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Dandruff

Hair loss and Dandruff

Most people have had the experience, their scalp is itchy and they are afraid to wear anything black, living in fear of another dandruff attack.

However it does not have to be like that, this is one cosmetic inconvenience that can be easily overcome.

There are many good products available, so you should easily be able to clear up the problem.

Dandruff and related conditions may seem at first easy enough to prevent with one of the modern-day shampoos, however, the problem is often much deeper than just a flaky scalp.

Very often dandruff or a flaky scalp can be more socially unacceptable than body odour or bad breath.

Some people feel that a lack of cleanliness causes dandruff, but this is far from the truth.

While dandruff does not actually cause hair loss, you can have a full head of hair and still have dandruff, it should be cleared up if possible, as a clean scalp can only help prevent hair loss.

Dandruff is a mild inflammation of the scalp causing flaking.

These flakes are often extremely visible on the hair and often fall on the shoulder showing high visibility of the problem. There is sometimes itching or soreness and the scalp can feel rather tight.

What is dandruff?

Dandruff is the most common condition affecting the scalp.

It is a mild skin condition, usually confined to the scalp, which can cause irritation and embarrassment to the sufferer. Treatment can often be simple.

Dandruff is the common term used for white skin flakes shedding from the scalp, or in some cases, other hair-covered skin.

Although dandruff is not contagious and usually not serious, it can be embarrassing and itchy.

Dandruff can happen at any age and is found in people between the ages of 12 and 80, however, the condition mostly occurs after puberty, usually between the ages of 20 and 30 and usually affects males more often than females.

A form of dandruff known as cradle cap occurs in newborns and infants

It is thought that as many as 90% of the population will at some point in their lives have a form of dandruff, but there is still a lack of total agreement about this condition.

Changing to a good quality shampoo may solve the problem, and nowadays there are many over-the-counter treatment shampoos.

For more persistent cases a doctor may advise hydrocortisone or coal-tar treatment.

It is often found that the problem with dandruff is worse in the winter months and better in the summer, this is thought to be caused by changes in humidity.

The skin cells on the scalp are constantly renewing and the old cells get pushed to the surface by the new ones. If you have dandruff, the process of skin renewal, or skin turnover, speeds up to twice the normal rate, hence a greater number of dead cells are shed.

The scalp becomes scaly and the skin cells shed and collect in clumps.

Dandruff responds very well to treatment, but will commonly recur if treatment is stopped.

Dandruff is believed to be associated with an overgrowth of a fungus commonly found on the skin and scalp, called Pityrosporum ovale.

Although the experts are certain that the yeast is involved, they can’t decide which comes first, does a reaction to the yeast actually cause the increased turnover and flaking, or does the flaky skin simply provide an ideal environment for the yeast to thrive? It seems very likely that the former is the case, so getting rid of the yeast should improve dandruff.

Hormones may also be involved because dandruff usually starts after puberty. For unknown reasons, people with some illnesses, such as Parkinson’s disease, are more likely to have dandruff.

It is sometimes associated with seborrhea where sebum production is excessive. Dandruff shares some features with seborrheic dermatitis, and both conditions are frequently treated with common topical medications.

Seborrheic dermatitis generally affects body sites in addition to the scalp, including the forehead, nasolabial fold, eyelash and eyebrow regions, and the outer ear.

Dandruff – The Symptoms

The flakes of skin are greyish white and are very often visible on the hair and shoulders. There is sometimes itching or soreness and the scalp can feel tight.

Dandruff scales usually occur as small, round, white-to-grey patches on top of the head.

Scaling can occur anywhere on the scalp, in the hair, on the eyebrows, the beard and can often spread to the neck and shoulders.

Dandruff is often known as “dry scalp”, but people with oily scalps tend to suffer the most. An oily scalp also supports the growth of P. ovale.

Since dandruff is a natural process, it can not be eliminated. It can only be managed and controlled.

If the scaling also affects other parts of the body, this may be due to other skin conditions such as eczema, seborrhoeic dermatitis or psoriasis.

Skin affected by seborrheic dermatitis is usually red and greasy with a white or yellowish flaky scale.

