Dandruff

Dandruff is a common scalp disorder characterised by:

• Flaky white to yellowish scales on the scalp
• Itching of the scalp
• Dry or oily scalp

Flakes due to dry scalp tend to be smaller and whiter, while dandruff flakes are larger and usually yellow-tinged due to an oily scalp.

Signs that your dandruff may be severe include:

• Large areas of redness or swelling on the scalp
• Severe itching and worsened flakes over time
• Persistent symptoms even after using anti-dandruff shampoo for a month

The causes of dandruff vary from person to person, but it is usually a result of improper handling of hair and scalp. According to experts, the cause of dandruff is rapid maturing and shedding of scalp cells precipitated by excessive oil secretion. Broadly speaking, the causes can be categorized into:

1. Microbial Factors

• Fungal Infection: Malassezia, a fungus, is one of the leading causes of dandruff. It stimulates the enzyme lipase, which is responsible for the production of saturated and unsaturated fats. Saturated fats aid in the growth and division of fungal cells, while unsaturated fats contribute to skin inflammation and irritation. This process alters the normal shedding of dead cells, leading to visible white flakes.
• Bacterial Infection: Bacteria found on the scalp that may lead to dandruff include Propionibacterium acnes and Staphylococcus epidermidis.

2. Non-Microbial Factors

• Dry scalp
• Oily or irritated skin/hair
• Poor hair hygiene
• Use of hair cosmetics/tools
• Scalp disorders like psoriasis and eczema
• Infrequent shampooing
• Extreme weather conditions

You are more likely to have dandruff if:

• Age: Dandruff usually begins during the teenage years and continues through middle age. However, older adults can also experience dandruff, and for some, it can be a lifelong issue.
• Being male: Dandruff is more prevalent in males than in females.
• Certain chronic illnesses: Conditions such as Parkinson's disease and other disorders affecting the nervous system may increase the risk of dandruff. Additionally, individuals with HIV or a weakened immune system are also at higher risk.
• Other conditions:
  • Stress and fatigue
  • Oily scalp
  • Intense itching, even when the scalp does not feel dry
  • Greasy appearance of hair
  • Improper hair brushing
  • Neglecting oily hair
  • Use of harsh shampoos
  • Frequent use of styling tools

Dandruff is diagnosed through a simple physical examination of the scalp. You may be asked a few questions about your hair care routine and symptoms. This examination will be conducted by a dermatologist (skin specialist) or a trichologist (hair and scalp specialist). Your dandruff may be classified as mild or severe, and based on this classification, your doctor may prescribe appropriate treatment. There are no blood tests or imaging tests required to diagnose dandruff.

By taking adequate measures to improve hair health, you can minimize the chances of dandruff.

• Cut down on high sugar foods, fats, and alcohol.
• Develop a hair and scalp care routine according to your hair type. If you have an oily scalp, frequent shampooing may help prevent dandruff. Gently massage your scalp to loosen flakes and rinse thoroughly. If your hair is dry and your scalp is sensitive, shampoo less frequently and condition your scalp between washings.
• Limit hair-styling products, as they can build up on your hair and scalp, making them oilier.
• Brush your hair often to improve circulation in the scalp.
• Do not share combs.
• When going out, cover your hair, as dirt and grease can aggravate the problem.

In most patients, dandruff can be controlled by daily washing with gentle anti-dandruff shampoo. If your dandruff is severe, the doctor may prescribe medicated shampoos that contain chemicals such as Zinc Pyrithione, Selenium Sulphide, Ketoconazole, Coal Tar, and Salicylic Acid.

These treatment options are aimed at treating the cause of the dandruff and managing the symptoms.

1. Antifungal Agents

As the name suggests, this class of drugs is aimed at treating the fungus responsible for dandruff. Most of these drugs work by affecting the membrane of the fungus, leading to the death of the microbes and aiding in treatment. Examples include:

• Zinc Pyrithione helps to prevent itching and flaking.
• Ketoconazole acts as a broad-spectrum antifungal agent by disrupting membrane function.
• Climbazole hinders the normal functioning of the fungal cell membrane.
• Selenium Sulphide-based shampoos can discolor the hair and scalp.
• Clotrimazole inhibits the synthesis of ergosterol, aiding in treatment.
• Piroctone Olamine inhibits the degradation of sebum triglycerides to oleic acid and arachidonic acid, which are responsible for inflammation and itching.

2. Anti-Proliferative Agents

Coal tar is used in the form of tar-based shampoos and is one of the most common examples of this class of anti-dandruff chemicals. It contains more than 10,000 chemical compounds that inhibit microbial proliferation and inflammation. This is mainly used to relieve the symptoms of dandruff.

