Dandruff is a common condition that is not dangerous or contagious, meaning it does not spread from person to person.
While dandruff certainly isn't something to be ashamed of, many people find it socially awkward to see white flakes of visible dandruff on their hair and clothes.
Dandruff is caused by a number of factors and you would be surprised to know that approximately half of the world's adult population is affected by dandruff. So you should never feel alone as this is a very common problem and affects many people.
In this post, we will discuss what is dandruff, the factors that can lead to dandruff and then we will jump on to the treatment part. In the end, I will also discuss two very effective home remedies for treating dandruff. So make sure to read till the end.
What is Dandruff ?
Dandruff is a skin condition that mainly affects the scalp (skin of the head), but it's not uncommon for people to discover dandruff flakes in their eyebrows, around their ears and along the sides of their nose.
To understand dandruff in a better way, you will have to first understand about a condition in dermatology known as seborrheic dermatitis. Seborrheic dermatitis also known as seborrhea is a long-term skin disorder. Symptoms include red, scaly, greasy, itchy and inflamed skin.
Areas of the skin rich in oil-producing glands are often affected, like face, chest or scalp. Now if you look at the term itself, you would understand half of its meaning. Seborrhea is made up of two words, sebum and rhea.
Sebum is the oily secretion of the glands present in your skin, and the word rhea is derived from the Greek word meaning flow. Dermatitis is also made up of two words, derma meaning skin and itis meaning inflammation. So seborrheic dermatitis basically means an inflammation of the skin in which seborrhea occurs or excessive production of sebum occurs.
Now seborrheic dermatitis can affect many areas of the skin like your face, area around your eyebrows, around your ears as well as the scalp. Basically any area of the skin that has a lot of sebum producing glands known as sebaceous glands.
So what's the link between seborrheic dermatitis and dandruff? Well dandruff is just a milder form of seborrheic dermatitis. When seborrheic dermatitis occurs in a mild form without excessive itching, redness and scaling of the scalp, it is known in simple terms as dandruff.
One of the most important cause of dandruff is a fungus known as Malassezia also known as Pitosporum. This fungus is a normal commensal of our skin meaning it is a harmless organism and lives in the glands of our skin and normally doesn't lead to any problems.
But in people with dandruff the levels of Malassezia are increased by 1.5 to 2 times its normal level. The fungus Malassezia particularly Malassezia globosa that metabolizes triglycerides present in the sebum by producing an enzyme known as lipase. This results in the production of a compound known as oleic acid.
Oleic acid is a fatty acid and it is shown to induce a dandruff like condition which is ultrastructurally identical to dandruff. Now as many of you know our skin cells are continuously shed from the top layers and new ones are added to the bottom ones and usually it takes about 40 to 50 days for the cells from the layer of skin to reach the topmost layer but in people with excessive levels of this fungus Malassezia the skin turnover rate is reduced to less than 7 days.
The result is that dead skin cells are shed in large oily clumps which appear as white or greyish flakes on the scalp, skin and clothes and this is the basic reason for dandruff.
So a dandruff scale is just a large clump of dead skin cells mixed with oily secretions of sebaceous glands and keratin.
Treatment of Dandruff
So now you know what is dandruff and why whitish flakes of dandruff are produced. Now let's jump over to the treatment part of dandruff and before we start with the medical treatment let's have a look at some of the lifestyle changes and tips you should keep in mind if you have dandruff.
Soften and remove scales from your hair
Apply mineral oil or olive oil to your scalp. Leave it in for an hour or so and then comb or brush your hair and wash it.
The products that I recommend are olive oil from ORS and herbal mineral oil from Khadi.
Avoid hard soaps
The second tip is to avoid hard soaps and use a moisturizer so as to keep your skin hydrated which prevents dryness.
Avoid hair styling products
Stop using hair sprays, gels and other styling products while you're treating this condition.
Avoid hair and skin products containing alcohol
4th tip is to avoid skin care and hair care products that contain alcohol. These can cause the disease to flare up.
Medical Treatment
The medical treatment is very simple usually consisting of only medicated shampoos, lotions and creams. But the problem with the medical treatment is that most people do not complete the whole duration of the treatment.
Most of the treatment regimes for dandruff have to be consistently followed for at least 2-3 months for complete eradication and to prevent future recurrences.
With that said let's look at the first line of treatment that is used for dandruff which is medicated shampoos.
Medicated shampoos
Medicated shampoos which contain anti-fungal and anti-inflammatory drugs are most commonly used to treat dandruff.
Shampoos containing compounds like ketoconazole, zinc pyrethione, pyroptanolamine, cyclopyroxolamine, selenium sulfide, sodium sulfacetamide, topical tarbinafine and ichthyolpale are most effective in treating dandruff.
These compounds have anti-fungal properties and they reduce the number and proliferation of Malassezia fungus on your scalp. I have selected some of the best shampoos among them all which mostly contain zinc pyrethione, cyclopyroxolamine and selenium sulfide as these have been proven by several studies to be the most effective compounds in treating dandruff.
These shampoos have to be applied twice weekly for the first 4 weeks and then only once weekly as a maintenance therapy for the next 1-2 months. While applying these shampoos make sure to leave them for 3-5 minutes in your hair so it can have its maximum anti-fungal effect.
Medicated lotions
The next category of medication that is used in this treatment are lotions of similar compounds that you can apply on your scalp and leave them on. These are also known as leave-on lotions. They usually contain zinc pyrethione, cyclopyroxolamine and other anti-fungal compounds.
These lotions are applied twice daily on the scalp for at least 4-6 weeks. Now almost 75-80% of people with dandruff will experience good response with these anti-fungal shampoos and lotions alone. If you have excessive flakes of dandruff and also deposits of white flakes on your scalp that are tough to remove you should consider using shampoos like the Neutrogena T-Sal 3% which contains salicylic acid.
This will help you to get rid of the flakes much easier. If you are not getting relief from the above treatment you can use hair washes that contain a mild steroid like Flucinolone. This helps to control the inflammation in the scalp that is also an important reason why dandruff occurs.
If all these topical medications don't work you can also consult your dermatologist for taking oral drugs like anti-fungal Itraconazole. To control the skin inflammation and turnover rate Acutane or Isotretinoin is also used but it is a prescription only drug and has some side effects.
Home Remedies for Dandruff
Now like I said in the end we will discuss two very effective home remedies for dandruff.
While there are plenty of over the counter products designed to treat dandruff natural remedies can be just as effective.
1. Using tea tree oil
Tea tree oil is an essential oil that can be used for several purposes including keeping skin, hair and nails healthy.
It is also proven to have powerful antimicrobial and anti-inflammatory properties which may help alleviate symptoms of dandruff. In fact, according to one review, tea tree oil is effective in fighting the specific strain of fungus that can cause both seborrheic dermatitis and dandruff. A four-week study examined the effects of tea tree oil on dandruff by treating 126 people daily with a shampoo containing either 5% tea tree oil or a placebo.
At the end of the study, the tea tree oil reduced the severity of symptoms by 41% and decreased greasiness and itchiness.
2. Using coconut oil
Well known for its multiple health benefits, coconut oil is often also used as a natural remedy for dandruff.
Coconut oil helps to improve skin hydration and prevents dryness which reduces symptoms of eczema and dandruff.
References
2. Borda LJ, Wikramanayake TC. Seborrheic Dermatitis and Dandruff: A Comprehensive Review. J Clin Investig Dermatol. 2015 Dec;3(2):10.13188/2373-1044.1000019. doi: 10.13188/2373-1044.1000019. Epub 2015 Dec 15. PMID: 27148560; PMCID: PMC4852869.
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