Dandruff

Dandruff is the term used to describe the shedding of large amounts of flakes of scalp from the scalp. It is particularly noticeable when we wear dark clothing because it shows as a shower of small white flakes.

Normally a small amount of flaking of dead skin occurs and it is removed either by brushing or shampooing them away.  

The increase in dead scalp flakes is usually caused by the scalp producing more layers of skin because it is affected by a fungal infection or from seborrhoeic dermatitis. Normally the skin covering the scalp falls off gradually and isn’t generally noticed on the clothing. When someone has dandruff caused by a fungal infection, the skin produces more flakes and the scalp is often greasy and itchy. Seborrhoeic dermatitis is related to eczema or psoriasis but affects areas producing sebum, such as the scalp.

People with eczema elsewhere on their body may also suffer from this inflammatory condition, which is also helped by antifungal treatments that treat dandruff.

Dandruff is generally worse in the winter months, as it appears to be relieved by exposure to sunlight. The condition may spread to other hairy areas, noticeably the eyebrows, eyelashes, face, armpits and groin.  Dandruff is not a contagious condition, so is not transmitted from person to person, and is not a reflection of personal hygiene.

Flaking skin on the scalp should first be treated with antifungal shampoos containing zinc, selenium or a specific antifungal agent called ketoconazole. The shampoo should be applied to the scalp and left in contact with the scalp for several minutes before rinsing off. If used in the shower then the scalp should be shampooed at the beginning and rinsed off at the end of the shower to allow reasonable contact time with the scalp. Shampoo containing zinc or selenium may be used daily if required, but those containing ketoconazole should only be used twice a week. All dandruff treatment should be continued for four weeks after symptoms have cleared, then may be used each week to ensure the symptoms do not recur. Ongoing treatment with shampoo or conditioning preparations that contain tar as an antiseptic may also be helpful.

If you or anyone in your family is bothered by flaking scalp then consult your community pharmacist. They can help with treatment and advice for this embarrassing condition, or refer you for further treatment if the condition becomes severe or appears to be unrelieved by treatment.