3. Keratolytics

Keratolytics are known to cause the skin to shed dead cells from the top layer by increasing moisture in the scalp. By preventing clumping of dead cells, they help to clear dandruff from the scalp. Salicylic acid is one of the most common examples of keratolytic agents.

These drugs are available in various forms such as shampoos, lotions/applications, creams, herbal oils, and gels.

By making small changes in your lifestyle, you can effectively manage dandruff. Here are some effective ways to address dandruff:

• Brush your hair regularly: Brushing your hair ensures that blood circulation in your scalp is maintained. It helps remove dead cells from your scalp. However, avoid brushes with sharp ends, as they can cause swelling and redness. Opt for a paddle brush or one with rounded tips for a milder effect.
• Avoid harsh shampoos: Certain chemicals in shampoos can lead to dry, irritable skin, precipitating itching and dandruff. Choose a mild herbal shampoo that is gentle on the hair and has a compatible pH balance.
• Avoid styling tools: Heat and chemicals can weaken your hair and damage your scalp. Practices like straightening, blow-drying, and perming can cause irreparable damage and exacerbate dandruff.
• Pick an anti-dandruff shampoo: Some commonly recommended over-the-counter anti-dandruff shampoos include Pyrithione zinc shampoos, tar-based shampoos, and ketoconazole shampoo. It is advisable to use these shampoos daily; however, as dandruff improves, alternate with a different shampoo to maintain hair health.
• Eat healthy: Enrich your diet with adequate portions of green vegetables, fish oil, lean proteins, and fruits. Incorporate leafy greens such as broccoli, kale, and lettuce into your daily meals to promote healthy skin, hair, and nails. Lean proteins like eggs, nuts, and beans contribute to building healthy skin and hair, so include these in your diet regularly.
• Get a little sun: Sunlight may help control dandruff. However, because exposure to ultraviolet light can damage your skin and increase the risk of skin cancer, avoid sunbathing. Instead, spend a little time outdoors, and remember to apply sunscreen on your face and body.

Dandruff should not be taken lightly because:

• It may indicate an overgrowth of a fungus called Malassezia, which, although present on the scalp of most people, does not typically cause symptoms.
• It can slow down hair growth.
• It signifies a microinflammation, which might be easily overlooked as there are no readily observable symptoms.

If you have dandruff or an itchy scalp with white flakes, consult a dermatologist to determine the cause and receive treatment before it becomes severe.

• Vinegar: To clean your scalp of dead skin and fungi, mix half a cup of white or apple cider vinegar with an equal volume of water. Pour the mixture over your hair, leave it on for 10 minutes, then scrub and rinse off with a mild shampoo or just water.
• Fenugreek (Methi): Make a paste of two tablespoons of fenugreek powder and half a cup of water. Apply it to the scalp and leave it in for 30-45 minutes; rinse off with a mild shampoo to strengthen and clean your hair thoroughly.
• Lemon (Nimbu): Massage the juice of two lemons into the scalp and then rinse off with a mixture of lemon juice and water. The antifungal properties and acidity of lemon will help restore the natural pH balance of the scalp.
• Salt/Baking Soda: Generously sprinkle some salt (table or Epsom) or baking soda on the scalp and massage gently to exfoliate. Rinse off with a mild shampoo for a clean look.
• Neem: Add about two handfuls of neem leaves to half a litre of water, bring it to a boil, and let it soak overnight. Wash your hair with the strained liquid. Neem is antifungal and helps relieve itching.
• Curd (Dahi): Apply fermented curd on the scalp and leave it in for about an hour. Rinse off with shampoo. The acidic nature of curd fights dandruff and acts as a conditioner.
• Orange (Santra) Peel: Apply a mixture of orange peel and lemon on the scalp and wash off after 30 minutes. The acidity of the mixture conditions the hair and combats dandruff.
• Honey (Sahed): Use 1/4 teaspoon of water mixed with 1 tablespoon of honey to massage the scalp for 2-3 minutes. Rinse off after 3 hours for shiny, dandruff-free hair.
• Coconut (Nariyal) Oil and Camphor (Kapoor): Take 2-3 teaspoons of warm coconut oil and dissolve a pinch of camphor in it. Massage gently on the scalp at night. Wash your hair in the morning with a mild shampoo. Repeat once or twice a week.
• Tea Tree Oil: Mix tea tree oil with water in a ratio of 1:3 and spray it on your scalp. Pat off the excess water but do not rinse it off.