Shedding skin cells is a natural process that occurs all over the body as new cells push up from beneath to replace the old ones. Excessive shedding of the skin on the scalp is called dandruff. Inflammation, that is redness/itching, is not a feature.
These flakes pose no health risk but can be itchy and cause embarrassment. Although dandruff cannot be cured, it can be controlled.
Seborrhoeic dermatitis is a form of dermatitis in which a fungus, Pityrosporum ovale, plays a role. Seborrhoeic dermatitis involves the scalp, the ear, the eyebrows, paranasal area, central chest and back.
Psoriasis may cause redness and scaling of the scalp. Psoriasis is a scaly eruption of the skin that usually begins between the ages of 5 and 26 years.
Sufferers can learn how to cope with it and it is not infectious.
Dandruff is caused by excessive shedding of the skin of the scalp
A scaly scalp without inflammation (see above) or loss of hair.
The prevalence in South Africa is unknown, but about 50 million Americans suffer from dandruff and spend roughly $300 million annually on products to control it. Dandruff can occur in any age group.
When to see a doctor
If home treatment does not improve the condition
If scaling is greasy and yellow
If the dandruff is localised in a few patches and is very itchy, which may indicate a fungal infection, dermatitis of psoriasis
Mild cases often improve with careful shampooing using over-the-counter anti-dandruff products. These can also be alternated with a regular shampoo.
Shampoos containing salicylic acid, coal tar, pyrithione zinc, selenium sulphide or sulphur are safe and effective for the treatment of dandruff.
Massaging the scalp vigorously as you shampoo helps to loosen the flakes so that they can be rinsed away. Thorough rinsing is essential, since shampoo residue can aggravate skin problems. For best results, shampoo daily, leaving the lather on for at least 10 minutes before rinsing. When the condition clears up, keep it in check by shampooing with medicated shampoo once or twice a week (these products are too harsh for daily use). Let your hair dry naturally instead of blow-drying it.
Brushing hair with a moderately stiff, natural-bristle brush can be of benefit. Full strokes from the scalp to the tips of the hair will distribute the hair’s natural oil away from the scalp to the hair strands.
In stubborn cases, a doctor may prescribe the following:
Steroid lotion or cream applied to affected areas to suppress flaking.
Coal tar or salicylic acid lotion to loosen thick scaling: these are usually applied and left on overnight under a shower cap. This treatment will help shampoos to work more effectively.
If psoriasis of the scalp is the underlying problem, a coal-tar shampoo and topical steroid may be needed.
Herbal remedies may relieve the itching and dryness, but a tar-based product is usually needed to subdue the greasy scales.
Reviewed by Prof H.F. Jordaan