The most common sites are the scalp but it can occur between the eyebrows, along the sides of the nose, behind the ears, in the external ear canal, over the breastbone, in the groin area, and sometimes in the armpits.

Causes of Dandruff

The cause of dandruff is usually due to the overworking of the sebaceous glands. These glands produce oil and help shed dead skin. In the case of a dandruff sufferer, the sebaceous glands are overactive, shedding more skin than usual.

Hormonal imbalance.

Poor health.

Poor hygiene.

Allergic hypersensitive.

Lack of rest.

Emotional stress.

Nutritional deficiencies, for example, a lack of vitamin B or essential fatty acids.

A diet high in sugar refined carbohydrates, fat and starch.

Heredity predisposition.

Excessive use of hair sprays and gels.

Improper use of hair-colouring products or excessive use of hot hair curlers or curling irons.

Cold weather and dry indoor heating.

Stress and anxiety.

Infrequent shampooing of the hair or inadequate rinsing of the scalp and hair.

Many people think that flaking occurs because their scalp is too dry, and stop using shampoo because they believe it makes the condition worse. This is not true. The flaking occurs due to the increased turnover of skin cells.

An overgrowth of yeast fungus (pityrosporum ovale) can lead to dandruff. The condition may improve in the summer and get worse in winter because UVA light from the sun counteracts pityrosporum ovale.

Not brushing the hair regularly to allow for normal shedding of dead skin cells can also result in dandruff.

The rate of shedding is increased if the scalp is already inflamed or itchy.

Dandruff Treatment

How is dandruff treated?

The aim of treatment is to reduce the level of the yeast pityrosporum ovale on the scalp.

Dandruff responds well to the use of medicated, anti-fungal shampoos, especially those containing, in order of effectiveness:

  • Ketoconazole
  • Selenium sulphide
  • Zinc pyrithione
  • Coal tar

Sometimes dandruff can be treated and prevented by using a good quality shampoo such as those sold by hair salons.

If dandruff does not disappear after a few weeks using a good shampoo, an anti-dandruff shampoo may solve the problem.

Shampoos normally contain one of five active ingredients: salicylic acid, coal-tar, zinc pyrithione, selenium sulfide and sulphur. These shampoos are non-prescription and the ingredients are approved for use by the United States Food and Drug Administration (FDA). Well, known over-the-counter brands include Head and Shoulders, Selsun Blue, Tegrin, Sebutone or Neutrogena T/Gel or T/Sal.

A newer anti-fungal product containing Ketoconazole was approved in 1997 by the FDA in the USA for over-the-counter sale in the form of Nizoral A-D shampoo.

It is available in the UK over the counter at most chemists. This medication can be helpful for particularly difficult cases, according to some pharmacists.

It should be noted there has been some concern over the use of Ketoconazole when using particular cholesterol-lowering drugs known as statins. Both medications compete for the same metabolism pathway via the liver and when Ketoconazole is taken orally, the toxicity of the statin can be increased.

Theoretically, there may be a small effect using Nizoral shampoo as a topical product on the skin, so the use of this product should probably be avoided if a statin is used, or doctor’s advice sought.

A compound called selenium, found in several shampoo products, is highly effective in controlling dandruff. The shampoo should be left on at least five minutes before being thoroughly rinsed. The hair and scalp should be shampooed with this type of shampoo at least once a week.

Also highly effective in treating dandruff is zinc. A lot of anti-dandruff shampoos contain zinc pyrithione which seems to be very good at clearing the problem.

A zinc vitamin supplement taken daily is excellent for the skin and hair.

When used in conjunction with a zinc-based shampoo the problem of dandruff should be kept at bay. Another supplement being given a lot of press at the moment regarding skincare is beta carotene, which is also claimed as being extremely beneficial to the hair and scalp.

If necessary, shampoo daily with these shampoos, lathering well and making sure the lather remains on the scalp for 5 minutes before rinsing to allow the active ingredients to work.

Take care with tar-based shampoos as they can stain light-coloured or grey hair and make the scalp more sun-sensitive. Anti-dandruff shampoos can make the hair brittle and weak, so the use of a good hair conditioner is recommended.

