Dandruff

Dandruff is a common form of skin dermatitis that occurs in parts of the body that are sebum/oil-rich such as the scalp, face, ears, chest, underarms and skin folds like under the breasts. The etiologic agent linked to this skin disorder is the fungi species Malassezia. Other factors like immune response, diet, stress, lack of sleep and changes in the weather are also implicated in the development of seborrhea dermatitis.

Dandruff manifests as thick, white or silvery flakes that form patches on the scalp. When present on the face, seborrhea produces greasy scales on the eyebrows, behind the ears and on the nasolabial folds that may appear reddish when scratched. It is usually itchy and scratching may predispose to secondary bacterial or fungal infection.

Seborrhea on the scalp does not lead to alopecia or permanent hair loss. Dandruff can also affect infants and is commonly referred as “cradle cap” which usually resolves after a few weeks. Dandruff is common in adolescents and is associated with increased activity of sweat glands; it is also common among adults, peaks at age 40 and commonly affects the scalp and face. Men are more prone to dandruff and it is usually worse among them compared to women.

Severe or generalized seborrhea is rare and occurs commonly among HIV patients, immune-compromised hosts and those with Parkinson’s disease. Patients who are on chemotherapy are also prone to severe seborrhea dermatitis.

Medical treatment of dandruff includes application of topical corticosteroids to reduce inflammation and application of topical anti-fungal creams such as ketoconazole. Systemic antifungal medications such as fluconazole and ketoconazole may be given intravenously in severe seborrhea dermatitis or generalized infection.

Shampoos that contain elements like tar, salicylic acid, zinc pyrithione, selenium sulfide and ketoconazole may help control dandruff when used 2-3 times a week. These shampoos may also be effective on seborrhea affecting the eyebrows and beard area. Dandruff on the eyelashes may be treated by scrubbing the lashes with baby shampoo using a cotton swab. The use of hair sprays, hair cream and pomades should be stopped as these contain harsh agents that may worsen or trigger recurrence of dandruff.

Treating Dandruff