Symptoms, Causes, and Treatment Options

Dandruff is a common scalp condition where flaky skin sheds from the scalp. Wet dandruff—or dandruff associated with an oily scalp—happens when extra sebum (oil) production on the scalp combines with an overgrowth of Malassezia, a yeast naturally found on the scalp.

Along with visible, oily flakes in your hair, wet dandruff can cause itching, redness, or irritation on your scalp. Nearly half of adults worldwide experience some form of dandruff, with wet dandruff affecting up to 10% of people. 

While it can be long-lasting, wet dandruff is manageable with proper scalp care, medicated shampoos, and, sometimes, prescription treatments. 

Symptoms of wet dandruff, or dandruff from an oily scalp, can vary in severity. They may come and go, worsening with hormonal changes, ongoing stress, or cold, dry weather. Common wet dandruff symptoms include: 

• Greasy flakes: Yellowish skin flakes stick to the scalp or hair due to excess oil. 
• Oily scalp: The scalp may feel excessively greasy or oily and appear shiny or wet. 
• Redness: Patches of inflamed skin on the scalp may appear mildly red in people with lighter skin tones or darker in people with deeper skin tones.
• Itchiness: Itching may worsen with sweat, low humidity, or cold temperatures. 

Depending on the underlying cause, symptoms may extend beyond the scalp and affect other areas rich in sebaceous (oil-producing) glands, including the eyebrows, eyelids, behind the ears, middle of the chest, and groin area.

Sebaceous glands are tiny structures in the skin that secrete sebum, an oily substance that helps moisturize and protect the scalp, hair, and skin. While sebum is important for healthy skin, overactive sebaceous glands can produce excess oil, creating the ideal conditions for wet dandruff. 

The most common causes of wet dandruff include Malassezia yeast overgrowth and seborrheic dermatitis.

Malassezia

Malassezia is a yeast that lives on most people’s skin as part of the body’s normal collection of microorganisms. When oil production increases, this creates the ideal environment for the yeast to multiply excessively, causing scalp irritation and skin flaking.

Seborrheic Dermatitis

Seborrheic dermatitis is a chronic skin condition associated with Malassezia overgrowth. It causes oily, red, and inflamed patches of skin, often with yellowish, greasy flakes. Seborrheic dermatitis is a leading cause of wet dandruff and may affect the scalp and other body areas.

Certain factors can trigger excess sebum production, creating conditions that allow yeast to overgrow on the scalp and leading to seborrheic dermatitis and wet dandruff. These include: 

• Hormonal fluctuations
• Weather changes, particularly cold, dry weather 
• Prolonged stress or stressful life events 
• Heavy alcohol use 
• Hair care products with chemicals 

Risk Factors 

Risk factors that may make you more prone to developing wet dandruff include: 

• Age: Wet dandruff is more common in adolescents due to hormonal changes, as well as adults 50 or older.
• Sex: People assigned male at birth are more likely to develop wet dandruff than those assigned female at birth. Men may have dandruff more often because increased testosterone levels can cause higher oil production in the scalp.
• Family history: Oily skin or seborrheic dermatitis that’s hereditary can increase your risk of wet dandruff. 
• Medical history: Certain health conditions, including Parkinson’s disease, human immunodeficiency virus (HIV), acne, obesity, stroke, or traumatic brain injury (TBI), can trigger excess oil production and lead to wet dandruff. 

Healthcare providers can usually diagnose wet dandruff by going over your medical history and examining your scalp.

Your medical history may indicate potential triggers, such as stress or hormonal changes, and pinpoint underlying causes, like seborrheic dermatitis. During the physical exam, your provider will check your scalp for oiliness, redness, and flaking. They may also examine your eyebrows, eyelids, nose, and chest. 

Diagnostic tests aren’t usually necessary to diagnose wet dandruff. However, some healthcare providers may order a fungal culture test, which involves sending a small skin sample from your scalp to a laboratory for testing.

This test can identify whether Malassezia yeast overgrowth contributes to your wet dandruff. 

Wet dandruff treatment focuses on controlling scalp sebum production and managing underlying causes. These approaches can help eliminate dandruff and its symptoms, such as itching or irritation. Treatment will vary depending on the cause and severity of the symptoms. 

