Dandruff

What is dandruff?

Dandruff is a common condition affecting the scalp, chest, and face, which are areas of the skin that are rich in oil-producing glands that end in hair follicles. It results in flaking of the skin and itching.

Is dandruff condition a medical emergency?

Dandruff is not a medical emergency.

Causes of dandruff

The exact cause of dandruff is not known but it appears to be a combination of genetic and environmental factors. In this problem, the turnover cells of the skin layers are faster than normal, and the cells also die earlier than normal. The dead cells clump together and this results in the formation of flakes. The following could contribute to this disease are:

• Very Oily skin, or extremely dry skin
• A fungus is known as Malassezia, that survives and feeds on the fats within the oily secretions of the human skin and the by-products of its metabolism
• Skin sensitivity to hair or body care products
• Other co-existing skin conditions such as psoriasis, or eczema

Risk factors for dandruff

 The risk factors for dandruff are:

• Cold weather
• Emotional stress
• Gender: Males are more likely to develop this disease
• Age: It usually starts around puberty and peaks by the age of 40 years
• Weakened immune system: As may be seen in HIV infections, chemotherapy, steroid therapy

Triggering factors

It may be triggered by cold weather or emotional stress.

Signs & symptoms of dandruff

The following are the symptoms and signs i.e.,

• Itching of scalp
• Flakes of skin that are visible on the hair on the scalp, eyebrows, and eyelashes, mustache or beard, shoulders, or the chest
• Redness of the skin may be seen sometimes in fair-skinned individuals
• Greasy patches on the scalp may sometimes be visible

Investigations

No investigations are required for establishing a diagnosis of dandruff. In very severe and persistent cases the following may be done to rule out other causes which are:

• Skin biopsy: If exfoliative erythroderma is suspected
• Fungal culture: To rule out other fungal infections

Diagnosis of dandruff

Diagnosis is done based on medical history and clinical evaluation.

Dandruff treatment options

It can most often be managed with gentle self-care and over the counter anti-dandruff shampoos. This is not responding to over the counter anti-dandruff shampoos that may require medicated shampoos.

A. Medical management

The medical management of dandruff may include medicated shampoos that contain:

• Ketoconazole: It is a broad-spectrum antifungal agent that has the longest duration of effect
• Zinc pyrithione: It is both antibacterial and antifungal
• Selenium disulfide: Can be used both as a lotion or a shampoo. This is seen to return if the application is discontinued
• Salicylic acid: Help to decrease the scaling
• Coal tar: It slows the growth of skin cells, and delays the shedding of skin layers

B. Role of diet/exercise/lifestyle changes/preventive measures

Some measures that may help to control or prevent dandruff can include:

• Regular (not daily) use of gentle shampoo to wash the hair; daily shampooing may be advisable if the scalp skin is very oily
• Limiting the use of hair care and styling products
• Avoiding emotional stress
• Eating a healthy and well-balanced diet with zinc and vitamins

Complications of dandruff

It may cause low self-esteem and a feeling of embarrassment.

Prognosis

The prognosis of this disease is generally excellent, and most cases resolve with self-care and over the counter anti-dandruff shampoos.

When to contact the doctor or hospital/how to identify the emergency or complications?

It is advisable to seek medical attention if dandruff persists or is getting worse despite regularly using over the counter anti-dandruff shampoos.

Indications for hospitalization if required

Hospitalization is not required.

Suggested clinical specialist/departments to consult for this condition

• Dermatologist or Trichologist