DANDRUFF

Dandruff: Causes and Treatment

Pityriasis capitis/simplex is more popularly known as dandruff and can be defined as non-inflammatory excessive scaling of the scalp that represents the more active spectrum of the physiologic desquamation.

Most often dandruff is purely a cosmetic problem with presence of unaesthetic flaking of scales on scalp, descending onto the face and the shoulders.

HISTORY OF THE PATIENT:

• Inquiry into severity, pruritus frequency of hair washing/shampooing and seasonal variation is required.
• Further inquiry into medication (gold therapy), dietary deficiencies (vitamin B complex), and history of acne, seborrhoeic dermatitis and psoriasis.

CLASSIFICATION:

Dandruff can be graded based on the degree of scale ranging from 0 to 10 i.e. from no trace of scaling to massive scaling.

Mild/Grade I - Visible fine scaling, non pruritic, non inflammatory of pure cosmetic significance.

Moderate/Grade 2 - Large scaling with pruritus, mild inflammatory changes associated with diffuse alopecia, acne or seborrhea.

Severe/Grade 3 - Severely inflammatory, severe signs may require scraping of potassium hydroxide mount (tinea capitis) or biopsy (seborrhoeic dermatitis, psoriasis).

PRINCIPLES OF MANAGEMENT

1. Patient education and explanation regarding:

   a) The cosmetic nature of the anti dandruff treatment.

   b) The seasonal variations i.e. increase in winter and reduction in summer.

   c) Importance of frequent washing of hair and scalp (to eliminate loose scales and other causes of dandruff.

   d) Avoid unnecessary use of excessive hair oil (greasy scaling) but minimal application at night to soften scales for easy dislodgement by shampoos.

   e) Use of conditioner shampoos for oily hair in those with greasy scalps.

2. Medical therapy is started with topical agent to control dandruff in either lotion or shampoo formulations.
3. Systemic therapy is instituted as second line of management for resistant cases, extremely severe forms or if related to psoriasis or seborrhoeic dermatitis.
4. Specific therapy for associated conditions such as secondary infection, eczematization and diffuse alopecia should be co-prescribed.

MANAGEMENT GUIDELINES FOR DANDRUFF THERAPY:

a) TOPICAL THERAPY: ANTIFUNGALS
KERATOLYTIC
ANTIMITOTICS
& OTHERS

b) SYSTEMIC THERAPY:

VITAMINS AND NUTRITIONAL SUPPLEMENTS