Dandruff is a perennial problem that upsets and disturbs the young and the old alike. It is more prevalent in the youth (50-70%) than in the old and hence it is considered as the problem of the youth.
Why do we get dandruff?
The cells of the epidermis (outer cells of our skin) wear off and new cells take their place. This is a continuous and natural biological process. Same is the case with the cells of the scalp also. Usually, it takes 3-4 weeks for a cell to wear off and a new cell to take its place. Generally, the old and worn out cells fall out at the time of bathing. So, it is not a serious matter to bother about. But, sometimes this exfoliation of dead cells on the scalp, because of some problem or the other, is alarming. This is what we call ‘dandruff’. The scalp of out head is covered by a crop of hair; and on the scalp, there are numerous sebaceous glands oozing out sebum (oil-like substance) continuously. The numerous dead cells (dandruff) and the oily substance make the head a messy affair.
There are two types of Dandruff
Dry type: The exfoliation is dry and the scales are silver colored.
Oily-type: the hair appears oily and messy because of the scaly dead cells and the sebum.
When the sebaceous glands in the head are excited for some reason, sebum is secreted in large quantities giving rise to dandruff.
The effect of hormones is more intense when one is young. The sebaceous glands become hyperactive and produce sebum excessively. Malassezia furfur, a naturally present fungus on the scalp, acts upon the sebum and converts it into oleic acid. Oleic acid irritates the scalp tissue, and this results in the formation of new cells in excess. So, the dead cells also increase. When we scratch our head, the dead cells, known as dandruff, drop on the shoulders as white scales. It is often mistaken that the acne on the shoulders is due to dandruff.
Dandruff could be a hereditary problem too.
Other factors of importance are tension and anxiety, the sebum glands are overstimulated, and this aggravates the problem of dandruff.
Some people use shampoo too frequently and do not care to wash it out thoroughly. In such cases, the chemical substances in the shampoo remain on the scalp and excite the turnout of the cells. This leads to dandruff. It is better to avoid using chemicals and creams. If unavoidable, care should be taken to wash the head thoroughly.
Combing the hair with undue pressure, twisting the hair for curls and using driers also increase the turnout of cells, leading to dandruff.
There is not a well-established debate that certain food items are responsible for causing dandruff. One thing can be said surely that consumers of oily and spicy foods are prone to get dandruff.
Dandruff is found to be more prevalent in patients with neurological problems like Parkinsonism.
When there is a sudden onset of cold climate and during winter, the scalp dries up, accumulating scales. This results in the gradual development of dandruff and itching.
The effect of Androgen hormones is high in the baldies and this causes dandruff in them in spite of the absence of hair.
The problem of dandruff is more prevalent in men than in women because the sebum glands are more in men. The effect of hormones on the glands in the head is also more in men than in women.
Ignoring Dandruff leads to complications
Dandruff should not be neglected. If neglected, it spreads to eye-brows, eye-lids, mustache, behind the ears, even chest and other parts. When we scratch at the site of dandruff, the bacteria that are naturally present on our skin find entry into the follicles and cause infection (folliculitis). This leads to hair-fall. Dandruff is not a primary cause of hair fall, but severe and neglected dandruff irritates the hair-follicles resulting in increased hair-fall. Of course, hair grows again when dandruff is controlled.
So, it is necessary that one should keep all these repercussions in mind and get dandruff treated as early as possible.
How far can the treatment be successful?
The appearance of dandruff is a part of body’s natural physiological process. And hence, it may not be possible to root it out completely. But, if dandruff is caused by excessive use of shampoo, pressure on mind etc., it can be treated successfully by identifying the root-cause and changing one’s habits and lifestyle. Better ways of dealing with dandruff are available now than before.
If dandruff is moderate, taking bath with anti-dandruff shampoo every alternate day will yield good results. ‘Zinc pyrithone’ is generally the main ingredient in all the anti-dandruff shampoo preparations. Its anti-fungal activity and tendency to stop the multiplication of cells will help controlling dandruff to a great extent. If there is no success with this, medicated shampoo should be used on the advice of a doctor.
