Dandruff is a very common scalp disorder which affects about 50% of the population. The word dandruff (dandruff, dandriffe) is derived from ‘tan’ meaning ‘tetter’ and ‘drof’ denoting ‘dirty’. It is nothing but the shedding of dead cells from the scalp, commonly described as the flaking of scalp skin.
Causes for dandruff formation
Pityrosporum ovale (Malassezia) is a yeast that is responsible for dandruff. Seborrhoea (excess sebum secretion) helps in the growth of this fungus.
Other add-on factors for dandruff formation
Over shampooing, frequent combing, use of certain harmful hair cosmetic products, dust exposure, diet poor in vitamins, mental stress and adolescent age group are other add -on factors for dandruff formation.
Clinical presentation of dandruff
Dandruff presents as dry white scales over scalp which falls on the shoulder and clothes whenever the hair is brushed. This flaking is persistent and often causes itching. It usually worsens in winter.
Dandruff and hair fall
There is a tendency for the hair to fall off from the affected part of the scalp. The dandruff may precede or accompany various types of hairfall like telogen effluvium in women and exacerbate androgenetic alopecia in men. It has been observed in a study that about 100-300 hairs were shed in dandruff sufferers whereas it was only 50-100 hairs in normal subjects.
Though various scalp preparations are available for dandruff control, Anti-dandruff shampoos are the first line in the management of dandruff. Anti-dandruff shampoos and other scalp products contain the following anti-fungal agents as active ingredients:
- Ketoconazole: Ketoconazole is a broad spectrum imidazole topical antifungal which acts by blocking the synthesis of ergosterol present in the Malassezia cell membrane and inhibits its growth.
- Selenium sulphide: Selenium sulfide has cytostatic effect on Malassezia as well as anti-seborrheic properties when used topically.
- Zinc pyrithione: Zinc pyrithione (ZPT) normalizes the keratinization and sebum production over scalp. There is a substantial reduction in Malassezia growth after its use.
- Coal tar: Tar causes dispersion of scales, which may reduce Malassezia population over the scalp. Combination of coal tar and ZPT is very safe and effective in controlling dandruff and associated symptoms.
- Ciclopirox : Ciclopirox interferes with the cell membrane integrity and the respiratory process of Malassezia, thereby minimizing its population.
- Salicylic acid: Salicylic acid is a keratolytic agent that will loosen the attachments between the corneocytes and allow them to get washed off. It decreases the scaling present over the scalp.
- Sulphur: Sulphur is a non-metallic element that is used for dandruff control. It has both keratolytic and antimicrobial activity.
- Naturopathic and herbal agents: Several natural herbal products are available in the market for dandruff control as alternative to synthetic antifungal agents.
The active principles of various naturopathic agents, including phyto-hormones, bioflavanoids, enzymes, tannic acid, fruit acids, amino acids, sugars, glycosides and essential oils are used as anti-dandruff agents.
Neem (Azadirachta indica) and Fenugreek (Trigonella foenum graecum) seeds are natural topical anti-dandruff agents with a wide range of medicinal purpose.
Henna (Lawsonia inermis) contains Lawsone and has a natural affinity to the proteins in the hair and prevent dandruff.
Tea Tree Oil (Melaleuca alternifolia) and Rosemary oil (Benincasa hipsida ) penetrate the top layers of the scalp and reduce scaling. They are also available as tonics, shampoos and lotions for scalp.
Licorice (Glycyrrhiza glabra) decreases the sebum secretion over the scalp. Lemon (Citrus limon) helps to restore the pH balance of the scalp.
Anti-dandruff treatment reduces scalp flaking and inflammation and prevent complications like loss of hair and secondary infection due to scratching. Timely intervention and proper life style modifications may help to control dandruff.