Dandruff

Symptoms: Itchy scalp, flakiness, red patches on the scalp, white oily flakes

Causes: Dry skin; irritated, oily skin; malassezia (yeast-like fungus)

Risk Factors: Age, certain illnesses, being male

Prevalence: Affects nearly 50% of the general adult population worldwide. In India, 70% population suffer from dandruff.

Severity: Mild to severe

Which doctor to consult: Trichologist, Dermatologist

Overview:

Dandruff is a common skin condition which causes flaky and itchy skin on the scalp. It is not serious or contagious. However, it can be embarrassing and difficult to treat. A more severe form of dandruff called Seborrheic dermatitis causes skin inflammation.

Dandruff may be caused by dry skin, irritated, oily skin, Malassezia (yeast-like fungus) or sensitivity to hair care products. This condition may worsen in the winter. 

Dandruff is more common in males than in females. Typically, dandruff starts in early adulthood and lasts into middle age. It doesn't mean older adults don't get dandruff. It may last a lifetime for certain people.

Mild dandruff can be treated by using a gentle shampoo daily. If that isn't effective, a medicated shampoo might be useful. Some home remedies also help to treat dandruff.

Symptoms:

The symptoms of dandruff may be severe if you are stressed and worsen in cold, dry seasons. The signs and symptoms of Dandruff include:

• Itchy scalp

• White oily flakes

• Dry flakes on scalp, hair, beard, moustache or eyebrows

• Red patches on the scalp

• Crusty, scaly scalp in infants with cradle cap

• Hair loss

Causes:

Dandruff may have various causes, including:

• Skin oil (sebaceous secretions or sebum)

• Dry skin

• Malassezia (a yeast-like fungus) feeds on the oils found on most adult scalps.

• A variety of personal hygiene products can result in contact dermatitis, a condition that causes red, itchy scalp.

• Other skin conditions like eczema and psoriasis

• Too much pressure on the scalp from hats

• Exposure to dirt or dust

• Inadequate shampooing can lead to a build-up of skin cells that produce flakes and itchiness or excessive shampooing and over-drying of the scalp.

Risk Factors:

Although almost anybody can get dandruff, some factors can increase your risk:

Age: Typically, dandruff starts in early adulthood and lasts through middle age. It doesn't mean older adults don't get dandruff. It may last a lifetime for certain people.

Being male:  Dandruff is more common in males than in females.

Certain illnesses: Parkinson's disease and other diseases that affect the nervous system, may also increase the risk of dandruff. HIV infection or a weakened immune system also increases the risk.

Possible Complications:

Dandruff rarely causes complications, and most people do not need to consult a doctor. But occasionally, dandruff could point to a more serious illness.

• It might indicate overgrowth of a fungus known as Malassezia, which is common on people's scalp but does not produce any symptoms. 

• It might slow down the growth of your hair. 

• It indicates a microinflammation, which is easy to miss because there are no easily noticeable symptoms.

Prevention:

You may reduce the chances of dandruff by following the necessary steps to enhance your hair health.

Practice good hygiene: Try your hardest not to touch your scalp, especially if it is itchy already. Irritation can get out of control when scratched. In addition to adding dirt to the mix when you touch and scratch, this can worsen dandruff.

Find the right shampooing balance for your scalp: To keep oils at bay, shampoo your hair frequently enough. However, avoid using too many products on your hair as this might irritate the scalp.

Reduce stress: For some people, stress can worsen dandruff. Although stress does not directly cause Malassezia to grow on your scalp, stress can weaken your immune system, which is precisely what it does to your body. Relax and do your scalp a favour. Consider going for a healing walk or doing some yoga. 

Breathe fresh air: Studies indicate that frequent outside exposure, particularly in areas with fresher air, can help minimize sebum accumulation on the scalp.

Massage your scalp: This may also prevent symptoms of dandruff.

Brush those locks: Brush your hair when it is damp (not wet) at least two times a day.

Limit friction: Limit the wearing of scarfs and hats, especially those of synthetic materials.

When to see a doctor?

Most people with dandruff don't need to see a doctor. However, consult a doctor/dermatologist:

• If consistent usage of dandruff shampoo fails to help your condition.

• If your dandruff is extremely bothersome or stubborn, you may have a fungal infection, eczema, or psoriasis.

• If the itching does not go away or if your scalp becomes swollen or red.

Diagnosis:

A doctor can often identify dandruff simply by looking at your hair and scalp. Take the bottles of any new hair care products you have started using to your visit, or be ready to tell your doctor about them as this will help them figure out what is causing your dandruff.

Treatment:

The most effective way to get rid of dandruff is to use dandruff shampoo and scalp treatments. 

Follow instructions: As there are many varieties of dandruff treatment shampoos and each has its unique instructions, it's important that you carefully read and follow the instructions of the product of your choice. Make sure you understand whether you should wash out the shampoo immediately or whether you should leave it on your hair for a specific period of time before washing.

Different skin and hair types need different care: African Americans might need to wash with a dandruff shampoo only once a week. To get the best results, Asian Americans and white individuals might need to switch between different dandruff shampoos with different ingredients. It might be preferable to consult a board-certified dermatologist, who can advise you on the best products for your skin type and hair type, as well as how often to apply them.

Antifungals: These drugs work by damaging the membrane of the fungus responsible for causing dandruff. Examples include: 

• Ketoconazole 

• Zinc pyrithione

• Selenium disulphide

• Piroctone olamine

• Ciclopirox

Exfoliating agents: 

• Coal tar- It inhibits the formation of new skin cells and causes the skin to shed its outermost layer of dead cells.

• Salicylic acid- It is an approved anti-dandruff active that is also found in a lot of cosmetic anti-dandruff shampoos sold all over the world.

Home Remedies:

The following choices can be considered if you wish to try some natural remedies before turning to medication solutions:

Baking soda: Gently massage it into your scalp in the shower and rinse your scalp after a few minutes.

Coconut oil: Rub 3-5 teaspoons into your scalp and let it sit for 1 hour. Then, shampoo and rinse your hair.

Apple cider vinegar: Mix 1/4 cup with 1/4 cup water. After applying it to your hair for 15 to 60 minutes, rinse it out. Do this two times a week.

Aloe vera: Apply to your scalp before shampooing.

Lemon juice: Apply two teaspoons to your scalp, then thoroughly rinse. Next, apply another teaspoon diluted with one cup of water. Do this daily.

Olive oil: Apply 10 drops to your scalp. Cover your head with a shower cap and leave overnight. In the morning, shampoo and wash your hair.