Dandruff

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Dandruff is a common scalp condition characterized by excessive flaking of the skin on the scalp. It affects almost half of all adults at some point. Dandruff is caused by a fungus called malassezia that feeds on the oils produced by the scalp. The main factors that contribute to dandruff include:

• Malassezia fungus: The malassezia fungus lives on the scalp and feeds on the sebum (oil) produced by the scalp. For some people, the presence of this fungus can lead to an irritating scalp reaction resulting in dandruff.
• Oil production: People with oily scalp tend to have more dandruff. The malassezia fungus thrives in the excessive oil, leading to increased flaking.
• Skin conditions: Certain skin conditions like seborrheic dermatitis, psoriasis, and eczema can also contribute to dandruff. They cause the scalp to become red, itchy and scaly.
• Sensitivity: Some people are more sensitive to the malassezia fungus even with normal oil production. This increased sensitivity leads to an exaggerated scalp reaction and more severe dandruff.
• Shampooing infrequently: Not shampooing often enough can lead to oil and skin cell buildup on the scalp, providing more food for the malassezia fungus and making dandruff worse.
• Harsh hair products: Hair sprays, gels, and dyes can dry the scalp and worsen dandruff in some people.
• Medical conditions: Conditions like Parkinson's disease, poor immune function, and nerve disorders may increase the risk of dandruff in some cases.
• Diet: A poor diet low in nutrients like zinc, B vitamins, and healthy fats may contribute to dandruff for some people.

The symptoms of dandruff include excess flaking and scaling of the scalp, and sometimes mild itching. Flakes may be white to yellowish in color and most often fall from the scalp onto the shoulders. Treatment options include:

• Ketoconazole shampoo: Most often used to reduce malassezia and control dandruff.
• Zinc pyrithione shampoo: Helps reduce flaking and relieves itching.
• Coal tar shampoo: Slows skin cell growth and reduces malassezia.
• Salicylic acid shampoo: Helps exfoliate the scalp and loosen scales.
• Steroid lotions: Help with inflammation and itching for seborrheic dermatitis.
• Tea tree oil: Has antifungal properties to help improve dandruff.
• Frequent shampooing: Shampooing 3-4 times a week can help prevent oil and skin cell buildup.
• Dietary changes: Eating a balanced diet with nutritional foods may help improve dandruff in some cases.

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Topic Highlights:-

• Old skin cells in the scalp are shed and gradually replaced with new cells.
• People suffering from dandruff have rapid cell turnover which leads to increased shedding of dead cells.
• Causes of dandruff include dry skin, infection, and skin disorders like psoriasis.
• This visual presentation describes in detail the causes, symptoms, diagnosis, and treatment for dandruff.
• The presentation also provides helpful information on the prevention and management of dandruff.

Transcript:-
Dandruff affects millions of men and women globally, which can lead to social embarrassment and self-esteem problems. Excessive flaking or shedding of skin cells from the scalp is called either dandruff, scurf or seborrhea. Medically termed as Pityriasis capitis, dandruff is a harmless condition in which the shedding of cells occurs at an abnormally faster rate. Dandruff is often associated with dry or oily skin. The presence of oil results in clumping-up of flakes which form plaques. Flakes of dandruff are visible and often drop on the shoulders, eyebrows, and clothes as a person combs or brushes his/her hair.

Skin constantly sheds off the old dead cells and replaces it with new cells, which normally takes 3 to 4 weeks. A small amount of flaking, as a result of dead skin accumulation on the scalp, is common. But people with dandruff have a rapid cell turnover that leads to excessive shedding of dead cells which clump together and flake off as white to yellowish scales from the scalp. Dandruff causes severe irritation and itching of the skin on the scalp. It generally appears first as small patches of scales and then progresses to the entire scalp. At times scaling may occur inside the ear, eyebrows, eye lids and along the skin folds. This condition is termed as seborrheic dermatitis.

The presence of oily or dry skin with the appearance of whitish or yellowish flakes which form plaques on the scalp that settles on the shoulders, eyebrows and clothes while combing is an unmistakable symptom of dandruff. Itching may be aggravated due to infection. Excessive itching may cause redness and inflammation of the scalp with the appearance of flakes. These symptoms are frequently accompanied by hair loss.

