Definition

Dandruff, also known as pityriasis sicca or pityriasis simplex, refers to the shedding of skin scales from the scalp. It is considered the mildest form of seborrheic dermatitis. Dandruff is a prevalent issue worldwide, affecting individuals across all races and ethnicities. Approximately half of the global population has experienced dandruff to some degree. While not contagious or medically serious, dandruff can be uncomfortable and challenging to manage, leading to self-consciousness and potentially impacting social, psychological, and emotional well-being.

Causes

Dandruff may arise from several factors, including:

• Oily and sensitive skin
• Dry skin
• Overgrowth of the Malassezia fungus, which feeds on scalp oils (commonly seen in adults)
• Irritation due to hair products (contact dermatitis)
• Underlying skin conditions such as psoriasis and eczema

Dandruff is not a result of inadequate hygiene, though irregular hair washing may exacerbate it.

Risk Factor

Dandruff can affect almost everyone, but several factors may increase susceptibility:

• Age: Dandruff frequently appears in young adults and is less common in children, where it usually manifests mildly. The condition tends to peak around age 20.
• Gender: Dandruff is more prevalent in men.
• Certain Medical Conditions: Diseases affecting the nervous system, such as Parkinson's disease, or those weakening the immune system, such as HIV, may elevate the risk of dandruff.

Symptoms

The main symptom of dandruff is the appearance of white or grayish scales that detach from the scalp, becoming visible between hair strands and potentially falling onto clothing. These flakes are especially noticeable on dark clothing or in darker hair. Additionally, dandruff can occur on other areas like the eyebrows or mustache and is commonly accompanied by itching, particularly on the scalp.

Symptoms may intensify with stress or in cold, dry weather.

Diagnosis

Dandruff is typically diagnosed by a doctor based on a physical examination of the scalp and hair.

Management

Dandruff symptoms, including flaking and itching, can generally be effectively controlled. For mild cases, regular use of anti-dandruff shampoo often suffices to reduce excess oil and prevent the buildup of skin cells. If symptoms persist, shampoos with active ingredients can be used two to three times weekly for a month. However, if you have oily hair, limiting shampoo use to three times a week may be uncomfortable; in this case, you may alternate with regular shampoo on non-treatment days as needed.

In addition to shampoos, a variety of hair and scalp products with or without active ingredients are available in liquid, foam, gel, spray, ointment, and oil forms. Finding an effective regimen may require trying several products, and once effective, long-term use may be necessary.

If you experience increased itching or a burning sensation after using a particular product, discontinue its use immediately. For symptoms such as a rash, hives, or difficulty breathing, seek medical attention.

Common anti-dandruff shampoos include:

• Zinc pyrithione: Antibacterial and antifungal properties.
• Coal tar: Reduces the rate of skin cell turnover. Note: It can cause hair discoloration, especially in lighter hair, and may increase photosensitivity.
• Salicylic acid: Helps reduce scaling.
• Selenium sulfide: Antifungal properties. Follow instructions carefully and rinse thoroughly, as it may discolor hair and scalp.
• Ketoconazole: Antifungal properties effective against dandruff-causing fungi.
• Corticosteroids: Useful for controlling itching, flaking, and skin irritation.

If a particular shampoo initially controls dandruff but becomes less effective over time, consider alternating with another product. While relapses may occur after treatment, using an active ingredient shampoo at a reduced frequency can help prevent recurrence.

Always read the product instructions; some shampoos require a brief application period before rinsing, while others need immediate rinsing. If symptoms persist after several weeks of using medicated shampoos, consult a healthcare provider for possible alternative treatments, including stronger shampoos or steroid creams.

Complications

Dandruff seldom leads to complications. However, in some cases, dandruff may signal a more serious underlying condition, resulting in:

• Infection: characterized by redness, pain, or swelling.
• Persistent severe dandruff: unresponsive to standard home treatments.

In severe cases, visible dandruff may affect the individual’s self-image, influencing social, psychological, and emotional aspects, ultimately reducing their quality of life.

Prevention

To minimize the risk of dandruff and to treat dandruff, consider the following:

1. Managing stress
   Stress affects overall health and can make the body more prone to conditions like dandruff or exacerbate existing symptoms.
2. Eating healthy diet
   A diet rich in zinc, B vitamins, and specific types of fats may help prevent dandruff.
3. Maintaining scalp and hair health
   For those with oily scalps, daily hair washing may help manage dandruff. Gently massaging the scalp can loosen flakes, which should then be thoroughly rinsed away.
4. Avoid direct sunlight exposure
   Limited sun exposure may aid in controlling dandruff; however, direct sunbathing should be avoided to reduce the risk of UV damage and skin cancer. Spending time outdoors with appropriate sunscreen on the face and body is recommended.
5. Limiting hair-styling products. Styling products can accumulate on the scalp, increasing oiliness and possibly worsening dandruff.

When to See a Doctor?

Most cases of dandruff do not require medical treatment. However, consult a doctor if:

• Symptoms persist after one month of anti-dandruff shampoo use.
• Dandruff is severe, or the scalp is intensely itchy.
• The scalp is red or swollen.

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