When dandruff has cleared, begin using a good quality shampoo and rotate the use of the anti-dandruff shampoos as necessary. Some sufferers may need to try a range of anti-dandruff shampoos to gain best results or rotate between various products, as continued use of one product seems to lose effectiveness over time.

If dandruff or itchy scalp persists for 3 weeks or the scalp becomes irritated or severely itchy, seek advice from a doctor. Prescription medication or creams may be able to help when over-the-counter shampoos do not.

In severe cases, dermatologists will prescribe a special ointment or lotion to treat the problem. It is generally agreed that drugstore products which contain zinc pyritheone or selenium sulfide are the most effective in ridding the scalp of dandruff flakes.

For instance, if shampoos aren’t working an application of 1 % – 2.5 % hydrocortisone cream once or twice a day may be effective.

If this too proves ineffective, a coal-tar preparation left on overnight may work. Sometimes a stronger corticosteroid preparation may then be recommended.

Lithium succinate ointment has also been proved to improve symptoms of dandruff.

A patchy, inflammatory scalp disorder not responding to usual treatments should have mycological samples sent for laboratory analysis to rule out Tinea capitis.

In addition to antifungal activity, several other mechanisms have been identified. Zinc pyrithione decreases the turnover of the rapidly dividing epidermal cells. Coal tar has antiseptic, antipruritic (anti-itching), and exfoliating properties.

If a scalp shows signs of redness, swelling, scabbing, or gooeyness – accompanied by flakes, in all likelihood there could be another scalp disease involved like psoriasis or ringworm.

Dandruff can also be due to nutritional deficiencies. It is recommended a person gets adequate amounts of vitamins B6, B12, F and selenium in their diet.

With any of these symptoms, it is important to see your health care provider immediately!

Traditional Dandruff Shampoos

One of the best-known treatments for dandruff for years was Head & Shoulders. The new dandruff shampoos have changed quite a bit and have become a lot more sophisticated.

Pantene make a good dandruff shampoo.

The best approach is to pick a product and try it. If the product works and is successful at controlling your dandruff, continue to use it.

It is important to remember that there is no known “official” cure for dandruff. Once you have the problem the best that you can hope for is management and control.

When using a retail dandruff product it is recommended that this product will need to be used continually.

Once dandruff shampoos or products are discontinued, dandruff will return. Thorough cleansing of the scalp and the hair will keep dandruff flakes out of sight for up to three days. It takes the scalp up to three days before it can generate a new batch of flakes.

A key point to remember is to select the mildest shampoo possible. Although detergent-based shampoos will clean the hair and scalp well, they often cause drying which will make the flaking worse.

Dandruff Prevention

You can help prevent dandruff by:

Regular daily brushing of your hair.

Make sure you wash your hair at least three times a week.

Using a specially medicated shampoo every 1-2 weeks to prevent a recurrence.

Thoroughly rinse your hair thoroughly after shampooing.

Try to avoid the use of chemicals on the scalp such as those used in hair colouring

Making sure that you have enough vitamins such as zinc, beta-carotene, B6, B12, F and selenium in your diet.

Dandruff may begin in infancy as cradle cap, then disappear until adolescence when oil glands become active. It can persist into old age on and off.

Tips on getting rid of dandruff

If your dandruff is mild, try shampooing your hair twice a week using any shampoo labelled ‘frequent use, for dry hair’ (not an ordinary ‘anti-dandruff’ shampoo). This will remove the flakes that are being shed, and the moisturizer in the shampoo will protect the scalp.

Avoid dyeing your hair (unless you absolutely must). We all have bacteria on our scalp, some of which are beneficial. These ‘good’ bacteria prevent dandruff yeast, and hair dyes reduce their numbers.

If you want to try a natural remedy, boil four heaped tablespoons of dried thyme in half a litre of water for 10 minutes. Let it cool and strain it through a sieve into a jar. Massage some of the liquid onto your scalp three times a week. Don’t rinse it out.

Look for a shampoo containing tea tree oil. Research from Australia (published in the Journal of the American Academy of Dermatology in 2002) showed that a 5% tea tree oil shampoo improved dandruff by 41%, which means that although it did not get rid of dandruff completely, there was a noticeable improvement.

