Dandruff: "It's Snowing"

by on February 1, 2013

Dandruff is a term commonly used to describe the flaking that often takes place on the scalp and sometimes the face. Most individuals mistakenly think that it is as a result of dry skin, poor hygiene and frequent shampooing. This misconception often leads to inappropriate and ineffective treatment. More recent research has shown that dandruff is a medical condition caused by the overabundance of a normally occurring scalp organism.


A more severe form of dandruff is due to a genetic condition known as seborrheic dermatitis or seborrhoea. In this condition, the turnover in skin cell production is faster than normal in affected areas. When this occurs, a lot of extra skin is shed resulting in the flakes seen. Another cause of severe dandruff is Psoriasis.

Dandruff usually begins anytime after puberty when the sebaceous (oil) glands that are linked to hair follicles come to life due to hormonal stimulation. Incidence is highest by age 40 years. These glands produce excess oil which is responsible for the greasy texture of dandruff and there is often associated inflammation leading to itching. There is a combination of rapid cell turnover and excess oil production.


There are factors that trigger seborrhoea such as stress, hormonal imbalances, neurological conditions and infections. Dandruff is very often caused by the body's reaction to a yeast-like fungus known as Pityrosporum ovale that naturally occurs on the scalp. The natural scalp-cell renewal process is accelerated and dead cells flake off faster when fighting this fungus. The severity is affected by stress, diet, hormones and climate.

Dandruff is a Medical and not a Cosmetic problem
Under normal conditions, P.ovale yeasts can live on the skin without causing any problems but when overgrowth of the organism occurs in response to stress, climatic change, hormonal changes, heredity and diet the response results in dandruff. The organism feeds off lipids in the skin and secretes enzymes that digest these lipids forming irritant fatty acids that lead to skin inflammation and tissue damage. The body's natural defense for fighting off this organism results in the flaking, scaling and itching symptoms of dandruff.

Treatment
The best way to treat dandruff is to tackle the several factors that contribute to its formation. A synergistic approach is aimed at killing the yeast and bacteria, exfoliating the build up of excess skin cells, slowing the rate of new skin formation and reducing inflammation.

Getting Rid of the Bugs

Ketoconazole is a very effective antifungal agent available as a shampoo. A popular brand is Nizoral which comes in the 2% prescription strength and the 1% over the counter preparation (Nizoral A-D). The cream is available and can be applied to the scalp and is useful in cases of facial dandruff. Ciclopirox is the active ingredient in the newest prescription antifungal shampoo, Loprox.

A good antibacterial shampoo is Carmol Deep Cleansing Antibacterial Shampoo which has added urea, a potent humectant, to treat flakiness. Zinc pyrithione is capable of killing both bacteria and yeast. It is available as a shampoo such as Neutrogena T/Gel or as a liquid that may be applied twice a day if daily washing is not convenient.

Exfoliate Dead Cell Buildup
Shampoos containing Salicylic acid (BHA) and glycolic acid (AHA) work to exfoliate the scalp and help remove excessive oil. Examples are Aqua Glycolic Shampoo, Ionil Plus Conditioning Shampoo Salicylic Acid Formula and Neutrogena T/Sal Shampoo.

Decelerate New Skin Cell Formation
Tar helps to slow down the process of rapid skin cell turnover by interfering with new cell formation. A lot of Tar containing shampoos are available an example is Neutrogena T/Gel Extra Strength Shampoo.

Reduce Redness and Itching
When the flare up is at its worst, topical steroids may be required to calm inflammation. These preparations, which are liquid drops in prescription and over the counter strengths, can be applied to the scalp twice a day until the inflammation subsides. These should not be used for more than two weeks at a stretch. Steroid shampoos such as prescription Capex could be used for about a week at a stretch and then once weekly to keep inflammation at bay. For cases due to Psoriasis where there is excessive dead cell buildup in thick crusts, a prescription potent steroid mask such as DermaSmoothe F/S Liquid may be applied at bedtime for 2-3 nights in a row with a shower cap then shampooed out in the morning.


Facial Dandruff
It is surprising for most people to imagine that dandruff could appear on the face. When it does, it is commonly found on the eyebrows and in between the brows, the nasolabial folds (the fold between the corner of the nose and mouth) and the beard area in men. Dandruff could appear on any part of the body that has hair. The appearance of dandruff is so unpredictable and periods of improvement may vary greatly.

Treatment of facial dandruff also needs a synergistic approach. A low dose steroid cream like DesOwen lotion could be combined with an antifungal cream such as Nizoral. Sulphur containing products exfoliate and are antibacterial. A prescription strength sulphur containing facial cleanser known as Ovace is available for the treatment of facial dandruff. Zinc containing cleansers are also useful.

It is important to note that Dandruff is controllable but not curable.

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Dr. Vivian Oputa is a Medical Practitioner and Specialist in Aesthetic Medicine, Surgery and Dermatology. She is the Medical Director of DermaCare Medical Ltd. and Clinical Director of the Clover Medical Company Beverly Hills, USA.

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