Dandruff afflicts half the world. So, what exactly is dandruff? Also known medically as Pityriasis simplex, dandruff is a near-physiological scaling of the scalp. In other words, it is an active end of normal scalp shedding. In a normal scalp, the skin undergoes regular maturity and the topmost layer is seen to contain only 3,700 immature cell /sq.cm. Whereas in cases of dandruff afflicted scalp we see 25,000 immature cells/sq.cm.
This disorder is seen more often in adolescence and adult life, suggesting influence of abdrogenic hormones and sebaceous activity.
Also suggested since the 19th century is the role of a yeast called Pityrosporum ovale. This is supported by the fact that anti-yeast drugs are of prime importance in treatment of dandruff and show wonderful results. What remains controversial is whether it is the yeast which causes dandruff or is it an inherent overstimulation of scalp that flakes and the yeast is just incidental.
Now we come to another important point. Dandruff or scaling of the scalp is also seen in a more severe disorder called Seborrheic Dermatitis. This disease affects those areas of the body which have a high population of sebaceous glands namely the scalp, face and trunk.
Contrary to the name there is no direct relation between increased sebum formation and Seborrheic Dermatitis. It is postulated that there may be a difference in the sebum content or its retention which causes irritation and inflammation. It differs from simple dandruff in the fact that it is inflammatory and on examination of the scalp and skin, a dermatologist can easily see red, itchy and scaly patches. The scales are more greasy, of a different colour and bacterial infection may also supersede. The treatment then calls for slightly more aggressive therapy as opposed to simple dandruff.
Itching and hair fall is associated with both conditions. Detachment of scales from the scalp can cause aesthetically unpleasant deposits on the collar and shoulders. Acneiform eruptions over the shoulders, back and chest are associated with dandruff too
Therapies and efficacy
Dandruff in its milder form calls for treatment which can control the disease at the lowest possible cost and inconvenience to the patient. Here we have proprietary over the counter amd supermarket shampoos such as Selsun, Head & Shoulders, Pantene etc. which contain Zinc Pyrithione or Selenium Sulphide.
The conditioners added into these preparations decrease the tangling, fly away phenomenon making it easy to comb hair in the ‘wet phase’ without breakage and enablingthe scales and deposits to be easily ‘brushed out’.
Cetrimide or Savlon washes are also effective and relatively economical to use though they may not always give a desired cosmetic aftereffect.
Where medicated shampoos are concerned it is purely within the dermatologists realms. I, for one, am always looking at various preparations individually and evaluating them not only as per their fast efficacy but also in terms of patient acceptability. This term includes how comfortable the patient is after using the shampoo in terms of perfume, lustre, hair gloss and manageability. Not less important is the cost of the preparation, its quality and last, but not the least, is the demand nowadays for natural products. If you see scaling on the eyelashes, eyebrows and rashes on the face and scalp, then a more aggressive line of treatment is necessary.
Sometimes it becomes necessary to use oral anti-fungals like Itraconazole, Fluconazole etc.
Anti-inflammatory drugs like topically applied steroidal preparations are at times indispensable, especially to control inflammation, itching and hairfall. Rarely do we need to use systemic steroids as well.
As you can well gather from the above, a unifying explanation for this common ailment, dandruff, remains elusive but treatment modalities are many.
So do take stock of your scalp, visit a dermatologist if necessary, wash away those flakes and then swish your hair with the confidence and style that you deserve.