For more severe dandruff, you need to deal with the yeast. You could try a shampoo, such as Selsun, containing selenium sulphide, which has an anti-yeast effect and is available without a prescription. Wet your hair, rub the shampoo onto your scalp and rinse off. Repeat, leaving the shampoo for 3-5 minutes before rinsing off.

Don’t use selenium sulphide within 48 hours of applying a hair colourant or a perm lotion. (Selegel and Lenium are similar shampoos. Lenin was discontinued in the UK in July 2000.

The most effective treatment is an anti-yeast shampoo containing ketoconazole (Nizoral), which you can buy from a chemist without a doctor’s prescription. Again, wet your hair, rub the shampoo onto your scalp and rinse off. Repeat, leaving the shampoo for 3-5 minutes before rinsing off.

Use it twice a week for 2-4 weeks to clear dandruff, and then once every 2 weeks, using a normal shampoo in-between times.

Anti-dandruff conditioners are also available.

Hints and tips for coping with dandruff

Don’t ignore it. Whatever you do, don’t ignore your dandruff or fall into a scratch-and-itch cycle. Ignoring the condition lets the scaling build up on your scalp.

That, in turn, can cause itching, which can lead to scratching. Scratching too vigorously can wound the scalp and leave it open to infection.

Shampoo often! The experts are unanimous on this point: Wash your hair often—every day if necessary. Generally, the more frequently you shampoo, the easier it is to control dandruff.

Start mild. Often a mild, nonmedicated shampoo is enough to control the problem. Dandruff is frequently caused by an overly oily scalp.

Shampooing daily with a mild brand diluted with an equal amount of distilled water can control the oil without aggravating your scalp.

Then get tough. If regular shampoos aren’t doing the job, switch to an anti-dandruff formula. Dandruff shampoos are classified by their active ingredients, which work in different ways.

Shampoos with selenium sulfide or zinc pyrithione work fastest, retarding the rate at which scalp cells multiply. Those with salicylic acid and sulfur loosen flakes so they can be washed away easily.

Those with antibacterial agents cut down bacteria on the scalp and reduce the chance of infection. Those with tar retard cell growth.

Tar It. For very stubborn cases you can use tar-based formulas. Lather with the tar shampoo and then leave it on for 5 or 10 minutes so the tar has a chance to work.

Most people rinse dandruff shampoos off too quickly, so make sure you leave it on for the recommended amount of time.

If you’ve avoided tar shampoos because you remember them as having unpleasant smells be aware that many newer formulas are much more pleasant.

Don’t be too harsh. If tar-based shampoos are too harsh for everyday use, alternate them with your regular shampoo.

Don’t mix black with a blonde. If you have blond or silver hair, you might want to think twice about tar-based shampoos. They can give light hair a brownish stain.

Switch-Shampoo. If you’ve found a brand of shampoo that works well for you, keep using it. Be aware, however, that your skin can adapt to a shampoo’s ingredients, so you’d be wise to change your brand every few months to maintain its effectiveness.

Massage it in. When shampooing, gently massage your scalp with your fingertips to help loosen scales and flakes. But don’t scratch your scalp. That can lead to sores that are worse than dandruff.

Steer clear of beer. If you use beer as a rinse and styling lotion, it may be causing your dandruff. Beer can dry out your scalp and eventually lead to dandruff.

Get into condition. Although dandruff shampoos are effective on your scalp, they can be a little harsh on your hair. So be sure to apply conditioner after every shampoo to counteract their effects.

Strike oil. Although excess scalp oil can cause problems, an occasional warm-oil treatment helps loosen and soften dandruff scales. Heat a few ounces of olive oil on the stove until just warm.

Wet your hair (otherwise the oil will soak into your hair instead of reaching your scalp), then apply the oil directly to your scalp with a brush or cotton ball. Section your hair as you go so you treat just the scalp. Put on a shower cap and leave it on for 30 minutes. Then wash out the oil with a dandruff shampoo.

Let the sunshine. A little sun exposure is good for dandruff. That’s because direct ultraviolet light has an anti-inflammatory effect on scaly skin conditions. And it may explain why dandruff tends to be less severe in summer.

But by all means, use sun sense. Don’t sunbathe; just spend a little time outdoors. Limit sun exposure to 30 minutes or less per day. And wear your normal sunscreen on exposed skin. You have to balance the sun’s benefit to your scalp against its harmful effect on your skin in general.

