Dandruff

Dandruff

 is the shedding of dead skin cells from the scalp (not to be confused with a dry scalp). Dandruff is sometimes caused by frequent exposure to extreme heat and cold. As it is normal for skin cells to die and flake off, a small amount of flaking is normal and common and get released normally after detergent treatment. Some people, however, either chronically or as a result of certain triggers, experience an unusually large amount of flaking which can also be accompanied by redness and irritation. Most cases of dandruff can be easily treated with specialized shampoos.

The severity of dandruff may fluctuate with season as it often worsens in winter.

Those affected by dandruff find that it can cause social or self-esteem problems. Treatment may be important for both physiological and psychological reasons.

As the epidermal layer continually replaces itself, cells are pushed outward where they eventually die and flake off. In most people, these flakes of skin are too small to be visible. However, certain conditions cause cell turnover to be unusually rapid, especially in the scalp. For people with dandruff, skin cells may mature and be shed in 2–7 days, as opposed to around a month in people without dandruff. The result is that dead skin cells are shed in large, oily clumps, which appear as white or grayish patches on the scalp, skin and clothes.

                                                    .............................................................

Causes

Dandruff has been shown to be the result of three required factors:

1. Skin oil commonly referred to as sebum or sebaceous secretions.

2. The metabolic by-products of skin micro-organisms (most specifically Malassezia yeasts)

 Fungus Malassezia furfur (previously known as Pityrosporum ovale) is mostely the cause of dandruff. While this species does occur naturally on the skin surface of both healthy people and those with dandruff, in 2007 it was discovered that the responsible agent is a scalp specific fungus. During dandruff, the levels of Malassezia increase by 1.5 to 2 times its normal level.

 Malassezia globosa, that metabolizes triglycerides present in sebum by the expression of lipase, resulting in a lipid byproduct oleic acid (OA)which penetrate the top layer of the epidermis( the stratum corneum)results in an inflammatory response in susceptible persons which disturbs homeostasis and results in erratic cleavage of stratum corneum cells.

3. Individual susceptibility.

**Rarely, dandruff can be a manifestation of an allergic reaction to chemicals in hair gels, sprays, and shampoos, hair oils, or sometimes even dandruff medications like ketoconazole.
There is some evidence that excessive perspiration and climate have significant roles in the pathogenesis of dandruff.

                                                     ............................................................

Treatment

1. Salicylic acid

 Selsun Blue Naturals Dandruff Shampoo

It contains 3% salicylic acid, and salicylic acid shampoo is known to be good for acne prone scalp. It’s a great exfoliator for the scalp by removing oily residue and styling products. You can even apply this shampoo as a body wash for those back acne that come up during the summer.

2. Kairos Acne Care Solutions Shampoo

Kairos is a hair care product line made for scalp acne healing and prevention. It will help avoiding scalp acne and removes factors on the hair that might be the trigger of the condition.

It contains 0.5% concentration of salicylic acid and a cocktail of natural ingradients such as tea tree oil, apple amino acids and sapndus mukurossi which has antibacterial properties.

Do NOT use Salicylic Acid Shampoo if:

• you are allergic to any ingredient in Salicylic Acid Shampoo
• the patient is a child or teenager with the flu, chickenpox, or shingles
• the patient is younger than 2 years old

Contact your doctor or health care provider right away if any of these apply to you.

Before using Salicylic Acid Shampoo:

Some medical conditions may interact with Salicylic Acid Shampoo. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

• if you are pregnant, planning to become pregnant, or are breast-feeding
• if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
• if you have allergies to medicines, foods, or other substances
• if you have had a severe allergic reaction (eg, severe rash, hives, difficulty breathing, dizziness) to aspirin or a nonsteroidal anti-inflammatory drug (NSAID) (eg, ibuprofen, naproxen, celecoxib)
• if you have liver or kidney problems, a skin infection, skin irritation, diabetes, or poor blood circulation
• if you have a history of Reye syndrome

Some MEDICINES MAY INTERACT with Salicylic Acid Shampoo. Tell your health care provider if you are taking any other medicines, especially any of the following:

• Ammonium sulfate because it may increase the risk of Salicylic Acid Shampoo's side effects
• Corticosteroids (eg, prednisone) because they may decrease Salicylic Acid Shampoo's effectiveness
• Anticoagulants, (eg, heparin, warfarin), aspirin, methotrexate, or sulfonylureas (eg, glipizide) because the risk of their side effects may be increased by Salicylic Acid Shampoo
• Phenylbutazone, probenecid, pyrazinamide, or sulfinpyrazone because their effectiveness may be decreased by Salicylic Acid Shampoo

This may not be a complete list of all interactions that may occur. Ask your health care provider if Salicylic Acid Shampoo may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

2. Coal tar

Ionil-T : Helps eliminate dandruff problems due to seborrhea and psoriasis.It appears to work by slowing down the production of skin cells, and has an anti-inflammatory effect.

