I can’t wear dark shirts, because they wind up covered with white powder. Is there any help for my dandruff?

Franziska Ringpfeil, M.D., Ringpfeil Advanced Dermatology, Haverford

There is, but it’s not a simple answer. Dandruff, whose medical term is pityriasis simplex capillitii, can most commonly affect the scalp, but it can also affect the face and eyebrow area.

It can be treated in a couple of different ways.

The simple approach is to use things available in drugstores, like dandruff shampoos. People who come to see us are those who have tried those products, but are frustrated because the dandruff hasn’t stopped. We then examine them, and depending on what the prominent feature of the dandruff is, we can customize a treatment plan to fit those specific needs.

The presence of dandruff does not necessarily mean just the flaking of the skull - other things can be going on as well. There could be wetness around the hair follicles, or scaling that produces more than fine flaking and can be greasy and looks as if it’s caked on in little mounds.

Often times, people who have dandruff have itching, which is responsible for the white flaking - if they didn’t have the desire to scratch, the flakes would not come off the scalp. So to take a proper medical approach, we need to know not just what it looks like, but understand why we develop dandruff. It’s not a disease, but a trait, and many people have it.

The first time it comes out is during infancy, because in the first year of life organs are extremely active due to hormones still active in the body after birth. The hormones then get lost as our bodies are not producing them, and in puberty they spring up again. The hormones produce sebum in the oil glands, and can lead to dandruff due to stimulation of inflammation.

Many people have this trait but don’t notice it until a stressful situation arises, when the hormones are released and stimulate androgen production. At times of stress, dandruff can be very pronounced.

Another trigger is often season change from humid summer to dryer climate, like our fall, and sometimes from spring to summer. We believe it’s a trigger because oil glands are not active during the humid summer, but in the dry winter they are active again to produce moisture on the skin. So it’s a combination of genetic predisposition and environmental factors. I recommend stress control through regular exercise, things like yoga.

I cannot influence the weather – I cannot say move to Florida. I can intervene if the inflammation and itching are pronounced, and we can then prescribe medications geared toward targeting the inflammation.