Calm down. Don’t overlook the role emotions play in triggering or worsening skin conditions such as dandruff and other forms of dermatitis. These conditions are often made worse by stress.

So if your emotions are overtaxed, look for ways to counteract the stress. Exercise. Meditate. Getaway from it all. And don’t worry so much about your dandruff!

Dandruff Complications

In rare cases, there may be an allergic reaction to ketoconazole. If you experience irritation, itching or a burning sensation you should stop using the shampoo immediately, and ask your pharmacist or doctor to recommend an alternative.

Itching of the scalp can break the skin and lead to infection. If this occurs you should see your GP for advice.

Related and similar conditions

Dandruff may also be caused by excessive dryness or by psoriasis. A few people have both conditions, which makes diagnosis difficult. Seborrheic dermatitis and psoriasis can be pretty difficult to tell apart.

Psoriasis tends to have a whiter scale, and affected areas bleed fairly easily if plucked, picked or scratched. Patches of psoriasis also tend to be thicker and more persistent.

Rarely, seborrheic dermatitis will become infected, a condition known as impetigo.

Tinea capitis – scalp ringworm – may be mistaken for dandruff in adults. This condition is uncommon after puberty and when it appears on adults, the features are different from those occurring in children.

Tinea capitis will not respond to tradition dandruff treatments or antibiotics. Lack of treatment can lead to scarring and permanent hair loss, as well as infection of others.

The incidence of scalp ringworm in children is on the rise in the United Kingdom and several cases of adults – particularly those of Afro-Carribean descent – have been eventually diagnosed with this condition after lengthy unnecessary investigations and treatments.

The vast majority of people with seborrheic dermatitis have no associated conditions. Sufferers of Parkinson’s disease, spinal cord injuries and other neurological conditions and AIDS can have outbreaks of seborrheic dermatitis.

Is It Dandruff or Dermatitis?

Severe dandruff is actually a disease known as seborrheic dermatitis, which requires prescription medications.

See a doctor if you have:

  • Scalp irritation
  • Thick scale deposits despite regular use of dandruff shampoos
  • Yellowish crusting
  • Red patches, especially along the neckline

Severe cases of dandruff are caused by a disease called seborrhoeic eczema or seborrhoeic dermatitis.

Seborrhoeic dermatitis causes greasy, bran-like scale. The seborrhoeic area – the scalp, the skin around the nose, the lines on the cheeks, the eyebrows, the ears and the torso – may also be red and itchy.

Seborrhoeic dermatitis becomes worse during the winter and tends to improve during the summer when sunlight relieves the symptoms.

It can vary from mild cases, which are only a problem in winter, to more severe cases where flaking occurs in places other than just the scalp.

The fungus Pityrosporum ovale is a significant factor in seborrhoeic dermatitis. Doctors don’t know exactly why, but anti-fungal treatment helps ease the condition.

As well as seasonal changes, stress and serious illnesses can cause an increase in the production of scale.

Seborrhoeic Dermatitis

Seborrhoea comes from the word sebum, which is the natural oil produced in the sebaceous glands that flow into the hair follicle.

Seborrhoeic dermatitis has been called a more extensive and severe form of dandruff because there is no clear division between the two.

Flaking, redness and itching are more severe and can appear on the scalp, in the eyebrows, around the nose and on the cheeks, behind the ears and even on the chest and around the groin.

It may interfere with the nutrition of the hair, resulting in partial baldness.

Some cases of dandruff are caused by the disease. Sebum may also accumulate in the ducts of the glands, causing the glands to become distended with undischarged sebum, and form a small hard body called a whitehead or comedo.

When the sebum in the mouth of the duct becomes oxidized, the comedo is known as a blackhead.

Dermatitis seborrhoeic like dandruff tends to have seasonal differences and usually gets better in the summer and worse in winter.

The treatment for seborrhoeic dermatitis is similar to dandruff, although a shampoo of coal tar seems to have a better effect on the scalp. If the problem is very severe you should seek advice from the doctor as a course on steroid’s may be required to clear it up.

Seborrhoeic appears to be heredity if some relative has it the chances are that is what you may have.

