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Jan 10, 2008

Scaling scalps

I HAVE lots of dandruff. It keeps falling onto my shoulders. It is very noticeable when I wear black. Sometimes, it sticks to my hair and it is very unsightly. I’ve been told dandruff is actually an infection. Is this true?

Dandruff is actually excessive skin scaling, the skin here being the one from your scalp.

Dandruff consists of white, oily-looking flakes of dead skin that fall off onto your hair and shoulders. Your scalp is also itchy and scaly.

The scientific name for dandruff is seborrhoea, which in Latin means “too much oil”.

There have been many theories about what causes dandruff. In history, dandruff has been attributed to having a dry scalp, having an oily scalp (!), shampooing your hair too often or not often enough (it’s amazing how you can’t seem to do too much of one or the other), too much stress, poor sleep, poor diet, and the use of too much hair styling products like mousse or gel.

It is true that some of these factors may indeed exacerbate your scalp skin flaking. However, the newest theory is that dandruff may be caused by a fat-eating, yeast-like fungus called malassezia.

So in effect, dandruff is a fungal infection.

Malassezia was previously known as the fungus pityrosporum.

You mean I actually have a fungal infection on my scalp?

Yes. Actually, you can find malassezia on the scalps of most people in the world. It usually doesn’t cause any problems. But when it grows out of control, it will feed on the oil secreted by your hair follicles and cause irritation to your scalp.

Your scalp will then produce even more skin cells, causing a high turnover, leading to more dead skin cells being flaked off at the top.

These dead cells fall off, but they tend to clump together, appearing as white, flaky and very visible dandruff.

Nobody knows why malassezia grows out of control on some people and not on others, but some causes include increased oil production, stress, hormonal fluctuations (like when you are having your period), illness, neurological disorders, when your immune system is suppressed and infrequent shampooing.

Is dandruff more common in men or women?

Dandruff is more common in men. Some scientists think this is because testosterone, the male hormone, makes men more susceptible to dandruff. Men also have larger sebaceous glands on their skin that produce more oil than women.

Dandruff is also more common in young adulthood through to middle age.

If you have very oily skin, you are also more prone to having dandruff.

My cousin has very severe dandruff. In fact, his dandruff is so bad he also has it on his eyebrows! His armpits are also red!

Your cousin doesn’t just have simple dandruff. In fact, he might be having seborrheic dermatitis. This is a condition that causes dandruff, among other symptoms and signs.

In fact, there’s been a lot of confusion with seborrheic dermatitis and dandruff, but in most people’s context, “dandruff” is used to denote the mild, flaky form of the disease that occurs on your scalp.

Seborrheic dermatitis is an inflammation of your skin. It causes flaky, white to yellow scales to form on most or all of your oily skin areas. Not only is your scalp affected, but also the inside of your ear, your eyebrows, the sides of your nose, the backs of your ears, your breastbone, your groin and your armpits.

It may or may not be associated with reddened skin.

Seborrheic dermatitis of the scalp is called “cradle cap”. This is common in newborn babies and may occur throughout infancy. It is not dangerous and will usually clear up on its own when your child turns one year old.

How do I treat dandruff?

If you have mild dandruff, you can reduce it by shampooing your hair daily with a gentle shampoo to reduce oiliness and build-up of dead cells.

If gentle shampoo doesn’t work, you can progress to the anti-dandruff shampoos. Not all anti-dandruff shampoos will work for you so you have to experiment with each and find out which one controls your dandruff. Remember, what works for your friend might not work for you!

Dandruff shampoos have active ingredients in them.

For example, there are zinc pyrithione shampoos which are antibacterial and antifungal. They have been shown to reduce malassezia. Examples: Selsun shampoo, Head & Shoulders.

Tar-based shampoos not only help with dandruff but also seborrheic dermatitis and psoriasis by slowing down cell turnover. Example: Neutrogena T.

Selenium sulphide shampoos prevent cell turnover and reduce malassezia. These can discolour your hair if you have dyed it, so use as instructed. Example: Selsum Blue.

Ketoconazole shampoos are the newest type. They contain a broad-spectrum antifungal that may work when other shampoos fail. Example: Nizoral.

You may use one of these shampoos daily until your dandruff is controlled, then cut back to two or three times a week.

If one loses its effectiveness, alternate between another. You must leave the shampoo on for at least five minutes to allow the ingredients to work.

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