Dandruff (Pityriasis Simplex)

Dandruff is a form of seborrheic dermatitis, an inflammatory condition in which dead scalp cells flake off leaving telltale signs on the shoulders and clothing. More severe cases also affect the skin around the nose, behind the ears, or in the armpits or genital area.

The flaking is thought to be caused by scalp cells that are aging too rapidly. Normally, dead skin cells are shed from the scalp during routine hair care. But when the normal growth pattern is altered, and excessive dead cells reach the scalp's surface simultaneously, they stick together and fall off in flakes. However, some researchers dispute this view and argue that a yeast called Pityrosporum ovale is responsible. Whatever the cause, dandruff does not lead to permanent hair loss or baldness.

Both dry and oily scalps develop dandruff. With an oily scalp, excessive fatty acids irritate the cells around the hair follicles, prompting an even more rapid cell turnover that leads to dandruff. In contrast, the flaking of a dry scalp is due to lack of moisture. Dandruff from a normal scalp is probably the result of poor hair care.
During periods of stress, fatigue, or illness, dandruff may increase. Hair coloring, waving, or straightening may also produce extra flaking.

Diagnostic Studies and Procedures

Dandruff is usually obvious and rarely requires a medical diagnosis. When it is persistent and does not respond to treatment, however, a doctor should rule out other skin disorders. If there is still doubt about the underlying cause, a biopsy may be taken from affected areas for laboratory study.

Medical Treatment

Ordinary dandruff does not need medical treatment, but severe cases may require a medicated shampoo. Some dermatologists prescribe an antifungal shampoo, such as ketoconazole (Nizoral). Although dandruff is not a fungal disease, fungi that normally live on the scalp can increase flaking.

Alternative Therapies

Aromatherapy. Practitioners recommend bathing the affected areas three times a week with a 2 percent essence of geranium in a distilled water base. Another remedy calls for massaging a 10 percent sage essence in an olive oil base into the affected areas, then waiting two hours before washing out the mixture. This procedure should be followed twice a week.

Herbal Medicine. Aloe vera has skin softening properties that can help alleviate dandruff. It is most effective when a freshly cut leaf is rubbed directly onto the affected area. Applying eucalyptus oil to the scalp is advocated by some herbalists.

Massage. Although this therapy cannot cure dandruff, it is a time-honored method for reducing the stress that may be an underlying cause. Reflexology, or foot massage, is also said to be effective.

Relaxation Therapies. All forms of meditation, including yoga, may help relieve a dandruff condition that is related to excessive stress. An increase in exercise may have a similar effect.

Self-Treatment

If your hair is oily, treat dandruff by brushing thoroughly and then washing with a shampoo for oily hair. Follow this with a dandruff shampoo that contains sulfur, such as Sebulex, Sebutone, or Selsun, to remove dead scalp cells and reduce the output of oil glands. Next, apply a lemon rinse, made with the strained juice of one lemon in a cup of lukewarm water, pour this on, work it through the scalp, and rinse with cool water. Do not use a commercial conditioner, which may actually compound the oil problem. Treat your hair wth this program twice a week until the condition is under control. If you shampoo more frequently, use a standard shampoo for oily hair followed by the lemon rinse. Blow-dry using a cool or warm setting, but avoid letting the hair dry naturally, because lying against the scalp allows wet hair to pick up oil more quickly. If possible, avoid hair spray as it is a magnet for oil.

Treat dry hair and dandruff first with a thorough brushing, then spread about a cup of hand and body lotion on the hair and work it into the scalp. Wrap the head with a towel that has been soaked in very hot water and wrung out, and leave it in place for about 20 minutes. Next, wash the hair with a mild dandruff shampoo, such as Head and Shoulders or Zincon that contains zinc pyrithione. If the dandruff persists, try a coal tar shampoo such as Denorex or Polytar. After shampooing, always rinse the scalp thoroughly with lukewarm water.

If you have normal hair, treat dandruff by brushing, washing with plain shampoo, and then applying an aspirin rinse, made by dissolving six aspirin tablets in a cup of warm water. The rinse should be poured over the hair, worked into the scalp, and left on for 15 minutes before rinsing. Once the dandruff disappears, you can return to a normal program of hair care.

For hair that has been bleached or permed, dandruff should be treated by first brushing, then shampooing with a protein, acid-balanced shampoo. Follow this with a mild dandruff shampoo that contains zinc pyrithione, and then rinse and apply a low-pH conditioner with protein.

Other Causes of Dandruff

The silvery scales of psoriasis are sometimes confused with dandruff. Eczema may also be responsible for dandruff. Babies often develop infantile seborrheic eczema, commonly referred to as cradle cap, which appears as thick and yellow crusted patches on the scalp.