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DANDRUFF - a patient's guide
Editorial Team
Overview
Dandruff is a mild skin condition, usually confined to
the scalp, that can cause irritation and embarrassment to
the sufferer. Treatment can be simple. Switching to a good
quality shampoo may solve the problem, and there are many
over-the-counter treatment shampoos. For more persistent
cases a doctor may advise hydrocortisone or coal-tar treatment.
Advice from a doctor should be sought if dandruff is persistent
or develops into sores or abscesses, as this could indicate
a more serious condition.
What is dandruff?
Dandruff is the common term used for white skin flakes
shedding from the scalp, or in some cases, other hair-covered
skin. Dandruff is not contagious and usually not serious,
although can be embarrassing and itchy.
Skin is naturally shed from the scalp, but in dandruff
sufferers it becomes noticable on the shoulders and causes
an itchy scalp. Seborrheic (seb-o-REE-ik) dermatitis is
the technical term for this common condition.
Dandruff is usually due to the overworking of the sebaceous
glands. These glands produce oil and help shed dead skin.
In the case of a dandruff sufferer, the sebaceous glands
are overactive, shedding more skin than usual.
Sometimes dandruff is caused by a naturally occurring
yeast fungus called Pityrosporum ovale. Some people have
more of this fungus than others, causing flaky scalp.
What are the symptoms?
Skin affected by seborrheic dermatitis is usually red
and greasy with a white or yellowish flaky scale. The most
common sites are the scalp but it can occur between the
eyebrows, along the sides of the nose, behind the ears,
in the external ear canal, over the breastbone, in the groin
area, and sometimes in the armpits. Most dandruff is due
to seborrheic dermatitis.
Related and similar conditions
Dandruff may also be caused by excessive dryness or by
psoriasis. A few people have both conditions, which makes
diagnosis difficult. Seborrheic dermatitis and psoriasis
can be difficult to tell apart.
Psoriasis tends to have a whiter scale, and affected areas
bleed fairly easily if plucked, picked or scratched. Patches
of psoriasis also tend to be thicker and more persistent.
Rarely, seborrheic dermatitis will become infected, a
condition known as impetigo.
Tinea capitis - scalp ringworm - may be mistaken for dandruff
in adults. This condition is uncommon after puberty and
when it appears on adults, the features different to those
occurring on children. Tinea capitis will not respond to
tradition dandruff treatments or antibotics. Lack of treatment
can lead to scarring and permanent hairloss, as well as
infection of others. The incidence of scalp ringworm in
children is on the rise in the United Kingdom and several
cases of adults - particulary those of Afro-Carribean descent
- have been eventually diagonised with this condition after
lengthy unnecessary investigations and treatments.
The vast majority of people with seborrheic dermatitis
have no associated conditions. Sufferers of Parkinson's
disease, spinal cord injuries and other neurological conditions
and AIDS can have outbreaks of seborrheic dermatitis.
How is dandruff treated?
Sometimes dandruff can be treated and prevented by using
a good quality shampoo such as those sold by hairdressers.
If dandruff does not disappear after a few weeks using a
good shampoo, an anti-dandruff shampoo may solve the problem.
Shampoos contain one of five active ingredients: salicylic
acid, coal-tar, zinc pyrithione, selenium sulfide and sulphur.
These shampoos are non-prescription and the ingredients
are approved for use by the United States Food and Drug
Administration (FDA). Well known over-the-counter brands
include Head and Shoulders, Denorex, Selsun Blue, Tegrin,
Sebutone or Neutrogena T/Gel or T/Sal.
If necessary, shampoo daily with these shampoos, lathering
well and making sure the lather remains on the scalp for
5 minutes before rinsing to allow the active ingredients
to work. Take care with tar-based shampoos as they can stain
light-coloured or grey hair and make the scalp more sun-sensitive.
Anti-dandruff shampoos can make the hair brittle and weak,
so use of a good hair conditioner is recommended.
When dandruff has cleared, begin using a good quality
shampoo and rotate the use of the anti-dandruff shampoos
as necessary. Some sufferers may need to try a range of
anti-dandruff shampoos to gain best results, or rotate between
various products, as continued use of one product seems
to lose effectiveness over time.
A newer anti-fungal product containing Ketoconazole was
approved in 1997 by the FDA in USA for over-the-counter
sale in the form of Nizoral A-D shampoo. This medication
can be helpful for particularly difficult cases, according
to some pharmacists.
It should be noted there has been some concern over the
use of Ketoconazole when using particular cholesterol-lowering
drugs known as statins. Both medications compete for the
same metabolism pathway via the liver and when Ketoconazole
is taken orally, the toxicity of the statin can be increased.
Theoretically, there may be a small effect using Nizoral
shampoo as a topical product on the skin, so use of this
product should probably be avoided if a statin is used,
or doctor's advice sought.
If dandruff or itchy scalp persists for 3 weeks or the
scalp becomes irritated or severely itchy, seek advice from
a doctor. Prescription medication or creams may be able
to help when over-the-counter shampoos do not. For instance,
if shampoos aren't working an application of 1 % - 2.5 %
hydrocortisone cream once or twice a day may be effective.
If this too proves ineffective, a coal-tar preparation left
on overnight may work. Sometimes a stronger corticosteroid
preparation may be recommended.
A patchy, inflammatory scalp disorder not responding to
usual treatments should have mycological samples sent for
laboratory analysis to rule out Tinea capitis.
How can dandruff be prevented?
Dandruff may begin in infancy as cradle cap, then disappear
until adolescence when oil glands become active. It can
persist into old age on and off. Although it may never be
cured, it can be managed.
Use a good quality shampoo.
Wash hair frequently, especially if dandruff is a problem.
Wash hair with a dandruff treatment shampoo, lathering
well and ensure lather remains in hair for 5 minutes before
rinsing to ensure effectiveness.
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