Lifestyle Changes 

If you have an oily scalp, simple hair care habits, such as regular washing and avoiding harsh hair products, can help reduce the oil and clear wet dandruff.

For straight hair and an oily scalp, washing your hair daily with a gentle shampoo can help remove excess oil and dandruff flakes. Curly, coarse, or thick hair may need less frequent washing.  Also, try only using alcohol-free hair care products to prevent harsh chemicals from irritating your scalp.

Over-The-Counter (OTC) Treatments

Over-the-counter (OTC) products may be enough to manage mild to moderate wet dandruff. These products include:

• Medicated shampoos: Shampoos with active ingredients like zinc pyrithione, ketoconazole, or salicylic acid can help manage oiliness and reduce yeast overgrowth. People with oily scalps may benefit from shampoos containing sulfates, such as sodium lauryl sulfate, which cleanse excess oil. People with sensitive skin or seborrheic dermatitis may need gentler, sulfate-free options.
• Coal tar shampoo: Coal tar shampoo helps slow skin cell turnover, reducing dandruff flakes in people with seborrheic dermatitis. Irritation can occur, so it’s best to test coal tar shampoo on a small patch of skin before regularly using it. You should also limit sunlight exposure and wear sunscreen while using coal tar, as it can cause light sensitivity.
• Tea tree oil: This oil has antifungal properties that may help control Malassezia yeast overgrowth. Undiluted tea tree oil can cause contact dermatitis (a skin rash due to an irritant). Using shampoos containing 5% tea tree oil for 3-10 minutes is generally safe for the skin.

Prescription Treatments

Healthcare providers may prescribe medications to manage recurrent or severe cases of wet dandruff. These medications may include: 

• Prescription-strength medication shampoos: Shampoos containing stronger antifungal drugs, such as Ketodan (ketoconazole) or Loprox (ciclopirox), help control Malassezia yeast and reduce wet dandruff flakes. 
• Topical corticosteroids: Medications like hydrocortisone cream help quickly reduce scalp inflammation and itchiness related to seborrheic dermatitis. Corticosteroids are a short-term solution due to possible serious side effects, such as a severe rash or skin infection.
• Zoryve (roflumilast foam): This foam is applied to the scalp once daily to reduce scaling, itchiness, and redness. 

For widespread or treatment-resistant seborrheic dermatitis, your healthcare provider may prescribe oral (taken by mouth) antifungal medications like Sporanox (itraconazole) or Lamisil (terbinafine). 

Healthcare providers may also try light therapy, which uses ultraviolet B (UVB) light to help clear extensive dandruff and scales. Most people need three weekly sessions for up to eight weeks to see improvement. 

While preventing wet dandruff may not always be possible, self-care strategies can help protect your scalp health and lower the risk of flare-ups. This may include: 

• Stress management: Incorporating stress-reduction techniques, such as meditation, nature walks, or yoga, into your daily routine may help manage stress levels and reduce wet dandruff flare-ups.
• A balanced diet: If seborrheic dermatitis is causing wet dandruff, eating a balanced diet rich in fruits, vegetables, whole grains, and lean proteins may help clear wet dandruff and associated symptoms.
• Frequent hair washing: Depending on your hair type, daily washing may help remove excess oil and dead skin cells from your scalp. 

Certain medical conditions can increase the likelihood of developing wet dandruff, including: 

• Psoriasis: This chronic skin condition causes thick, scaly patches on the skin and scalp. Although different from dandruff, scalp psoriasis can cause similar symptoms and may coexist with seborrheic dermatitis, leading to what some call sebopsoriasis.
• HIV/AIDS: Research shows that seborrheic dermatitis, including wet dandruff, is more common in people with HIV.
• Neurological disorders: People with neurological disorders, including Parkinson’s disease, TBI, and stroke, are more likely to develop seborrheic dermatitis-related wet dandruff. 

Wet dandruff is manageable but requires consistent treatment and lifestyle adjustments to control symptoms. Depending on the underlying cause, wet dandruff can come and go, switching between periods of improvement and flare-ups.

Keeping a consistent hair care routine, addressing triggers like stress or diet, and regularly using medicated shampoos can help keep wet dandruff under control. 

See a healthcare provider if self-care strategies and OTC dandruff shampoos are ineffective in controlling your wet dandruff. Your provider can help identify any underlying causes and recommend effective treatments.