DandruffAlso known as pityriasis capitis
Dandruff is a common hair problem that needs no introduction. It affects around 50% of people worldwide at some point in their life, irrespective of their gender and ethnicity.
Dandruff is a scalp disorder which causes the scalp to flake and/or itch. The dead cells on the scalp tend to stick to each other due to surface debris and oil on the scalp. This in turn leads to flakes with itchy scalp and also causes the hair to shed at a faster than normal rate.
Dandruff is seen to mostly occur between puberty to middle-age as this is the phase when the sebaceous glands are most active. The severity of dandruff may fluctuate with the season but it usually worsens during winter.
If left untreated, it can cause fungal infections of the skin & may also lead to severe hair fall. The common treatment options for dandruff include use of home remedies and medicated shampoos.
- All age group
- Both men & women
- Seborrheic dermatitis
- Scalp folliculitis
- Head Lice
Symptoms Of Dandruff
Dandruff is a common scalp disorder characterised by:
Flaky white to yellowish scales on the scalp
Itching of the scalp
Dry or oily scalp
Flakes due to dry scalp tend to be smaller and whiter. Dandruff flakes are larger and usually yellow-tinged due to oily scalp.
Signs your dandruff may be severe:
Large areas of redness or swelling on the scalp
Severe itching and worsened flakes over time
Having symptoms even after using anti-dandruff shampoo for a month
Causes Of Dandruff
The causes of dandruff vary from person to person, but it is usually a result of improper handling of hair and scalp. According to experts, the cause of dandruff is rapid maturing and shedding of scalp cells precipitated by excessive oil secretion.
Broadly speaking, the causes can be categorised into:
1. Microbial factors
A) Fungal infection
Malassezia, a fungi, is one of the leading causes of dandruff. It is known to stimulate the enzyme lipase which is responsible for the production of saturated fats and unsaturated fats. While saturated fats aid in the growth and division of the fungal cells, unsaturated fats are responsible for skin inflammation and irritation. Moreover, it also alters the normal shedding of the dead cells leading to visible white flakes.
B) Bacterial infection
Bacteria that can be found on the scalp and may lead to dandruff include Propionibacterium acnes and Staphylococcus epidermidis.
2. Non-microbial factors
Oily or irritated skin/hair
Poor hair hygiene
Use of hair cosmetics/tools
Scalp disorders like psoriasis and eczema
Extreme weather conditions
Risk Factors For Dandruff
You are more likely to have dandruff if:
Dandruff usually begins during teenage years and continues through middle age.That doesn't mean older adults don't get dandruff. For some people, the problem can be lifelong.
2. Being male
Dandruff is more prevalent in males than in females.
3. Certain chronic illnesses
Parkinson's disease and other diseases that affect the nervous system also seem to increase risk of dandruff. So does having HIV or a weakened immune system.
4. Other conditions
Stress and fatigue
Your scalp feels oily
You experience intense itching even when the scalp does not feel dry
Your hair looks greasy at most times
Not brushing your hair properly
Leaving oily hair unattended
Using harsh shampoos
Using styling tools too often
Diagnosis Of Dandruff
Dandruff is diagnosed by a simple physical examination of the scalp. You may even be asked a few questions about your hair care routine and symptoms. 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 appropriate treatment. There are no blood tests or imaging tests to diagnose dandruff.
Prevention Of Dandruff
By taking adequate measures to improve hair health, you can minimize the chances of dandruff.
Cut down on high sugar foods, fats and alcohol
Develop a hair and scalp care routine according to your hair type. If you tend to have an oily scalp, frquent shampooing may help prevent dandruff. Gently massage your scalp to loosen flakes. Rinse thoroughly. If your hair tends to be dry and your scalp is sensitive, shampoo less frequently and condition your scalp in between washings.
Limit hair-styling products. Hair-styling products can build up on your hair and scalp, making them oilier.
Brush your hair often to improve circulation in the scalp.
Do not share combs
When going out, cover your hair as dirt and grease aggravates the problem
Specialist To Visit
If you have dry and itchy scalp or white flakes on your scalp, then do consult a doctor to treat your condition. The best doctor to visit for your skin and hair related problems are:
Dandruff may get worse if fungus Malassezia increases in number. Consult a dermatologist if:
Dandruff does not get controlled in spite of frequent cleansing with over-the-counter shampoos.
Flakiness also spreads to eyebrows, ears, and eyelid margins (seborrheic dermatitis).
The scalp is red, swollen, or extremely itchy.
Treatment Of Dandruff
In most patients, dandruff can be controlled by daily washing with gentle anti dandruff shampoo. If your dandruff is severe, the doctor may prescribe medicated shampoos that contain chemicals such as Zinc Pyrithione, Selenium sulphide, Ketoconazole, Coal Tar and Salicylic Acid.
These treatment options are aimed at treating the cause of the dandruff and managing the symptoms.
1. Antifungal agents
As the name suggests, this class of drugs are aimed at treating the fungus which is responsible for the dandruff. Most of these drugs work by affecting the membrane of the fungus which leads to death of the microbes thereby aiding in the treatment. Examples of this class of drugs include:
Zinc Pyrithione helps to prevent itching and flaking
Ketoconazole acts as a broad spectrum antifungal agent by disrupting the membrane function
Climbazole works by hindering the normal functioning of the fungal cell membrane
Selenium Sulphide based shampoos can discolor the hair and scalp.
Clotrimazole inhibits the synthesis of ergosterol (a type of fat) thereby aiding in the treatment
Piroctone Olamine inhibits the degradation of sebum triglycerides to oleic acid and arachidonic acid which are responsible for inflammation and itching
2. Anti-proliferative agents
Coal tar is used in the form of tar based shampoos and it is one of the most common examples of this class of anti-dandruff chemicals. It contains more than 10,000 of chemical compounds that inhibit proliferation (division of the microbes) and inflammation. This is mainly used to relieve the symptoms of dandruff.
