Dandruff is a mysterious topic.  Mysterious from the viewpoint that there is no commonly agreed upon theories about what actually causes the condition.   There is also no known published cure.
Even though there are estimates that as much as 97% of the population of the United States

will at some point in their lives have a form of dandruff, there is still a lack of total agreement about many elements of the condition.
Dandruff can happen at any age but is most commonly found in people between the ages of 12 and above.
A form of dandruff known as cradle cap occurs in newborns and infants.

General Description of Dandruff

Dry or Greasy Dandruff

Dandruff can cause either an overly dry scalp with itchy white flakes that may be waxy or greasy or dandruff can manifest as an oily greasy scalp with scales.  
 

What Is Dandruff?

A person's entire body surface continuously sheds dead skin cells. The skin itself sheds every twenty-four days.
Dandruff, the shedding of dead skin cells from the scalp at an excessive rate, is the result of the normal growing process of the skin cells of the scalp.
 

Excessive Sloughing Of Old Cells

In a normal scalp, the process of sloughing off old cells and manufacturing of their replacements is very orderly and complete.  In the dandruff scalp, there is mass disorder and often the departing cells are not dead before leaving the scalp. 
Why there should be a speedup in the scalp's cell production is still a debated mystery.
There appear to be two different causes of dandruff.  Internal and external.
 

Internal Causes

Among the myriad of internal causes suspected are:

• hormonal imbalance
• poor health
• excessive perspiration
• poor hygiene
• allergic hypersensitive
• lack of rest
• emotional stress
• excessive consumption of sugar, fat, starch
• improper nutrition
• heredity pre-disposition

There is still no other published cure for the skin disorders that can cause dandruff so most of the 50 million people in the United States who have it find they get it again and again.
 

External Causes

The following factors may make the flaking of dandruff worse and considered to be external causes for the problem:

• Excessive use of hairsprays and gels.
• Improper use of hair-coloring products or excessive use of electric hair curlers
• Cold weather and dry indoor heating.
• Tight fitting hats and scarves.
• Infrequent shampooing of the hair or inadequate rinsing.
• Stress, anxiety and tension.

Dandruff & The Fungus Theory

Contrary to popular theory, although bacteria may aggravate a dandruff condition, germs do not cause the initial problem. The precise cause of dandruff is unknown.
Most medical authorities consider dandruff, even the mildest forms, to be a type of scalp or skin related disease. 
Clinically, one description of dandruff is seborrhea capitos or excessive sebum production of the scalp. 
Today most skin specialists agree that dandruff is associated with a tiny fungus called Pityrosporum ovale, P. ovale for short.
This fungus lives on our bodies and scalp all the time, usually without causing a problem.  Unfortunately, for some people, it can increase in numbers, leading to dandruff.
 

Additional Causes of Dandruff

Dandruff is seasonal. It is most severe during the winter and mildest during the summer. The most common symptom of dandruff is scaling with occasional itching.
Dandruff scales usually occur as small, round, white-to-gray patches on top of the head.  Scaling can occur anywhere on the scalp, in the hair, on the eyebrows, the beard and can spread to the neck and shoulders.
Dandruff is often known as "dry scalp", but people with oily scalps tend to suffer most. An oily scalp also supports the growth of P. ovale.
 

Dandruff & Baldness

As always, myths and rumors pervade any type of hair or scalp condition.   For many years the common belief was held that untreated dandruff would eventually lead or contribute to baldness.
Current thinking does not support these original beliefs.  Many people, both men and women, live under the fear that dandruff may lead to baldness.   Although these conditions may occur at the same time, there is absolutely no known or documented evidence that baldness is related to dandruff.
 

Traditional Treatments For Dandruff

The most common dandruff treatments are shampoos containing:

• coal-tar
• pyrithione zinc
• salicylic acid
• selenium sulfide
• sulfur

Daily shampooing with thorough rinsing has been the treatment recommended until the present.
Since dandruff is a natural process, it can not be eliminated.  It can only be managed and controlled.
 

