Dandruff is a condition rather like acne which, although not serious, can be acutely embarrassing to those who suffer from it and a source of amusement to those who don’t. It is also the most common cause of itching of the scalp, but is not a sign of general ill health.
Normally, everyone’s skin cells, including those on their scalp, are replenished about every 28 days and the top layer regularly shed in minute, usually unnoticeable pieces. In dandruff sufferers, this process may be speeded up and the particles shed are larger and easily seen. With milder forms of dandruff, sometimes known as scurf, the flakes of skin are dry and white and tend to clump together in the hair. Touching the hair – which most people do many times a day without realising it – dislodges the fragments and they fall on to the shoulders, looking like a white powder.
This type of dandruff can usually be controlled by washing the hair two or three times a week with a medicated, anti-dandruff shampoo. These often contain tar, sulphur or salicylic acid to soften and help loosen scale and scalp debris. Other anti-dandruff shampoos for more severe cases contain zinc pyrithione or selenium sulphide to reduce the development of dandruff by slowing down the growth of skin cells, as well as having mild antifungal properties.
There is, however, a more severe form of dandruff called seborrhoeic dermatitis of the scalp, which may not respond to these shampoos. It can occur on other parts of the body, too, and may be very difficult to treat effectively.
Seborrhoeic dermatitis can affect both children and adults. On a baby’s scalp it is known as cradle cap and the condition often also appears as a nappy rash for which your doctor can prescribe a cream. For adults and older children, Capasal Therapeutic Shampoo may help, as it ‘dissolves’ the skin flakes but also contains a moisturiser to protect the skin from dehydration.
When they occurred in adults, both seborrhoeic dermatitis and other forms of dandruff used to be thought to be due to over-production of sebum. Diet, hygiene, climate and stress were also thought to play a part. However, recent research has shown that it is the sufferer’s over-reaction to a minute, fungus-like organism called Pih/rosporum ovale. It is the reaction to the fungus, rather than the fungus itself, that causes the scalp’s top layer of skin to flake off as dandruff, or gives rise to the symptoms of seborrhoeic dermatitis.
In this condition, which is most common in young men but can affect women, too, the flakes of skin are large, yellow and oily. The skin on the scalp becomes red, inflamed and soggy, especially around the edges, and may be infected by other germs. Eyelashes, eyebrows, skin folds on either side of the nose and behind the ears can all be affected, as can other parts of the body, such as the chest, armpits, breasts and groin.
Neither dandruff nor seborrhoeic dermatitis is catching, because, as I said, it is not the fungus itself that produces the symptoms – as it is with athlete’s foot, for instance – but an over-reaction to it which only occurs in susceptible people. The fungus itself is around all the time. Why some people
If you find your dandruff cannot be controlled by medicated shampoos from your pharmacist, do consult your doctor, as there are now effective treatments which he or she can prescribe. The same advice applies if you think you have seborrhoeic dermatitis. Your doctor’s examination will exclude other possible skin conditions such as psoriasis and eczema, and suitable treatment can then be suggested.
If dandruff or scalp symptoms are severe, there is now some good news for sufferers. A specific antifungal shampoo called Nizoral is available on prescription and is very effective. Your doctor may suggest using this twice weekly for about four weeks, interspersed with milder medicated shampoos on other days. You may then be advised to use the antifungal shampoo less frequently to prevent symptoms recurring. Regular hair-washing with this shampoo may also help if your eyelids are inflamed and crusty, although another organism – the staphylococcus – is often involved in this case too. It causes a condition known as blepharitis, to which many people are prone from childhood. Symptoms can usually be controlled by removing crusts from the eyelids by bathing them with a cotton wool bud dipped in baby shampoo, diluted to half strength, and then applying an antibiotic ointment to the rims.
Your doctor may prescribe antifungal and/or various anti-inflammatory applications for skin rashes on other parts of the body due to seborrhoeic dermatitis; taking antibiotics by mouth may be necessary if the rash becomes infected by other germs.
So, if the usual medicated shampoos do not keep your dandruff at bay, don’t feel that it is too minor a problem to bother your doctor with. Any of these conditions can be very distressing and embarrassing and there is a lot that can now be done to treat them.
Capasal Therapeutic Shampoo, Denorex, Genisol, Lenium, Polytar Liquid