Dandruff

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Vaibhav Shah 

                                                         Dandruff

        The condition popularly known as dandruff is, in its most common and mild form, little more than a normal shedding of dead skin cells from the scalp. When the white flakes land on the collar or shoulders of one’s clothing they become an unattractive cosmetic nuisance. Some people experience a heavier accumulation of flakes that adhere to the scalp and fall in a literal blizzard onto clothing, bedding and furniture. When a person has excessive oiliness of the scalp, a heavy accumulation of flakes can be pasted to the scalp in oily mounds and adhere to hair in whitish globs. This condition is most likely when production of skin oils (sebum) is at its peak in puberty and adolescence, or when the production of androgenetic (male) hormones is out of balance. “Oily dandruff” that is not accompanied by inflammation or itching may be a mild form of seborrheic dermatitis that is discussed below.

      Common, mildly shedding dandruff is usually managed successfully by regular use of a mild, anti-dandruff shampoo once or twice a week. Over-the-counter shampoos containing ketoconazole, zinc pyrithione tar or selenium oxide often work well to manage mild dandruff. It is a condition of no medical consequence. More severe dandruff with excessive oiliness, crusting and itching may be a form of seborrheic dermatitis and should be managed under the care of a dermatologist or other physician.

     The topical hair restoration medication minoxidil (Rogaineâ) can cause or worsen dandruff in some patients. Dandruff due to this cause varies from mild to severe. In some cases minoxidil can cause scalp irritation, dryness and itching that can progress to broken and bleeding scalp skin. The condition may be worse in winter when humidity is low. When a side effect of this severity occurs, the patient should contact his or her physician. Dandruff and dry, irritated skin associated with minoxidil can be treated with anti-dandruff shampoos, decrease of the drug dose from twice to once a day, or discontinuation of the medication.

          Seborrhea—Oily Skin, Scalp and Hair

        The sensation of “oiliness” or “greasiness” of skin, scalp and hair is one that most people dislike and believe to be unattractive to other people as well. To some extent, the perception of “oiliness” or “greasiness” is highly personal and may or may not be objectively identified with excess skin oil (sebum) production. A feeling of oiliness in hair may also be associated with accumulation or degradation of hair cosmetic products, or with accumulation of by-products of heavy scalp perspiration. Excess sebum production frequently occurs during adolescence—a peak period from which sebum production usually declines as a person ages.

Excess sebum production is a clinically important feature in many cases of acne, and treatment of acne may include treatment to reduce sebum production. While acne is commonly believed to be a teen-age disease it persists into adulthood for millions of people.

Seborrhea can cause scalp and hair to feel oily or greasy. Unlike seborrheic dermatitis, however, the oiliness is not associated with crusting, inflammation and intense itching. The cause of severe seborrhea should be diagnosed by a dermatologist in order to rule out other conditions and determine the best treatment.