Traditional Dandruff Shampoos

In the very beginning of the development of products for dandruff there were very few retail products available. 
One of the best known was Head & Shoulders.  Early products also included Enden, Banish, Fostex, Rinse Away and Double Danderine.
The current offerings have changed quite a bit and have become a lot more sophisticated.  I can not personally offer a recommendation on the best product since I have luckily been spared the dandruff curse.
The best approach is to pick a product and try it.  If the product works and is successful at controlling your dandruff, continue to use it.  It is important to remember that there is no known "official" cure for dandruff.   Once you have the problem the best that you can hope for is management and control.  
If utilization of a retail dandruff product is used it should be remembered that this product will need to be continued indefinitely.  Once the dandruff shampoo or dandruff products are discontinued, the dandruff will return.
Thorough cleansing of the scalp and the hair will keep dandruff flakes out of sight for up to three days.  it takes the scalp up to three days before it can generate a new batch of snowy flakes.
A key point to remember is to select the mildest shampoo possible.   Although detergent based shampoos will clean the hair and scalp well, they often cause drying will will make the flaking worse.
 

Some Retail Dandruff Shampoo Choices

Listed below are some of the current retail dandruff brands:

• Brylcreem
• Genderm
• Glover's
• Good Sense
• Head & Shoulders
• Pantene Pro-V Dandruff Formula
• Pentrax
• Pert Plus
• Polytar
• Scalpicin
• Sebulux
• Selsun Blue
• Suave
• Tegrin
• Zicon
• ZNP
• Neutrogena

To get a detailed list with more information check out the dandruff products at: Drugstore.com.
 

Nizoral Shampoo

Nizoralis the only shampoo containing a patented active ingredient known as ketoconazole (discovered by Dr. Paul Janssen in Beerse, Belgium).
This ingredient is medically proven to be effective against P. ovale and acts directly to inhibit growth of the fungus.
Most other anti-dandruff shampoos work by normalising the pH of the scalp.  Nizoral is the most well-studied anti-dandruff shampoo available today. There is over a decade of clinical experience with Nizoral.
This product is the number one choice of doctors and pharmacists, who have recommended an anti-dandruff shampoo to millions of dandruff sufferers all over the world.
Nizoral shampoo is also unique in that it's effect is long-lasting. Even after rinsing, Nizoral carries on working for several days. This means that you don't need to use Nizoral every day making it extremely cost-effective.
As dandruff is not always limited strictly to the scalp, Nizoral is also available as a cream which is especially useful for treating dry, flaky skin and seborrhoeic dermatitis around the eyebrows, in the beard, and in the folds around the nose.
 

Treatment In Severe Cases

In severe cases dermatologists will prescribe a special ointment or lotion that will contain sulfur, salicylic acid, resorcinol, tar, selenium sulfide and cadmium sulfide.  The concentration and frequency of use is dependent upon the severity of the case for which it is prescribed.  
It is generally agreed that drugstore products which contain zinc pyritheone or selenium sulfide are the most effective in ridding the scalp of dandruff flakes.
If a scalp shows signs of redness, swelling, scabbing, or goeeyness - accompanied by flakes, in all likelihood there could be another scalp disease involved like psoriasis or ringworm. 
With any of these symptoms it is important to see a physician immediately.
 

Diet

According to the Encyclopedia of Natural Healing by Siegfried Gursche, nutrition can play a big part in controlling dandruff.
To counteract the inefficient carbohydrates and fatty-acid metabloization which can cause dandruff, include plenty of B vitamins in your diet.
Nutritional yeast and raw wheat germ are two excellent sources of B vitamins, particularly vitamin B6 which plays an important role in controlling dandruff.
Eggs and cabbage also provide vitamin B6 in addition to supplying sulfur which is nature's beauty mineral for the scalp.
Sometimes an allergy to daily products may cause dandruff in which case alternative food sources of vitamin B6 are preferred.  Other common allergens which provoke dandruff are chocolate, nuts and shellfish.
Refined carbohydrates in white flour or sugar can cause dandruff and should be avoided as much as possible because they deplete the body of B vitamins.  Saturated animal fats and trans-fatty acids found in margarine or shortening clog the arteries and interfere with the metabolization of the essential fatty acids.  The good fats, found in nuts and flax seed benefit the body and promote healthy scalps.
 

