss.
But, once your scalp is treated and clears, in most cases, it does grow back.
Your GP or trichologist will help you develop a plan to get the condition under control with prescription shampoos, creams, and topical steroids.
Habits that might worsen scalp issues
Prevention is always better than cure, so make sure you’re not triggering scalp issues in your day-to-day with these expert-recommended dos and don’ts
Going to bed with damp or wet hair
“Yeasts that feed these conditions love a humid environment, so I always advise my patients to dry their hair and scalp before going to bed,” says Annabel.
Overuse of dry shampoo
“Using too much dry shampoo day after day can be a trigger for seborrheic dermatitis, so make sure you wash it out every other day to stop oil and yeast building up in it,” says Eva.
Washing hair frequently
“Let’s bust the myth that shampooing frequently is bad for your hair and scalp,” says Annabel. “It’s actually beneficial.”
Eva agrees that we should wash daily or every other day.
Scalp oils and massagers
There’s been a rise in these kinds of products on the haircare shelves, but Annabel advises to stay clear.
Oils may soothe temporarily, but they make the scalp greasier and encourage more build-up.
And scalp massagers can irritate the scalp further.