 Tar helps reduce the production of skin cells, giving you a healthier looking scalp. Reduces itching and flaking. Contains the equivalent of 1% Coal Tar. For best results use at least twice a week or as directed by a physician.
Many other coal tar shampoos are available in market like Coal Tar shampoo , Polytar shampoo , T/Gel shampoo.

3. Sulfur

Sulfur is a non-metallic element, has both keratolytic and antimicrobial activity. The keratolytic effect is thought to be mediated by the reaction between the sulfur and the cysteine amino acid in the keratinocytes, whereas the antimicrobial effect may depend on the conversion of sulfur to pentathionic acid by normal flora or keratinocytes. A normal chicken egg can be used to solve dandruff utilising the sulphurous element of egg white which attracts dandruff when rubbed into the scalp.

 KAVI Sulfur Shampoo is made with colloidal sulfur to help reduce the scaling and itching associated with dandruff and seborrheic dermatitis of the scalp. Additionally, colloidal sulfur will enhance the hydrolipidic layer’s acidity and protect the scalp’s pores from acne and other bacterial infections.

Designed for daily use, the KAVI Sulfur Shampoo is easy on the senses and a practical replacement to traditional shampoos.  

4. Regulators of keratinization

  Zinc pyrithione is best known for its use in treating dandruff and seborrhoeic dermatitis. It also has antibacterial properties and is effective against many pathogens from the streptococcus and staphylococcus class.

 Some studies have shown a significant reduction in the number of yeasts after use of ZPT, which is an antifungal  agent.
 A dramatic reduction of structural abnormalities found in dandruff with the use of ZPT; the population abundance of Malassezia decreases, parakeratosis gets eliminated and corneocytes lipid inclusions are diminished.

Zinc pyrithione is approved for over-the-counter topical use in the United States as a treatment for dandruff. It is the active ingredient in several anti-dandruff shampoos such as Cedel , Pantene , Head &Sholders and Clear.                                                                                                       

                                                                                                                                            

5. Selenium sulfide

It is believed that selenium sulfide controls dandruff via its anti Malassezia effect rather than by its antiproliferative effect, although it has an effect in reducing cell turnover. It has anti-seborrheic properties as well as cytostatic effect on cells of the epidermal and follicular epithelium. The excessive oiliness after use of this agent has been reported in many patients as adverse drug effect.

Head&Shoulders and Selsun blue in market contain seleniun sulfide

6. Imidazole antifungal agents

Imidazole topical antifungals such as ketoconazole act by blocking the biosynthesis of ergosterol, the primary sterol derivative of the fungal cell membrane. Changes in membrane permeability caused by ergosterol depletion are incompatible with fungal growth and survival.
Ketoconazole is a broad spectrum, antimycotic agent that is active against both Candida and M. furfur . Of all the imidazoles, ketoconazole has become the leading contender among treatment options because of its effectiveness in treating seborrheic dermatitis as well.

Nizoral is a shampoo that contains a broad-spectrum antifungal, which inhibits the growth of yeast and other fungal infections providing relief from dandruff. Ketaconazole is also known to have anti-androgenic effects and Ketoconozole can cause a reduction in the production of testosterone and other androgens by the adrenal gland and by the male and female reproductive organs. Nizoral shampoo contains 2% Ketoconazole and is often prescribed for the treatment of fungal infections of the scalp and sebbhoreic dermatitis

 Nizoral shampoo is also unique because it's effect is long lasting. Even after rinsing, Nizoral carries on working for several days. This means that you don't need to use Nizoral every day making it extremely cost-effective. And unlike some other anti-dandruff treatments, Nizoral shampoo has a pleasant fragrance and is pH balanced leaving hair soft, healthy and clean.

7. Hydroxypyridones
In contrast to the imidazole antifungals, the hydroxypyridones do not affect sterol biosynthesis; instead they interfere with the active transport of essential macromolecule precursor, cell membrane integrity and the respiratory process of cells. Ciclopirox is widely used as an AD agent in most preparations.
 Ciclopirox Shampoo, 1%, is an antifungal indicated for the treatment of seborrheic dermatitis of the scalp in adults. Patients should be advised to avoid contact with the eyes and mucous membranes. If contact does occur, the patient should rinse thoroughly with water.
8. Naturopathic agents

There are several naturopathic agents which have been claimed to have antidandruff activity. However, in most cases, these naturopathic agents are used in combination with synthetic agents. Studies from India have shown that the herbal preparations are as effective as synthetic substances in controlling dandruff both by in vitro and in vivo studies.

9. Topsoil
The living organisms commonly found in topsoil are beneficial for controlling the production of sebum by the scalp. Mix topsoil with filtered (non chlorine) water until a mud paste the consistency of oatmeal is achieved. Apply paste directly to the scalp and allow contact for ten minutes. Application once a week will control dandruff.

10. Water temperature

Like other skin conditions, hot water can exacerbate dandruff or itching. Using slightly cooler water (not cold) during regular hair washing and rinsing has been found to reduce dandruff in some individuals.