If A is for alopecia, B is for balding, and C stands for colouring, then D is definitely for dandruff in the hair lexicon. Every person has dandruff at some point in their lives, regardless of their age or ethnicity. Dandruff can affect any hair-bearing area or even a part that has very tiny hair follicles. When dandruff affects other parts of the body like this, it is known as seborrhoeic dermatitis.
Causes of dandruff
- Dry skin: Lack of moisture and sebum on the scalp can cause flaking
- Inflamed oily skin: Can cause sticky, itchy dandruff
- Irregular shampooing: Lack of regular cleaning could lead to pile-up of dead cells and flaking
- Fungal multiplication: Sometimes, the normal fungus in the scalp multiplies abnormally, leading to dandruff
- Haircare products: Irritation caused by haircare products like gels and hair dyes could lead to dandruff
- Diseases: Conditions such as psoriasis, seborrhoeic dermatitis and allergies may lead to scaling
- Climatic conditions: Cold and dry weather can lead to as well as exacerbate flaking.
This sounds downright silly, does it not? Anyone can and does recognise dandruff. So, what is the big deal? The big deal is really in recognising when your dandruff needs attention. The top layer of the scalp—not unlike the skin—is composed of dead cells which need to be shed periodically for the new cell cycle to continue.
So, theoretically a little dandruff is normal, necessary even. But it should be totally free of itching and other symptoms. However, when you start scratching your head frequently or find dandruff falling on your shoulders, clothes and face, it signals a deeper issue and should be addressed urgently.
Normal scalp health
The health of our scalp is maintained by multiple factors such as our overall health, diet and the good bacteria we consume through our food. So, if any of these factors is altered, the organisms that usually reside in our scalp can also start multiplying, worsening the scaling on the surface. Increased secretion of sebum is the starting point, which then promotes continued proliferation of the organisms, leading to increased scaling.
This could, in many cases, be the precursor to other symptoms and conditions as well.
Tests to determine dandruff
Patients always ask me whether there are any tests available to determine dandruff. The answer is, no. This is because a good clinician will correlate the patient’s symptoms and the clinical appearance and arrive at a clear-cut reasoning on the causes of the dandruff and how to treat it. The only thing to keep in mind is that chronic dandruff can sometimes be a precursor to conditions like psoriasis. Thus, any dandruff not responding to regular care for over six months requires a visit to the dermatologist.
Diet and dandruff
Diet plays an important role in scalp and hair health. From the perspective of dandruff, it is important to eat a diet that consists of food items that are anti-inflammatory and are rich in antioxidants. Fruits and vegetables of different colours, and whole grains help in providing this balance. Inclusion of zinc, B vitamins and certain good fats is also vital. So, include fish, eggs and walnuts as well as flax seeds in your diet.
Treating dandruff needs a multi-pronged approach which I often refer to as the SCALP approach:
- Shampoo often: If you have an oily scalp, daily shampooing may help prevent dandruff.
- Cut back on styling products: Hair sprays, styling gels, mousses and hair waxes can cause build-up on your hair and scalp, making them oilier.
- Aim to eat healthy every day: Include as many things as possible from the above list to ensure good scalp health.
- Learn to manage stress: Stress affects your overall health and can trigger dandruff or worsen existing symptoms.
- Pick your shampoo judiciously: Knowing which anti-dandruff shampoo works best for you is the key to staying dandruff-free.
The good news is that over-the-counter [OTC] shampoos do work for commonly found dandruff. Here are some of the popular ingredients that work:
- Zinc pyrithione: Another anti-scaling and anti-fungal ingredient that slows down the growth of microorganisms that cause dandruff and similar conditions, such as scalp psoriasis. In addition, it improves the texture and shine of your hair, and controls any unpleasant odour that your scalp may emit.
- Selenium sulphide: One of the oldest anti-dandruff ingredients, it is quite effective in controlling scaling but could irritate the scalp. So, even though it is available OTC, I would recommend consulting your dermatologist first.
How to choose the right shampoo
The first thing each of us does when we have dandruff is to buy an anti-dandruff shampoo. So, look for one of the ingredients listed above. In case one shampoo does not work, look for another one with a different ingredient.
It is important to understand that dandruff is recurrent and that shampoos must therefore be used routinely and regularly.
It is also important to reach all areas of the scalp adequately and to leave the shampoo in for four to five minutes before rinsing thoroughly. If necessary, reapply and rinse again. Shampooing may be necessary every day when you first begin using your antidandruff shampoo, but you can eventually settle down to a once- or twice-a-week routine.
What the doctor does
The dermatologist will rule out all underlying causes—like a possible psoriasis, seborrhoei- dermatitis, etc.—in case of chronic dandruff. In the event that the dandruff seems sticky, the doctor will prescribe oral tablets—anti-fungal or antibiotic—to control the infection. In certain cases, topical steroids may also be prescribed, along with a steroid shampoo. Any other underlying conditions will be treated appropriately, according to the diagnosis.
Flake not, freak not!
Chronic dandruff is known to cause tremendous stress and social embarrassment, especially to younger individuals. However, knowing that it can be controlled easily can help alleviate a lot of this turmoil. It is important to spend time with your doctor to understand your condition fully and to recognise that the resolution of the condition is eminently easy.
Excerpted with permission from Let’s Talk Hair by Aparna Santhanam, published by Collins
This was first published in the November 2013 issue of Complete Wellbeing.