Treating dandruff in the dermatology clinic

Dandruff – a flaky, itchy scalp – is a bit of a mystery to the medical community, with the exact cause unknown. Just about everyone agrees, however, that dandruff is not caused by being unclean.

We do know a few things about dandruff, with the causes and some management strategies all part of the puzzle.

What we know about dandruff:

• Many people find that their dandruff improves as they age
• It is believed that around half of those living in Western Europe and North America have dandruff
• Men get dandruff more often than women
• People with oily skin get more dandruff than those with drier skin
• Diet may play a part – too sweet, salty or spicy, plus excess alcohol, may make dandruff worse

Some known contributing factors to dandruff:

• Seborrheic dermatitis – oily, irritated skin that is covered with flaky white or yellow scales, closely linked with a fungus (Malassezia) that lives on everyone’s scalp. This fungus uses our natural hair oils to survive, which can get out of control. Dandruff may be the result of irritation that causes extra skin cells to be produced – as these skin cells fall off, they mix with oil and appear as dandruff.
• Insufficient hair brushing – keeping dead skin cells out of your hair by brushing can help keep hair free from debris.
• Yeasts – yeast may play a part, in which case dandruff will become worse in winter and feel better in summer. UV light tends to help kill off yeasts.
• Prone to dry skin – if you often have dry skin, having dandruff becomes more likely. Dry skin itches and flakes anywhere on the body, and this type of dandruff is not oily, but dry.
• Skin conditions – those with psoriasis and eczema may get more dandruff.
• Parkinson’s, neurological illness, stroke – some people with neurological and other diseases can be prone to having dandruff and seborrheic dermatitis.
• Irritation reaction – if you are sensitive to your shampoo or other hair-care products, you may be inadvertently causing dandruff.
• HIV – just over 10 per cent of those living with HIV will have seborrheic dermatitis.

Treatments for dandruff

Treating dandruff typically centres around slowing down the skin-cell turnover or stemming the growth of fungus. Anti-dandruff shampoo is readily available, containing special ingredients that tend to block fungal growth temporarily. Active ingredients include ketoconazole, selenium sulfide, zinc pyrithione, coal tar, salicylic acid, tea tree oil, or green tea extracts. Use of these shampoos every day until the problem gets under control can usually help manage dandruff.

These shampoos need good scalp surface area connection for several minutes to exert their effect, so don’t wash it off too quickly. Additionally, a trip to a dermatologist to see what the problem might be – and how to treat it with more effective solutions than shampoo – may be in order. Your dermatologist can test your scalp to check what exactly is going on, and provide tailored treatments.

Treat the cause of your dandruff, not just the symptoms.
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