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Dandruff

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Ismail Munir

Overview

Dandruff is a common scalp condition characterized by the shedding of dead skin cells from the scalp, often resulting in visible flakes. 
&nbsp;

Dandruff is one of the most common scalp conditions and affects around 50% of adults worldwide<a href="#accordion">[4]</a>. It is not contagious and, usually, is not a serious medical condition either. However, it can be bothersome and affect a person&#39;s confidence.

Dandruff can occur at any age, but it tends to be more common during adolescence and adulthood. It&#39;s observed in both males and females, but there may be some variations in the prevalence between genders. 
&nbsp;

Dandruff is generally categorized based on the underlying causes and characteristics of the condition.

<ol>
	<li>Dry Dandruff (Simple Dandruff): Dry dandruff is characterized by small, white, or greyish flakes that are often accompanied by an itchy scalp. It occurs due to the excessive shedding of dead skin cells from the scalp. The skin may appear dry and irritated, leading to itchiness. 
	Dry dandruff is more common among people with dry skin. Cold weather, dry air, and the use of harsh hair products can exacerbate this type of dandruff. 
	&nbsp;</li>
	<li>Oily Dandruff (Seborrheic Dermatitis): According to the National Eczema Association, seborrheic dermatitis is a chronic form of eczema that affects body areas that secrete the most sebum<a href="#accordion">[2]</a>. 
	Oily dandruff involves larger, greasy, yellowish flakes that adhere to the scalp and hair. This type is often associated with an overgrowth of a yeast called Malassezia on the scalp, which thrives in areas with excess oil production. 
	 
	In addition to the scalp, seborrheic dermatitis can affect areas with a high concentration of oil glands, such as the face (eyebrows and sides of the nose), chest, and back. It can cause redness, inflammation, and more intense itching compared to dry dandruff. 
	&nbsp;</li>
	<li>Mixed Type: Some individuals may experience a combination of dry and oily dandruff features. For example, they may have oily patches on the scalp along with dry, flaky areas. 
	The characteristics of dandruff can vary over time and will require different approaches to management. 
	&nbsp;</li>
</ol>

Sign and Symptoms

Here are the key signs and symptoms associated with dandruff:

<ul>
	<li>Visible Flakes: The primary sign of dandruff is the presence of white or greyish flakes on the scalp, hair, and sometimes clothing. It can extend beyond the scalp to areas with hair follicles, such as the eyebrows, beard, and sides of the nose. These flakes can vary in size and are often noticeable. 
	&nbsp;</li>
	<li>Itchy Scalp: Dandruff is frequently accompanied by itching, which can range from mild to severe. Scratching the scalp can exacerbate the itching and lead to temporary relief followed by increased irritation. 
	&nbsp;</li>
	<li>Dryness Or Oiliness: Depending on the type of dandruff, the scalp may appear dry or oily. Dry dandruff is often associated with a dry, flaky appearance, while oily dandruff can lead to a greasy appearance due to excessive oil production. 
	&nbsp;</li>
	<li>Redness And Irritation: In cases of more severe dandruff or seborrheic dermatitis, the scalp may become red, inflamed, and sensitive. This can contribute to discomfort.</li>
</ul>

In infants with cradle cap, it may present as a greasy, scaly, crusty red or yellow patch on the scalp<a href="#accordion">[1]</a>.

It&#39;s important to note that dandruff symptoms can vary from person to person. These symptoms may be more severe due to <a href="https://merisehat.pk/disease/stress">stress </a>or the cold, dry season. 
&nbsp;

Causes

The top layer of the skin is always renewing itself. Cells move outward, die, and flake off. These tiny pieces of skin are usually too small to see. But sometimes, this renewal happens much faster, like with dandruff. In the case of dandruff, new skin cells might only take 2-7 days to grow and fall off instead of the usual period of a month. This creates clumps of noticeable dead skin on the scalp. 
&nbsp;

While the exact cause of dandruff may vary from person to person, here are some common factors that can contribute to the development of dandruff:

<ul>
	<li>Yeast Overgrowth: Malassezia is naturally present on the scalp. However, in some individuals, an overgrowth of this yeast can lead to an inflammatory response that triggers the shedding of excess skin cells, resulting in dandruff. 
	&nbsp;</li>
	<li>Sebum Production: Sebum is the natural oil produced by the skin to moisturize and protect it. Overproduction or irregular composition of sebum can contribute to dandruff. 
	&nbsp;</li>
	<li>Dry Skin: Dry skin can lead to flaking and itching, which are common symptoms of dandruff. In some cases, cold weather or dry air may worsen the condition. 
	&nbsp;</li>
	<li>Sensitivity To Hair Care Products (Contact Dermatitis): Some hair care products, particularly shampoos, conditioners, or styling products containing strong chemicals or fragrances, can irritate the scalp and trigger dandruff-like symptoms in sensitive individuals<a href="#accordion">[2]</a>. 
	&nbsp;</li>
	<li>Improper Hair Hygiene: Not shampooing frequently enough or not effectively cleansing the scalp can allow dead skin cells, oils, and other debris to accumulate, potentially leading to dandruff. 
	&nbsp;</li>
	<li>Stress: Stress can affect various aspects of health, including the skin. Stress might exacerbate dandruff symptoms or trigger flare-ups in individuals predisposed to the condition. 
	&nbsp;</li>
	<li>Certain Medical Conditions: Conditions such as psoriasis, eczema, or immune system disorders can affect the scalp and lead to flaking and inflammation, resembling dandruff.</li>
</ul>

Note: A combination of factors may influence dandruff rather than a single cause. 
&nbsp;

Diagnosis

There are no specific tests required for diagnosing dandruff, as it&#39;s a visible and common scalp condition. However, it&rsquo;s important to consult a dermatologist or healthcare professional for a proper diagnosis.

<ul>
	<li>Medical History: The healthcare provider will ask about the symptoms, including the appearance of flakes, itching, and any other discomfort the individual is experiencing on their scalp. 
	&nbsp;</li>
	<li>Physical Examination: A dermatologist will visually examine the patient&rsquo;s scalp and hair to observe the presence of white or greyish flakes, redness, irritation, or other signs associated with dandruff. 
	&nbsp;</li>
	<li>Scalp Analysis: They may use a dermatoscope, a handheld magnifying tool, to assess the condition of the scalp and hair follicles. 
	&nbsp;</li>
</ul>

<ul>
	<li>Differentiation From Other Conditions: If the treatment does not affect dandruff, doctors may order a skin biopsy to rule out other issues<a href="#accordion">[2]</a>. 
	&nbsp;</li>
</ul>

<ul>
	<li>Questions About Hair Care Routine: The <a href="https://merisehat.pk/article/the-virtual-healthcare-revolution-bridging-gaps-with-online-doctor-consultations">healthcare</a> provider will also ask about the hair care routine, including the frequency of shampooing, the types of products the individual uses, and any recent changes in their hygiene routine. 
	&nbsp;</li>
</ul>

Treatment

The treatment and management of dandruff typically involve a combination of proper scalp care, lifestyle adjustments, and the use of over-the-counter or prescription products.

While the specific approach can vary based on the severity of dandruff and individual preferences, treatments for dandruff nowadays mainly aim at using substances that fight against this fungus and help get rid of it. 
&nbsp;

This is because, similar to all living things, Malassezia fungus grows well when it gets nourishment, which in this case, is the fatty acids present in sebum. That is, if the scalp is oily, it becomes a great environment for Malassezia to grow. When Malassezia multiplies rapidly, it messes up how the skin naturally renews itself.

<ul>
	<li>Gentle Shampooing: Regular and gentle shampooing with an anti-dandruff shampoo is key. Choose shampoos that contain active ingredients known to be effective against dandruff, such as:</li>
</ul>

<ol>
	<li>Pyrithione Zinc &ndash; Control the growth of yeast on the scalp</li>
	<li>Salicylic Acid &ndash; Exfoliate dead skin cells from the scalp</li>
	<li>Ketoconazole &ndash; Reduce yeast growth</li>
	<li>Fluocinolone &ndash; Control itching, irritation, and flaking</li>
	<li>Tar-Based &ndash; Slow cell death on the scalp</li>
	<li>Selenium Sulfide &ndash; Kill dandruff-causing fungi 
	&nbsp;</li>
</ol>

Always follow the instructions on the shampoo label, as each brand may contain different active ingredients. Some require lathering and leaving the shampoo in the hair for a few minutes before washing, while others don&rsquo;t.

Gently massage the scalp during shampooing. It helps exfoliate dead skin cells and improves blood circulation. 
&nbsp;

Use lukewarm water and choose mild, sulfate-free shampoos because hot water and harsh products can worsen dryness and irritation.

