Disease: Dandruff
(Seborrhea)

    Dandruff facts

    • Dandruff is produced when the skin of the scalp exfoliates excessively.
    • The white dusty flakes of material in the hair and on the shoulders are fragments of the superficial stratum corneum.
    • Lack of shampooing can enhance dandruff by allowing flakes to accumulate on the hair.
    • There are a number of scalp diseases than can produce dandruff.

    What is dandruff? What causes dandruff?

    The most common cause of dandruff is seborrheic dermatitis (seborrhea), which tends to occur on the scalp, ears, face, mid-chest, and mid-back. The cause of seborrhea is unknown, although a yeast that often lives on the skin, Malassezia furfur, may play a role.

    A common secondary manifestation of seborrhea of the scalp is dandruff. Seborrhea produces plaques of itchy dermatitis with scaling. It is the accumulated scale that we call dandruff. Reddish, scaly plaques may also appear in the eyebrows, on the forehead, in the ear canal, on the folds of skin that extend from the nostril to the commissure of the lips. Although skin affected by seborrhea may feel and look dry, this is not the case; moisturizers are of little help in its control.

    Scalp seborrhea does not cause permanent hair loss. Often, scalp seborrhea doesn't even itch significantly. Seborrhea can appear during infancy, starting shortly after birth and lasting several months. It may affect the scalp ("cradle cap") or produce scaly plaques on the body. Seborrhea may occur at any age.

    Some people who have weakened immune systems, such as those on chemotherapy or those with HIV disease or certain neurological disorders, may have very severe seborrhea. It is important to emphasize, however, that seborrhea is a very common condition, affecting perhaps 5% of the population (with men predominating). The vast majority of those who have it are completely healthy and have no internal or immune problems.

    There are a variety of other inflammatory diseases that can produce excessive scaling and therefore dandruff, including psoriasis, fungal infection of the scalp skin (tinea capitis), and allergic contact dermatitis.

    What treatments are available for dandruff?

    Treatment of seborrhea (dandruff) is directed at fighting the skin inflammation. This is done either directly, by using cortisone-based creams and lotions (which reduce inflammation), or by using topical anti-yeast lotions and shampoos. Treatment should be directed at the cause of the dandruff.

    What doesn't help dandruff?

    • Moisturizing: Moisturizing lotions don't do much more than smooth out scales and make plaques look redder.
    • Switching brands of shampoo: Shampoo doesn't cause dandruff. However, medicated shampoos (see below) can help.
    • Changing hair-care routines: There is no "right" shampoo or conditioner. What is more important is the frequency with which these agents are used. As a rule, the more frequently one shampoos, the better the result. Seborrhea and dandruff are not caused by excessive shampooing "drying out the scalp." Hair dyes and conditioners do not cause or aggravate dandruff.
    • Switching antiperspirants: When underarms are red from seborrhea, almost anything will make them redder, including antiperspirants, even though they are only aggravating the seborrhea and not causing it.

    What over-the-counter products can help dandruff?

    1. Shampoos: Here are some ingredients in medicated shampoos that you can look for to help control dandruff of the scalp. All are available over the counter.
      • Tar (T/Gel)
      • Salicylic acid (T/Sal)
      • Zinc pyrithione (like Head & Shoulders)
      • Selenium sulfide (Selsun Blue)
      • Ketoconazole (Nizoral)
      One can use any of these either all of the time or just once or twice a week, depending on how severe the symptoms are. If the problem quiets down or disappears, use unmedicated shampoos. If one kind of shampoo works for a while and "runs out of gas," switch to another. For resistant cases, alternate two different types.
    2. Creams: Two additional types of medication that help seborrhea are cortisone creams and antifungal creams.
      • Corticosteroid creams reduce inflammation. These can be purchased over the counter in either 0.5% or 1% concentrations. They are safe to use on the face and will often help in just a couple of days when applied twice daily. These products also are available as scalp lotions that are applied once a day, preferably on damp hair after shampooing. One can use scalp corticosteroid creams together with medicated shampoos.
      • Antifungal creams are often effective, apparently because they reduce the number of yeast organisms living on the skin. Over-the-counter creams include 1% clotrimazole cream and miconazole cream 2%. Antifungal creams also are applied once or twice a day.

    As with shampoos, creams should be applied until the seborrhea subsides. When the seborrhea comes back (and it will, sooner or later), the creams should be used again.

    What treatments are available for dandruff?

    Treatment of seborrhea (dandruff) is directed at fighting the skin inflammation. This is done either directly, by using cortisone-based creams and lotions (which reduce inflammation), or by using topical anti-yeast lotions and shampoos. Treatment should be directed at the cause of the dandruff.

    What doesn't help dandruff?

    • Moisturizing: Moisturizing lotions don't do much more than smooth out scales and make plaques look redder.
    • Switching brands of shampoo: Shampoo doesn't cause dandruff. However, medicated shampoos (see below) can help.
    • Changing hair-care routines: There is no "right" shampoo or conditioner. What is more important is the frequency with which these agents are used. As a rule, the more frequently one shampoos, the better the result. Seborrhea and dandruff are not caused by excessive shampooing "drying out the scalp." Hair dyes and conditioners do not cause or aggravate dandruff.
    • Switching antiperspirants: When underarms are red from seborrhea, almost anything will make them redder, including antiperspirants, even though they are only aggravating the seborrhea and not causing it.

    What over-the-counter products can help dandruff?

    1. Shampoos: Here are some ingredients in medicated shampoos that you can look for to help control dandruff of the scalp. All are available over the counter.
      • Tar (T/Gel)
      • Salicylic acid (T/Sal)
      • Zinc pyrithione (like Head & Shoulders)
      • Selenium sulfide (Selsun Blue)
      • Ketoconazole (Nizoral)
      One can use any of these either all of the time or just once or twice a week, depending on how severe the symptoms are. If the problem quiets down or disappears, use unmedicated shampoos. If one kind of shampoo works for a while and "runs out of gas," switch to another. For resistant cases, alternate two different types.
    2. Creams: Two additional types of medication that help seborrhea are cortisone creams and antifungal creams.
      • Corticosteroid creams reduce inflammation. These can be purchased over the counter in either 0.5% or 1% concentrations. They are safe to use on the face and will often help in just a couple of days when applied twice daily. These products also are available as scalp lotions that are applied once a day, preferably on damp hair after shampooing. One can use scalp corticosteroid creams together with medicated shampoos.
      • Antifungal creams are often effective, apparently because they reduce the number of yeast organisms living on the skin. Over-the-counter creams include 1% clotrimazole cream and miconazole cream 2%. Antifungal creams also are applied once or twice a day.

    As with shampoos, creams should be applied until the seborrhea subsides. When the seborrhea comes back (and it will, sooner or later), the creams should be used again.

    Source: http://www.rxlist.com

    Treatment of seborrhea (dandruff) is directed at fighting the skin inflammation. This is done either directly, by using cortisone-based creams and lotions (which reduce inflammation), or by using topical anti-yeast lotions and shampoos. Treatment should be directed at the cause of the dandruff.

    Source: http://www.rxlist.com

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