Dandruff

Dandruff is a common skin condition that affects the scalp. Typically, those with dandruff complain of white flaky scales on the scalp, which are sometimes associated with an itchy sensation. Although irritating, it is a non-inflammatory process that is generally more troublesome from a cosmetic perspective.

Dandruff is most commonly encountered in young males, and rarely occurs in the very young or very old. It tends to be more problematic in dry climates and during the winter season. There is also some evidence implicating a fungal origin, particularly yeast of the Malassezia spp. It is thought that the flakes arise because of a disruption in the turnover and cohesiveness of the cells of the scalp.

Although this condition has no absolute cure, it can be managed. Removing the hair from the scalp (shaving) can be an affective way of controlling dandruff, but this doesn't appeal to everyone. For patients with a minor degree of dandruff (frequent but not excessive) (i.e. three times a week to daily), washing of the scalp with a non-medicated shampoo can be enough of an intervention. The ingredients in the shampoo can help detach the flakes so they are rinsed away.

Should this step not control the dandruff, a medicated shampoo can be tried. These products try to decrease the turnover rate of cells on the scalp and/or possess antifungal activity. Selenium sulfide (0.5-2%), zinc pyrithione (1-2%) and ketoconazole (2%) are available in non-prescription shampoos aimed at controlling dandruff. For those shampoos, it is very important that they have enough contact time with the scalp to work; therefore the directions on the product label should be observed. Shampooing first with a non-medicated product can assist in removing all the debris on the scalp before treating the area. If the desired results are not attained, treatment with products containing keratolytics (e.g., salicylic acid, precipitated sulfur) or coal tar can be tried. Keratolytics act by loosening the flakes so that they can be removed more easily from the scalp. Coal tar may be particularly effective for itching, but may not always be cosmetically acceptable, however, there are formulations that address these issues.

If, after an adequate trial of these agents, the dandruff does not clear up (or becomes worse), talk to your doctor or pharmacist.