Mortifying reason more of us than ever are suffering from dandruff – and how to rid yourself of the embarrassing problem for good

Dandruff, the scourge of black jumper wearers everywhere, is on the rise.

Already half the world’s population is thought to have it, but new research suggests there’s been a 53 per cent increase in a particular form, seborrheic dermatitis – an inflammatory skin condition that leads to dandruff – according to a study published in the journal Clinical, Cosmetic and Investigational Dermatology.

This is partly down to the population growing and ageing (more on that later) over the 30-year study period, but the researchers, from several institutions in China, suggested that the rise in dandruff could also be attributed to a shift in the microbes that live on our scalp.

And this reflects environmental and dietary factors and increased colonisation by Malassezia yeast.

So does this mean we should changing how we treat our flaky scalps?

Dandruff is clearly on many of our minds – the UK hair and scalp care market was worth £1.8billion in 2024, with anti-dandruff products generating the most revenue, according to market analyst Grand View Research.

Dandruff is essentially the mildest form of inflammatory skin flaking on the scalp – inflammation causes the turnover of skin cells (the natural process of shedding dead skin cells and replacing them with new one) to accelerate unevenly, so the skin cells regenerate too fast, piling up on the scalp and then flaking off.

‘This appears as light white/grey flakes, usually with some itchiness, and generally limited to the scalp’, explains Dr Roshan Vara, a hair transplant surgeon at The Treatment Rooms in London.

While this kind of mere dandruff is a standalone problem, scalp flaking can also be caused by more severe inflammatory scalp conditions, with some types more significant and harder to treat.

The difficulty is knowing which one you have as each requires different treatment.

The biggest trigger of this inflammation generally is a naturally occurring yeast, Malassezia, which lives on everyone’s scalp and feeds on sebum (the oil your scalp produces).

‘Everyone’s got a bit of yeast living on them, with different microorganisms on different parts of the body,’ says Dr Adam Friedmann, a consultant dermatologist at ProDerm UK.

‘Malassezia on the scalp feeds on the oils in the skin and breaks them down into byproducts that irritate it, causing an inflammatory response.’ This accelerates skin turnover.

‘Inflammation releases chemical signals that tell skin cells to multiply faster, shortening the normal renewal cycle,’ he adds.

‘The scalp then sheds immature cells before they’re properly matured – which appear as flakes.’

At the point where this becomes visible we describe it as ‘dandruff’, he adds.

But dandruff is also a symptom of seborrhoeic dermatitis, a common inflammatory skin condition, scalp psoriasis and eczema, explains Dr Vara.

‘In these cases, you’ll see flaking along with more obvious redness – that’s the inflammation – than if it was dandruff alone, and sometimes patches of the same skin condition spread beyond the scalp to other parts of the body.’

Dandruff might not be regarded as a serious health complaint, but it can cause significant distress. As Dr Friedmann explains, ‘skin disease of any sort can cause real embarrassment and anxiety, and dandruff is no exception’.

But how might microbes play a part, as it’s now thought?

While the role of Malassezia yeast has long been recognised, it appears this may be part of a wider problem within the community of microbes on the scalp – the scalp microbiome.

‘There’s been a surge of interest in the scalp microbiome recently with dandruff and seborrhoeic dermatitis – and potentially, conditions such as psoriasis or eczema – associated with an imbalance in these microbes,’ says Dr Vara.

For instance, recent research has found that the composition of the communities of microbes on the scalp differ significantly between healthy scalps and in people with dandruff.

More severe dandruff is associated with increased levels of certain fungi and bacteria – not surprisingly these include Malassezia yeast, but also bacteria such as Staphylococcus capitis and other Corynebacterium species.

And your sex makes a difference. A study published in the British Journal of Dermatology last year found that men and women with similar levels of dandruff were found to have different microbiome profiles. For instance, men had more of the microbes associated with dandruff, but didn’t have more severe dandruff.

The researchers concluded: ‘These results… suggest potential mechanistic differences between male and female dandruff conditions, which may require different intervention strategies.’

Generally, dandruff is more common in males than females.

It starts at puberty, because the rush of hormones causes more oil production in the scalp.

R esearch published in the Journal of Clinical and Investigative Dermatology in 2016 found that it affects approximately 50 per cent of the population worldwide, peaking in numbers affected and the severity at around 20 years old, becoming less prevalent in people over 50.

‘Men tend to produce more oil in their scalps, mainly driven by their testosterone,’ says Dr Vara.

‘This oil production will affect the scalp microbiome and cause an increase in Malassezia, which in turn causes more skin irritation and dandruff.

‘And men in their early 20s will have higher testosterone levels compared to men in their 50s.’

Conversely however, ageing is also a trigger for developing dandruff because of changes in oil production, skin barrier function, immune response and cell turnover – all of which can contribute to scalp inflammation.

The researchers behind the study in Clinical, Cosmetic and Investigational Dermatology speculated that ageing populations might be partly driving the rise in seborrheic dermatitis as the condition tends to occur more often in older adults.

So, what’s the best way to tackle common dandruff?

First, people with oilier scalps are at increased risk of dandruff because an oily scalp is a prime environment for Malassezia.

But don’t go harsh, Dr Vara cautions: ‘While these yeasts and bacteria may play a part in causing an itchy, flaky scalp, the goal isn’t to get rid of them but to keep a healthy balance between them.

‘You can support this through a thorough but gentle haircare routine, minimising harsh chemical exposures like hair dye and shampoos containing sulphates, and making positive lifestyle changes – such as reducing stress and prioritising quality sleep.’

Lack of sleep increases stress and raises cortisol levels, leading to more scalp oil production, weakened immune response to fungus and increased skin sensitivity.

‘Diet, too, may potentially play a role – with higher sugar intake and processed foods associated with a rise in Malassezia yeast on the scalp – even pollution may play more of a role than previously thought, due to fine particulate matter potentially damaging the scalp barrier,’ says Dr Friedmann.

Otherwise, treatment for basic dandruff hasn’t changed in decades.

‘Many of the anti-dandruff shampoos are just anti-fungal – if you kill off the yeast then you reduce the flaking considerably,’ says Dr Friedmann.

H e adds that if the redness and scaling extend beyond the scalp to the skin on the face/neck around the hairline, or appear on the ears, you might have psoriasis and should see a dermatologist.

If you have flaky skin due to eczema or psoriasis, anti-inflammatory steroid scalp lotions such as Dermovate or Elocon ‘control it really well, even just used once or twice a week’, says Dr Friedmann.

Coal tar products are a recognised treatment for dandruff caused by psoriasis.

Coal tar shampoo is a keratolytic – meaning a substance that breaks down keratin, which is a strong, fibrous protein that forms the main structural material of your hair, nails and outer layer of skin.

It works by slowing the overgrowth of skin cells on the scalp and restricting bacterial and yeast growth that provokes the inflammatory reaction, says Dr Friedmann.

There are also now more effective drugs for treating inflammatory conditions such as eczema – biological drugs, as they’re known, are targeted to switch off the parts of the immune system that cause the flaky skin and that will help dandruff if this is one of your symptoms.

More rarely, dandruff is caused by autoimmune conditions such as lichen planus which causes itchy patches all over the body as the immune system attacks skin.

As Dr Friedmann explains, ‘lichen planus can get into the hair follicles and cause flaking and hair loss’.

He adds: ‘Any time that dandruff is associated with hair loss and it’s really time to watch out because if you don’t treat it quickly, the loss can become permanent.’