Dandruff : What you need to know.

Dandruff is part of a common dermatological condition called “Seborrhoeic dermatitis” with dandruff being the most common & mildest form of the disease. It is said that 50% of the adult population worldwide are affected by it.

The title of an article published in the Indian journal of dermatology read: Dandruff: The most commercially exploited skin diseases” which is aptly put. We’ve all seen the amount of commercially available anti-dandruff shampoos out there in the market. Their marketing strategies, using celebrities to endorse products with the labels such as “get rid of dandruff”, “100% dandruff free forever” etc. What they fail to mention is that, one will only be dandruff free, if one uses the product forever as well.

That being said there is still no clear explanation of why it occurs nor is there is cure for it yet. ( Yes, its frustrating that most dermatological conditions still don’t have any cure, but science is evolving, and so far dandruff is completely manageable)

So what causes dandruff?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4852869/

How does it present?

Seborrhoeic dermatitis can present in infancy, and is thought to be due to the maternal androgens (male hormones) that stimulate the sebaceous glands (oil producing glands) to produce more sebum. This commonly presents as “cradle cap” in infants. The condition is self limiting, which usually resolves with just regular bathing and with application of moisturisers. Medicated shampoos containing 2% ketoconazole may be required for persistent cases.

Yellowish greasy scales can be seen adherent to the scalp

Dandruff

In adults, it usually starts at puberty. In it mildest form i.e dandruff one may experience itchy oily scalp, with easily removable dry white flakes. These flakes are the upper layers of the skin (stratum corneum) that are being shed off and not dirt. It has been observed that patients with dandruff do experience an increase amount of hair loss as well.

Picture Source: https://www.dailypioneer.com/2017/impact/6-easy-ways-to-control-your-dandruff.html

Seborrheic dermatitis

Coming to the more serious form called seborrheic dermatitis, here,inflammation (red inflamed skin) is marked and the condition is not limited to the scalp. Areas with high amount of sebaceous glands may be involved as well such as behind the ears, around the nose and mouth, forehead, chest. Patient will present with recurrent flares of such red itchy skin with greasy yellow scales. These flares are usually precipitated by emotional stress.

Now lets see how it can be managed.

Firstly its important to remember that there is no one time cure for dandruff or seborrheic dermatitis.

Dandruff may occur in individuals who have never experienced it before, if the conditions mentioned as the causes find a favourable environment and it may also resolve once such conditions are removed.

Avoid hair oil application, this can favour the over growth of the yeast Malassezia (or if that’s something you’re used to doing and do not want to give that up, then strictly avoid applying to the scalp & apply the oil only to the hair)

Use shampoos specially labelled “anti-dandruff”, but remember not to blindly trust labels, and look for ingredients such as anti-fungals (active against the yeast) like 2% ketoconazole, selenium sulfide, ciclopirox olamine, and 1% zinc pyrithione (helps regulate sebum production). Salicylic acid helps remove the excess sebum and helps exfoliate the flakes better.

Use 2-3 times per week for at least a month.

Massage gently into the scalp, leave for ~ 2-3 mins and rinse it off. Continue using such shampoos once a week for maintenance even when the dandruff has cleared. This will help prevent recurrence.

Conditioners can be used as usual, which is to be applied only to the hair shaft avoiding the scalp.

  • Bioderma Nodé DS antidandruff shampoo contains Zinc pyrithione, & salicylic acid as active ingredients. It also contains sodium shale oil sulfonate (extract from fine grained sedimentary rocks), which is approved in Europe for its anti inflammatory properties. This shampoo helps remove the flakes from the scalp, helps those with the oily sclap and also acts on the yeast. Advantage: Effectively controls dandruff, does not dry the hair out and has a neutral smell. Disadvantage– Expensive ~ Rs 1400, some people may actually prefer some scent to their shampoo.
  • Neutrogena T/Sal shampoo : Also conatins salicyclic acid as active ingredient. Ideal for oily scalp. Price – ~1300

Over the counter affordable anti dandruff shampoos containing zinc pyrithione.

Loreal professional anti dandruff shampoo contains zinc pyrithione with salicyclic acid. MRP – Rs 590

Scalpe + shampoo contains both ketoconazole and zinc pyrithione. Also does not dry out the hair.

Dove anti-dandruff shampoo contains zinc pyrithione but also ingredients that helps with hydrating the hair.

When to see a dermatologist?

When the skin on your scalp, face etc is red, itchy with yellowish greasy scales which in this case the seborrheic dermatitis may require a course of topical steroids to bring the inflammation down.

When the redness extends beyond the hairline and the scales are firmly adherent to your scalp,this could be a form of psoriasis instead.

Picture source:https://www.webmd.com/skin-problems-and-treatments/psoriasis/ss/slideshow-scalp-psoriasis-tips

When you notice your child having patches of hair loss, with either pustules (boils) or scaling, in this case, examination by a dermatologist is necessary to rule out fungal infection.

Pic source:https://www.webmd.com/skin-problems-and-treatments/picture-of-ringworm-of-the-scalp-tinea-capitis

Here are some questions I’ve received on this topic.

1. Could you suggest shampoos for dandruff that does not cause hairfall?

The shampoos are not the cause of the hair loss but its rather the dandruff that causes it. And list of shampoos are given above.

2. Does dandruff cause hair fall? And how to promote thick hair growth?

Yes, individuals with dandruff do experience from more hair fall. Its been noticed that they have 100-200 hair fall per day compared to the normal 50-100 per day

Hair thickness is determined by your genetics, there is nothing that can change that. However for a person with male or female pattern hair loss, the terminal hair (the thick black hair on the scalp) is turned to vellus hair (thin, fine hair normally seen in other other parts) which gives the impression of thinning of hair. Its always best to get this examined by a dermatologists, since the treatment for this is completely different.

3. Does dandruff worsen in pregnancy?

Yes, it can. As you can see from the explanation on the causes of dandruff, increase activity of the sebaceous glands (which in turn produce more oil, and facilitates overgrowth of the yeast) is one of the main factors in causing dandruff. Sebaceous glands activity also increases during pregnancy especially during the 3rd trimester due to increase level of the hormones -progesterone and androgens. But fear not!! This is completely reversible post delivery. And the anti-dandruff shampoos are completely safe to be used during pregnancy.

4. Solution for oily scalp and dandruff that is not getting controlled?

Check out the shampoos I mentioned earlier containing salicyclic acid (available ay nykaa, amazon) . This should help control the excess sebum production in your scalp. Use a combination of shampoo, for example, one containing salicylic acid on one day and one containing anti-fungals on the other hair wash day. You could also increase the frequency of shampooing, like 3 times times a week with these medicated shampoos and 2 times a week for maintainence.

5. I also have a very oily scalp, and I get too many DIY suggestions from people and I don’t know which one to believe.

Management of oily scalp, check answer on question no 4. As for the DIY lemon juice, onion juice, daily hair washes etc, its all time consuming, messy, requires a lot of effort and all un-necessary for something that is not even scientifically proven. Just stick to the advises that is known to work, follow the instructions as mentioned above and you’ll be able to manage your condition in no time.

Featured picture source: Unsplash