Nutritional Supplements

Supplementing the essential fatty acids is more important since these are usually lacking.  Evening primrose oil is a good source of gamma linolenic acid (GLA), easily absorbed by the body. 
B6 deficiencies also cause dandruff.   To prevent imbalances, the entire B complex should be included.  In addition, vitamins A and E are important for skin health. 
Silica is also recommended for improving scalp health.  It is available in capsules from a vegetable source and in a liquid gel form.
 

Daily Dosages

Most Important:

• Evening primrose oil, two 500 mg capsules three times daily
• Vitamin B complex, 50 mg twice daily with meals
• Vitamin B6 or Pyridoxal-5-Phosphate, 50 mg twice daily

Helpful

• Vitamin A, 10,000 IU (not during pregnancy)
• Vitamin E, with mixed tocopherols, 400 IU
• Silica, 1,000 mg, two 500 mg capsules daily

Some Natural or Alternative Dandruff Shampoo Choices

Listed below are some of the current health food store brands of dandruff shampoo products:

• Nature's Gate Tea Tree
• Nature's Gate Aloe
• Calaguala Fern & Cade Tar Scalp Treatment Shampoo (Aubrey Organics)
• Selenium Blue Shampoo (Aubrey Organics)
• Cedarwood Oil (Karooch Essential Oils)
• Eucalyptus Oil (Karooch Essential Oils)
• Rosemary Oil (Karooch Essential Oils)
• Big Sky Tea Tree Shampoo/conditioner (Prairie Naturals)
• Moonshine Recovery Emollient (Prairie Naturals)
• White Lightening Scalp Tonic (Prarie Naturals)

Alternative Treatments

Apple cider vinegar used as the final hair rinse after a shampoo has proven very effective in balancing the pH levels of the scalp and controlling dandruff.
Do a rinse that is 1 part of apple cider vinegar to 3 parts of warm water.  Apply cider vinegar can also be applied directly (undiluted) to the scalp.  After the vinegar has had a chance to soak into the scalp, shampoo with a very mild shampoo.
Garlic and oil of oregano are also excellent for fighting dandruff.  You can take it internally or externally depending on what seems to work best for your situation.
 

Improving Circulation

Alternating hot and cold water on the head increases circulation to the scalp.  Yoga headstands will also help with circulation.  Exercising out in the fresh air will also help with circulation to the scalp.
Brush your scalp carefully to loosen scales before shampooing.  If you wash your hair daily use small amounts of baby shampoo.  Harsh shampoos will just cause the sebaceous gland to overcompensate by producing more oil than necessary.
Deep breathing adds oxygen to the body which will help kill the fungus and overall help circulation.
 

Sulfur Products Are Beneficial

Onions are high in sulfur.  Cut a fresh onion in half and rub it on the scalp.Wash your hair once a week with a sulfur based soap.
Avoid hair products that contain alcohol which dries out the scalp.  Also avoid hair dryers which will also dry the scalp and add to the problem.
 

Tea Tree Oil & Aloe

Both tea tree oil and aloe is beneficial in combating dandruff.  You can apply the aloe directly from a leaf of the plant and massage it into the scalp.  Be sure to apply a good conditioner after shampooing since aloe may be drying.
Tea tree oil can be applied directly to the scalp or added to shampoo.
 

Alternative Physicians

Dandruff has been proved to respond to homeopathic treatments, acupuncture and acupressure and special massage.  Cell salts and flower essences also have added benefit.
Before undertaking treatments that involve serious herbs, cell salts or homeopathy, consult the appropriate alternative health care provider.
 

Summary

Dandruff can affect many different people in every age group.  There is still controversy over whether dandruff is caused by fungus or by excessive sebum production of the scalp.
Dandruff can manifest as either very dry and flaky scalp or very oily scalp with flakes.
There are many different retail shampoos that are designed to combat dandruff including the old standby, Head & Shoulders.  This article also lists several "natural" brands that can only be purchased at the health food stores.
There are many types of treatments that can be used to manage and control dandruff.  Nutritional supplements, vitamins and herbs offers some new options along with traditional chemically based anti-dandruff shampoos and ointments.
Whatever type of solution you select, take your time and understand that every treatment works differently for every situation.
The Hair Boutique makes no recommendations on the best products or treatments and recommends that a doctor or health care practitioner be consulted before undertaking any treatments that could have a medical impact.