It acts as a keratolytic agent which is known to cause the skin to shed dead cells from the top layer by increasing the moisture in the scap. As it prevents clumping of the dead cells together it helps to clear dandruff from the scalp. Salicylic acid is one of the most common examples of keratolytic agents.
These drugs are available in various forms such as shampoos, lotions/applications, creams, herbal oils and gels.
Home Care For Dandruff
By making small changes in your lifestyle, you can get rid of dandruff effectively. Here are some effective ways to manage dandruff:
1. Brush your hair regularly
Brushing your hair ensures that blood circulation in your scalp is maintained. When you brush your hair, you remove dead cells from your head. But brushes with sharp ends will cause swelling and reddish patches in your scalp. Use a paddle brush. Brushes that have balls in the ends are even milder.
2. Avoid harsh shampoos
Certain chemicals in shampoos can lead to dry and irritable skin and precipitate itching and dandruff. Choose a mild herbal shampoo that is gentle on the hair and has a compatible pH balance.
3. Avoid styling tools
Heat and chemicals make your hair weak and damage the scalp. Straightening, blow-drying, and perming or any kind of artificial heat can cause irreparable damage and precipitate dandruff.
4. Pick an anti-dandruff shampoo
Some commonly recommended anti-dandruff shampoos available over the counter are Pyrithione zinc shampoos, Tar-based shampoos and Ketoconazole shampoo. It is recommended to use these shampoos daily however as dandruff gets better, alternate it with some other shampoo to avoid loss of hair health.
5. Eat healthy
Enrich your diet with optimum portions of green vegetables, fish oil, lean proteins and fruits. Include green leafy veggies such as broccoli, kale, lettuce to your daily diet. It encourages and improves your skin, hair, nails and overall health. Lean proteins (eggs, nuts, beans) help in building healthy skin and hair. So add these to your daily servings in some or the other form.
6. Get a little sun
Sunlight may be good for controlling dandruff. But because exposure to ultraviolet light damages your skin and increases your risk of skin cancer, don't sunbathe. Instead, just spend a little time outdoors. And be sure to wear sunscreen on your face and body.
Complications Of Dandruff
Dandruff should not be taken lightly because
It may be pointing towards overgrowth of a fungus (called Malassezia) which despite being present on the scalp of most people does not cause any symptoms
It can slow down your hair growth
It denotes a microinflammation, which might be easily overlooked as there are no readily observable symptoms.
So if you have dandruff or itchy scalp with white flakes, do consult a dermatologist to know the cause of it and get it treated before it becomes severe in nature.
Alternative Therapies For Dandruff
Home remedies for dandruff
1. Vinegar: To clean your scalp of dead skin and fungi, mix half a cup of white/apple cider vinegar with equal volume of water and pour the mixture over your hair. Leave it on for 10 minutes, then scrub and rinse off with a mild shampoo or just water.
2. Fenugreek (Methi): Make a paste of two tablespoons of fenugreek powder and half-cup water. Apply on the scalp and leave it in for 30-45 minutes; rinse off with a mild shampoo to strengthen and clean your hair thoroughly.
3. Lemon (Nimbu): Massage the juice of two lemons into the scalp and then rinse off with a mixture of lemon juice and water. Besides its antifungal properties, the acidity of the lemon will restore the natural pH balance of the scalp.
4. Salt/Baking soda: Generously sprinkle some salt (table or Epsom)/baking soda on the scalp and a massage gently to exfoliate the scalp. Rinse off with a mild shampoo for a clean look.
5. Neem: Add about two handfuls of neem leaves to water (half litre), bring it to a boil and then let it soak overnight. Wash your hair with strained liquor. Neem is antifungal and relieves itching.
6. Curd (Dahi): Apply fermented curd on the scalp and leave it in for about an hour. Then rinse off with shampoo. The acidic nature of curd will fight dandruff and act as a conditioner as well.
7. Orange (Santra) peel: Apply a mixture of orange peel and lemon on the scalp and wash off after 30 minutes. The acidic nature of the mixture conditions the hair and combats dandruff.
8. Honey (Sahed): Use 1/4 teaspoonful of water mixed with 1 tablespoon honey to massage the scalp for 2-3 minutes and rinse off after 3 hours for shiny dandruff free hair.
9. Coconut (nariyal) oil and camphor (kapoor): Take 2-3 teaspoons of warm coconut oil and dissolve a pinch of camphor in it. Massage gently on the scalp at night. Wash your hair in the morning with a mild shampoo. Repeat it once or twice a week.
10. Tea tree oil: Mix tea tree oil with water in the ratio (1:3) and spray it on your scalp. Pat the excess of the water but do not rinse it off.
Frequently Asked Questions
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- Narshana M and Ravikumar P: An overview of dandruff and novel formulations as a treatment strategy. Int J Pharm Sci Res 2018; 9(2): 417-31.
- Manuel F, Ranganathan S. A new postulate on two stages of dandruff: a clinical perspective. Int J Trichology. 2011;3(1):3-6.
- How to treat dandruff. Scalp. American Academy of Dermatology (AAD).
- Ranganathan S, Mukhopadhyay T. Dandruff: the most commercially exploited skin disease. Indian J Dermatol. 2010;55(2):130-134.
- Sheth U, Dande P. Pityriasis capitis: Causes, pathophysiology, current modalities, and future approach. J Cosmet Dermatol. 2021 Jan;20(1):35-47.
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