Dandruff is caused due to one of the following reasons:

The yeast-like fungus called Malassezia furfur or Pityrosporum ovale is a common inhabitant of the scalp of many individuals and does not cause any harm. When the organism feeds on oils secreted by hair follicles and grows in large numbers, it causes irritation, leading to increased cell turnover. Hence an excess of dead skin cells are shed. The exact cause of overgrowth of these organisms is not known.

Some factors that can contribute to this malaise are:

• Increased oil production in the scalp. People with oily skin and hair are prone to dandruff as the yeast Malassezia feeds on the oil.
• Dry skin during winter.
• Hormonal fluctuations.
• Infrequent shampooing and extra sensitivity to the fungus.
• Excessive use of cosmetics.
• Poor diet.
• Seborrheic dermatitis – characterized by red, greasy skin, covered with white or yellow scales, can lead to dandruff. This affects the areas rich in oily glands like eyebrows, sides of the nose, groin and sometimes armpits.
• Psoriasis – a condition in which the dead skin cells accumulate to form thick silvery scales may result in dandruff. It affects the scalp as well as knees, elbows and trunk.
• Cradle cap – a condition that affects the newborn, which causes crusty scalp and peeling of the scalp tissue.
• Contact dermatitis – caused due to sensitivity to certain hair cosmetics, results in a red, itchy and scaling scalp.
• Shampooing too often also causes scalp dryness, resulting in dandruff.

Dandruff can occur at any age, but is more common between young adulthood and middle age. Statistically more men have been found to have dandruff – possibly because the male sebaceous glands are larger, increasing the chances of increased secretion of sebum that interacts with the fungus. Male hormones are also believed to affect the oil glands, resulting in dandruff.

People who suffer from prolonged periods of illness such as Parkinson’s disease are highly susceptible to this condition and are likely to have dandruff. People overcoming stress, stroke, a compromised immune system or a heart attack may also develop dandruff. Dandruff rarely occurs as an allergic reaction, but oily foods and junk food can trigger this condition.

Dandruff can be self-diagnosed. If the scaling is severe and affects other regions it could be seborrhoeic eczema or seborrhoeic dermatitis, which requires medical attention. Tests done to identify Malassezia infection include:

Direct microscopy-- Skin scrapings from the scalp are examined under the microscope to detect the presence of fungus. Culturing of the organism is rarely done, but if necessary, they are grown on a specialized medium.

Dandruff can be controlled by reducing the oiliness of the scalp and its cell turnover. This can be done by regular use of various medicated shampoos with different active ingredients:

• Tar-based shampoos have coal tar, a by-product of coal manufacture, that reduces cell turn over.
• Shampoos containing salicyclic acid eliminate scaling.
• Zinc pyrithione is both anti-fungal and anti-bacterial and shampoos containing this ingredient can reduce the dandruff-causing fungus
• Selenium sulfide shampoos prevent cell turnover and can reduce the fungus.
• Ketoconazole shampoos have the anti-fungal agent ketoconazole that control the proliferation of Malassezia fungus.

It is important to shampoo regularly to bring dandruff under control. Excessive flaking could also be due to Seborrheic dermatitis or psoriasis. If the problem persists even after regular hair care, it would be advisable to consult a dermatologist to pursue a more aggressive treatment. Anti-fungal creams, which contain active ingredients similar to those in shampoos, may also be prescribed. Mild steroids such as cortisone-based liquids, gels, and foams may be prescribed to reduce inflammation of the scalp.

Dandruff can be prevented or managed by oneself by paying attention to all the likely triggers that cause this condition: maintaining overall health and avoiding stress that triggers dandruff and preventing an oily scalp by regular shampooing to remove excess oil. Many of the medicated shampoos are also available over-the-counter. It may be helpful to part the hair into small sections, apply the shampoo and leave it on the scalp for a little while. The scales should be loosened with the fingers and the scalp scrubbed before rinsing thoroughly.

Some hair products such as hair sprays, styling gels and hair waxes can make the scalp oilier and their reduced use may improve the dandruff condition. A healthy diet that provides sufficient zinc and B vitamins can help in the fight against dandruff. Sunlight is good for dandruff and spending sufficient time taking part in outdoor activities can be useful in dandruff control. Tea tree oil extracted from the Australian tea tree has anti-fungal properties and has been known to be effective against dandruff. Several home remedies have been recommended and used over time for this malaise – some work and some do not. All remedies ultimately require proper hair care.