<ul>
	<li>Manage Stress: Stress management can help prevent flare-ups or worsening of dandruff symptoms. Engage in stress-reduction techniques such as yoga, meditation, and deep breathing. 
	&nbsp;</li>
</ul>

<ul>
	<li>Eat A Healthy Diet: A balanced diet rich in nutrients contributes to overall skin health. Omega-3 fatty acids, zinc, and vitamins B and D are particularly beneficial for the skin. Staying hydrated can also benefit the skin. 
	&nbsp;</li>
	<li>Supplements: Probiotics are known for their multiple health benefits, including improving immune function and preventing skin conditions. According to one study, taking probiotics for 56 days reduced dandruff severity significantly. Probiotics are found in fermented foods, but they are also commonly available as supplements<a href="#accordion">[5]</a>. 
	&nbsp;</li>
</ul>

<ul>
	<li>Prescription Treatments: If over-the-counter shampoos are not effective, a dermatologist may recommend prescription-strength options, including stronger medicated shampoos, gels, ointments, sprays, and oils. 
	&nbsp;</li>
	<li>Alternative Medications: While some shampoos contain tea tree oil, there is not much research supporting its use to control dandruff. It&rsquo;s known for its antibiotic and antifungal properties, but it can also lead to allergic reactions in some people. 
	&nbsp;</li>
</ul>

<h5>Important!</h5>

<ul>
	<li>You may have to try multiple products to see which one is suitable for you.</li>
	<li>Sometimes, a shampoo may work but then lose its effectiveness over time.&nbsp;</li>
	<li>Also, it&rsquo;s possible that you need to repeat this treatment or use it long-term.</li>
	<li>Tar-based shampoos can make the scalp more sensitive to sunlight. It can also cause discoloration if the person has light-colored hair.</li>
	<li>It&rsquo;s recommended to do a patch test first when trying new products, such as tea tree oil. Stop using it if you develop an allergic reaction like hives, stinging, or difficulty breathing, and inform your doctor immediately<a href="#accordion">[1]</a>! 
	&nbsp;</li>
</ul>

Dandruff itself is generally not a serious medical condition, and most cases can be managed effectively with proper scalp care and treatment. However, if left untreated or if the underlying causes are not addressed, dandruff can lead to certain complications or exacerbate other conditions.

<ul>
	<li>Secondary Infections: Constant scratching of the scalp can create openings in the skin that provide entry points for bacteria. This can lead to secondary bacterial infections on the scalp, causing additional discomfort and requiring medical treatment. 
	&nbsp;</li>
	<li>Hair Loss: While dandruff itself does not directly cause hair loss, constant itching and inflammation can weaken hair follicles and potentially contribute to hair thinning or breakage. 
	&nbsp;</li>
	<li>Emotional And Social Impact: Dandruff can affect self-esteem and confidence due to its visible nature. Persistent flakes and itching can lead to embarrassment and social discomfort. 
	&nbsp;</li>
	<li>Worsening Of Underlying Conditions: If dandruff is a symptom of an underlying skin condition, such as seborrheic dermatitis or psoriasis, leaving it untreated can lead to the exacerbation of these conditions, causing more severe symptoms and complications. Chronic conditions require ongoing management to prevent flare-ups. 
	&nbsp;</li>
	<li>Spread To Other Areas: In some cases, dandruff-causing fungi or bacteria can spread to other areas of the body, leading to conditions like fungal infections or folliculitis. 
	&nbsp;</li>
</ul>

Here are some risk factors associated with dandruff<a href="#accordion">[1][2][3]</a>: 
&nbsp;

<ul>
	<li>Age: Dandruff is more common in adolescence and middle age. It tends to decrease with age.</li>
	<li>Gender: Men are often more susceptible to dandruff than women.</li>
	<li>Personal Or Family History: Individuals with neurologic and psychiatric conditions, like Parkinson&rsquo;s disease, traumatic brain injury, or epilepsy, may be more prone to dandruff. It&rsquo;s also common among those who have a weak immune system, with 30-83% of seborrheic dermatitis occurring in individuals with HIV. 
	A history of skin disorders, like acne or eczema, can trigger seborrheic dermatitis. Seborrheic dermatitis is also more common among people with underlying medical conditions such as eating disorders, obesity, and alcohol dependency. 
	Moreover, a genetic predisposition is also a possibility if dandruff runs in the family.</li>
	<li>Hormonal Changes: Hormonal changes, such as during puberty, pregnancy, or certain medical conditions, can affect oil production and increase the risk of dandruff.</li>
	<li>Seasonal Changes: Dandruff usually worsens during cold, dry months.</li>
	<li>Lifestyle: Although research is ongoing, some dietary factors, such as consuming too much sugar or unhealthy fats, might influence the risk of dandruff in susceptible individuals. 
	&nbsp;</li>
</ul>