Psoriasis

Psoriasis is an autoimmune disease that appears on the skin.

It occurs when the immune system mistakes the skin cells as a pathogen and sends out faulty signals that speed up the growth cycle of skin cells.

However, psoriasis has been linked to an increased risk of stroke. The most common form, plaque psoriasis, is commonly seen as red and white hues of scaly patches appearing on the top first layer of the skin.

Some patients, though, have no dermatological symptoms.

Psoriasis is usually a more severe problem than the above and affects about 3% of the population. It is not contagious but can be passed on through the family.

It is usually seen as silvery flaky scales on the scalp or anywhere on the body. The more serious cases of psoriasis should be referred to a doctor for treatment.

Doctors often prescribe steroid creams to help cure the problem. People have recently been praising the use of evening primrose oil to try and treat the problem.

Women taking this as a daily supplement have reported excellent improvement in their skin as well as in their general well being.

Myths about Dandruff

Dandruff is due to dryness of the skin

False Dandruff is caused by a rapid turnover of cells, so more dead cells are shed from the surface. In fact, dandruff occurs in areas where the grease glands of the skin are most active, and the skin is not usually dry.

Dandruff is more common in males than in females

True Probably because the grease glands are affected by hormones.

Dandruff is affected by the weather

Probably true Sunlight inhibits the growth of the Pityrosporum ovale yeast.

Dandruff results from poor hygiene

False Dandruff is caused by rapid turnover of skin cells, probably as a reaction to the Pityrosporum ovale yeast. However, dandruff sufferers do not have more of the yeast than other people – they are just more sensitive to it.

Dandruff is contagious

False You can’t ‘catch’ dandruff from someone else, such as by using his/her brush or comb.

Wearing a hat worsens dandruff

Possibly true Pityrosporum ovale yeasts thrive best when protected from sunlight. Also, wearing a hat prevents sweat from evaporating, and this may encourage the yeast.

Coping with dandruff

Choosing a hairstyle without a severe parting will help to· conceal dandruff flakes.

Avoid wearing dark or plain-coloured clothing.

Carry a small clothes brush to brush away any scales that may appear on your clothing.

Avoid bleaching, colouring or perming your hair as the chemicals used may irritate your scalp.

Try to resist the temptation to scratch your scalp when it itches as this will aggravate the condition.

Massage the scalp gently when you wash your hair and rinse thoroughly before drying.

Avoid scraping or scratching your scale when· you brush or comb your hair.

Use a specially formulated shampoo such as Oilatum® Scalp Treatment Shampoo on a regular basis.

Traditional and Natural Dandruff Treatments

Boric Acid

Boric acid is a very old remedy for treating dandruff and is freely available from your chemist.

Moisten with a little water and rub well into the scalp, then rinse out thoroughly with warm water.

This should be carried out just before you shampoo your hair in the normal way.

Rosemary

An infusion of fresh rosemary made with boiling water and allowed to cool till it is warm makes a good final rinse to help clear the scalp.

Thyme

Thyme is reputed to have mild antiseptic properties that can help alleviate dandruff.

Make an effective rinse by boiling 4 heaped tablespoons of dried thyme in 2 cups of water for 10 minutes.

Strain the brew and allow it to cool.

Pour half the mixture over clean damp hair, making sure the liquid covers the scalp.

Massage in gently. Do not rinse.

Save the rest for later use.

Vinegar

Apple cider vinegar is poured over the hair, massaged into the scalp, and left to dry for a few minutes.

Then the hair is washed.

The process is repeated daily until dandruff disappears, usually within a few days.

Vinegar 2

Ingredients:

1/2 cup water

1/2 cup white vinegar

1 teaspoon of lemon juice

Directions:

Combine ingredients then apply directly to the scalp. Use before shampooing. Apply twice a week.

Asprin

You can treat dandruff with aspirin. Just crush two aspirin and add to your regular shampoo.

Essential Oils

Lavender, Lemongrass, Rosemary.

Make a hair tonic using a few drops of each oil with 7fl Oz of distilled water and two teaspoons of cider vinegar.

Shake well and store in a dark bottle.

Massage this mixture into the scalp a few times a week.

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