Description of Dandruff
Excessive shedding of dead skin from the scalp is called dandruff. In medical terms, it is called pityriasis capitis. Shedding skin is a normal phenomenon of the body as skin cells die and flake off. White flakes or scales are visible as dandruff when there is an excessive shedding of dead cells.
Causes and Risk Factors
Dandruff occurs normally and cannot be prevented. It gets worse due to a yeast-like fungus Malassezia globosa. It lives on the scalp and feeds on the oils secreted by glands present on the scalp. Dandruff may get aggravated due to various reasons such as:
1. Dry skin: People who have dry skin are more prone to dandruff. There will be excessive flaking of the scalp without any redness.
2. Autoimmune diseases: In some autoimmune disorders like psoriasis and eczema, patients are prone to excessive shedding of skin cells, thereby increasing the flakes on the scalp and other affected body parts.
3. Irritated, oily skin: It is marked by greasy red skin covered with white and yellow scales. In this condition, called seborrheic dermatitis, excessive greasy scales will be seen even on eyebrows, nose, back of the ears, groin, and armpits.
4. Unhygienic conditions such as not shampooing enough can increase the chances of accumulation of dead skin cells, which later shed as dandruff.
Factors that may increase the risk for having dandruff are:
1. Oily hair and scalp
2. Poor diet
3. Certain illnesses, e.g., Parkinson’s disease
4. Immunocompromised [e.g., acquired immune deficiency syndrome (AIDS)] patients
6. Frequent exposure to extreme heat and cold
Signs and Symptoms
Common signs and symptoms of dandruff are:
1. White, yellowish, or grayish scales on scalp and hair
2. Powdery scales falling off on clothes
3. Itchy scalp
4. Excessively dry or oily scalp
Dandruff is diagnosed by a simple physical examination of the scalp. It will be done by a dermatologist (skin specialist) or a trichologist (hair and scalp specialist). Your dandruff may be classified as mild or severe and on the basis of it, your doctor may prescribe gentle or medicated anti dandruff shampoos.
There are no blood tests or imaging tests to diagnose dandruff.
In most patients, dandruff can be controlled by daily washing with gentle antidandruff shampoo. If your dandruff is severe, the doctor may prescribe medicated shampoos that contain:
1. Zinc pyrithione prevents itching and flaking. Example: Heads & Shoulders anti dandruff shampoo.
2. Ketoconazole act as a broad spectrum antifungal agent. Example: Nizoral AD, Ketonext shampoo.
3. Coal tar helps in slowing down shedding of the skin cells. It may be the only active ingredient in the antidandruff shampoo or may be used along with salicylic acid or ketoconazole. Example: Neutrogena T/Gel shampoo.
4. Tea tree oil can be used for daily shampooing to reduce scales. Example: Himalaya Herbals antidandruff shampoo.
5. Selenium sulfide slows down skin death. Example: Selsun Blue
If dandruff gets worse due to external factors like weather or cosmetics, it can be controlled by avoiding exposure to the causative factor.
Some home remedies that can be used to control dandruff include:
1. Boil some neem leaves in water. Strain and use it to rinse hair.
2. Mix some lemon juice with water and apply it on the scalp. Rinse after 5 to 10 minutes.
3. Mix a teaspoon of lemon juice in some 4 tablespoons of yogurt and apply it on the scalp. Rinse after 20 minutes.
4. Use a hair mask prepared from fenugreek seeds. Soak 2 to 3 tablespoons of fenugreek in water for a few hours. Grind it and apply on scalp for about 30 minutes. Rinse off.
5. Mix one part of apple cider vinegar with three parts of water. Use this to rinse your hair.
6. Apply some crushed garlic, aloe vera gel, or tea tree oil for controlling dandruff.
7. Massaging with coconut oil will help control dandruff and moisturize the hair.
8. Massage with warm extra virgin olive oil followed by wrapping your hair in a warm towel and shampooing.
Complications and When Should You See a Doctor
Dandruff may get worse if fungus Malassezia increases in number. Consult a dermatologist if:
1. Dandruff does not get controlled in spite of frequent cleansing with over-the-counter shampoos.
2. Flakiness also spreads to eyebrows, ears, and eyelid margins (seborrheic dermatitis).
3. The scalp is red, swollen, or extremely itchy.
Dandruff is not contagious; it does not spread from one person to another.
Prognosis and Prevention
Dandruff cannot be cured. It can only be controlled. Prognosis of dandruff is usually excellent with quick relief from antifungal shampoos. Frequent shampooing is the best way to control dandruff.
Patterson JW. The spongiotic reaction pattern. In: Patterson JW ed. Weedon's Skin Pathology. 4th ed. Philadelphia, PA; Elsevier; 2016:chap 5.
Frequently Asked Questions about Dandruff
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