Here are some preventive measures to consider: 
&nbsp;

<ul>
	<li>Maintain Good Scalp Hygiene: Regularly shampoo the hair to keep the scalp clean and prevent the buildup of oils, dead skin cells, and debris that can contribute to dandruff. Choose a mild, sulfate-free shampoo that is suitable for the hair type and doesn&#39;t overly strip the scalp&#39;s natural oils. 
	 
	According to the American Academy of Dermatology, African people should shampoo once a week using a dandruff shampoo. Moreover, Asians and Caucasians should shampoo daily but restrict their use of dandruff shampoo to twice a week<a href="#accordion">[3]</a>.</li>
	<li>Avoid Harsh Hair Care Products: Choose hair care products that are gentle on the scalp and hair. Avoid using products that contain strong fragrances, harsh chemicals, or irritants.</li>
	<li>Limit Heat Styling And Hair Treatments: Excessive heat styling and chemical treatments can dry out the scalp and lead to flaking. Use heat styling tools sparingly and opt for protective hairstyles when needed.</li>
	<li>Avoid Frequent Hair Washing: While it&#39;s important to keep the scalp clean, washing the hair excessively can strip away natural oils, potentially leading to dryness and flaking. People with drier hair, for instance, benefit from less frequent shampooing along with a moisturizing conditioner for the scalp or the hair[1].</li>
	<li>Protect From Sun Exposure: Protect the scalp from sunburn by wearing a hat or using sunscreen on exposed areas of the scalp.</li>
	<li>Use A Humidifier: In dry environments, using a humidifier can help maintain optimal scalp moisture levels, reducing the risk of dryness and flaking.</li>
	<li>Regular Physical Activity: Engage in regular physical activity to improve blood circulation and overall health. Physical activity can also help manage stress, which can influence dandruff.</li>
	<li>Limit Hair Products: Minimize the use of hair care products that can irritate the scalp, such as hair sprays and gels, because too many styling products build up on the scalp.</li>
	<li>Avoid Scratching: Try to resist the urge to scratch the scalp because it may worsen irritation and inflammation. 
	&nbsp;</li>
</ul>

According to a recent study, it&rsquo;s not just the fungus that causes dandruff; bacteria too have a role to play. A new technology called next generation sequencing helped the team analyze the genetic composition of the entire scalp microbiome and define the types of fungi and bacteria present in more than 100 people with both healthy and dandruff-affected scalps<a href="#accordion">[4]</a>. 
&nbsp;

The findings showed:

<ul>
	<li>Malassezia was present 10 times more on dandruff scalps than on healthy ones.</li>
	<li>Staphylococcus capitis was present 100 times more on dandruff scalps than on healthy ones. 
	&nbsp;</li>
</ul>

Key Points

<ul>
	<li>Dandruff is a common scalp condition characterized by the shedding of dead skin cells from the scalp, resulting in visible flakes.</li>
	<li>Dandruff is often categorized as dry dandruff or oily dandruff.</li>
	<li>Dandruff can be caused by multiple factors, including an overgrowth of the yeast Malassezia on the scalp, excess oil production, and dry skin.</li>
	<li>Symptoms include visible flakes on the scalp, itching, dryness, scalp sensitivity and, in some cases, redness or inflammation.</li>
	<li>Dandruff is usually diagnosed based on its characteristic signs and symptoms. No specific tests are required for diagnosis.</li>
	<li>Treatment involves using specialized shampoos containing active ingredients like zinc pyrithione, salicylic acid, or ketoconazole. Prescription treatments might be recommended for more severe cases.</li>
	<li>While dandruff itself is not serious, persistent scratching can lead to scalp irritation and secondary infections and worsen underlying skin conditions.</li>
	<li>Risk factors include age, gender (more common in men), oily or dry scalp, family history, hormonal changes, and certain skin conditions.</li>
	<li>Good scalp hygiene, maintaining a balanced diet, and stress management can help prevent dandruff.</li>
</ul>