Dandruff

Dandruff is characterized by flaking of dead skin on the scalp, and is often accompanied by itching. This condition is common and is most prevalent in youngsters and men.

Causes and triggers

Unusually fast skin renewal or a fungal overgrowth may be responsible for dandruff. However, many cases are simply the result of dry skin. Symptoms therefore tend to worsen in dry winter conditions.

The following skin conditions may also be responsible for causing dandruff:

• Seborrheic dermatitis
• Eczema
• Psoriasis

Treatment

Frequent hair washing is recommended to keep dandruff under control. Depending on individual hair type and symptom severity, daily hair washing may be helpful. A medicated shampoo can be used several times a week at the onset of treatment then as needed once symptoms have improved. Treatment can be continued for as long as necessary.

If symptoms do not improve after 4 to 6 weeks of using a medicated shampoo, try a different dandruff shampoo. A gentle, non-medicated shampoo may be used between medicated shampoo uses.

There are various types of medicated shampoos. Some are antifungals, while others can slow skin cell renewal or help slough off and eliminate dandruff flakes.

The most common over-the-counter dandruff treatments are:

• Ketoconazole (e.g., Nizoral)
  • Helps eliminate fungus on the scalp.
• Zinc pyrithione (e.g., Head & Shoulders, Selsun Blue, Dan-Gard)
  • Slows skin cell renewal, and may help fight future fungal infections on the scalp.
  • May be used daily, if needed, since it is well tolerated.
  • May cause discoloration of hair dyes.
• Selenium sulphide (e.g., Selsun and Selsun Blue)
  • Similar to zinc pyrithione, but can be more irritating and dry out hair even more.
  • Do not use more than twice a week. Excessive use may lead to greasy-looking hair, and may cause hair loss (reversible).
  • May cause hair discoloration, especially if hair is dyed or permed. It is therefore important to rinse hair thoroughly after washing.
  • May damage jewelry. Remove all jewelry before using.
• Coal tar (e.g., Sebcur)
  • Slows skin cell renewal.
  • Makes skin more sensitive to sunlight.
  • May stain skin and hair.
• Salicylic acid (e.g., Selsun Blue Botanicals for Itchy Dry Scalp)
  • Exfoliates the scalp and helps slough off and eliminate dead skin cells, thereby preventing the formation of crusty patches.
  • Often combined with other agents.
  • May cause an allergic reaction.
• Combination of products (e.g., Tardan)
  • Many products combine the properties of several agents.

Below are instructions on how to correctly use medicated shampoo to control dandruff:

• Wet hair and separate into small sections.
• Lather right down to the roots and the skin of the scalp, and massage.
• Leave the shampoo on for at least 5 minutes before rinsing.
• Repeat if necessary.
• Rinse hair thoroughly.

When should I see a medical professional?

• If you continue to have an itchy scalp despite using a dandruff-fighting shampoo for several weeks.
• If you notice redness or swelling on the scalp.

For more information:

• Canadian Dermatology Association