The medicated shampoo products generally contain coal tar, salicylic acid, sulfur, selenium sulfide etc. Shampoos containing ketoconazole, Cyclopiroxy-olemin and other substances have been introduced in the market They are effective against not only fungus but also spread of dandruff. 1% Ketoconazole is there in general anti-dandruff shampoos, while it is 2% in the medicated ones. The latter yield better results.
Corticosteroid shampoos are prescribed if there is intense itching. Shampoos with a combination of corticosteroid and Ketoconazole are prescribed if there is severe dandruff and intense itching. Such preparations will control the inflammation and the fungus to reduce dandruff gradually. Besides using them, applying ointment of Tacrolimus will be of considerable benefit in stimulating the immunity system. The ointment should be applied at bedtime and a thorough bath should be given in the next morning.
Hair should not be washed immediately after applying a medicated shampoo. Shampoo should be applied to the wet hair and a 5-minute gap should be allowed for the medicine to act upon dandruff and then the hair should be washed thoroughly. Doing so, twice a week is enough if the problem is moderate. Depending upon the severity, taking the treatment on alternate days or even every day for 15 days is advised. The frequency is to be gradually tapered down to twice a week and then once a week for a period of 6 weeks. Using the treatment for more than 6 months without a doctor’s prescription is not at all advisable. Later, the medicated shampoo should be applied occasionally only when dandruff erupts.
Appearance of scaly flakes dos not necessarily indicate dandruff. Certain other problems like Psoriasis also present this symptom. Thick scales appear in patches here and there on the head and when scratched white powdery substance falls off. There is no itching. This condition can be suspected as Psoriasis. Dandruff is not limited to patchy sites. Moreover, there will be itching and falling off of flakes.
Lice may be another cause for aggravation of dandruff in girls.
‘Pemphigus foliaceus’, with its characteristic small red lesions, may also appear as dandruff, which in fact, is not connected with dandruff. Therefore, any problem that appears like dandruff persists for more than 3 months, it is better to consult the doctor to rule out Psoriasis.
Tips to control dandruff
- Applying a mixture of lukewarm water and two spoonfuls of lemon juice and a thorough bath after half an hour.
- Applying sour curds, the yolk of the egg to the head and bath after some time.
- Applying a mixture of apple vinegar and water in the ratio of 1:3 and a thorough bath after half an hour.
- Applying lukewarm hair oil and taking bath after some time.
- ‘Tea-oil’, available in Australia so far is now available in India. Applying this Tea-oil in 5% concentration and taking bath after half an hour
- Applying paste of gooseberry.
- Once dandruff is controlled with prescribed medication, it is better to prevent it using these house-hold remedies.
If you do not want to suffer from dandruff, you should change your habits and way of living
How to manage the situation?
- Reduce mental pressure and tension.
- Take frequent head-bath.
- Avoid using strong or highly concentrated shampoos.
- Reduce applying sundry hair-creams and avoid ‘styling of hair’.
- Exposure to sunlight now and then is beneficial.
- Fresh fruits and nutritious food will be of considerable help.
- People with ‘dry type of dandruff’ can apply hair oil in all seasons except in summer.
Dandruff in infants
Infants may also suffer from dandruff. The sebaceous glands are stimulated by the hormones released in the mother during pregnancy resulting in unwanted cell-division and dandruff in infants. Dandruff in infants is called ‘Cradle cap’. It disappears after a year of their birth. Care should be exercised while using ‘Baby shampoos’ and shampoos like ‘Povidine – iodine anti-dandruff shampoo’.
If dandruff is associated with other problems like uncontrollable diarrhoea, red spots on the body, improper growth etc., consulting the right physician is mandatory to rule out any problems of immunity like HIV infections.