Dandruff

Introduction

Dandruff (pityriasis capitis) is a chronic, relapsing, noninflammatory hyperproliferative skin condition, which is often seen as socially unsightly and a source of embarrassment.

  • It is considered to be a mild form of seborrheic dermatitis, associated with an overgrowth of the yeast Malassezia furfur.



Symptoms

Dandruff

Dandruff is characterized by greyish-white flakes or scales on the scalp and an itchy scalp as a result of excessive scaling. It may also affect beards.

  • Flakes of dead skin are usually visible in the hair close to the scalp and are visible on the shoulders and collars of clothing.
Differential Diagnosis of Dandruff



Management

The use of a hypoallergenic shampoo on a daily basis will usually control mild symptoms.

In more persistent and severe cases, a medicated shampoo can be used to control the symptoms. Treatment options include

  • Coal tar
    • Unknown mechanism of action.
  • Zinc pyrithione
    • Should be used daily until dandruff clears.
  • Selenium sulphide
    • For adults and children >5 years old, use the product (left on for 5-10 minutes before rinsing) twice a week for the first 2 weeks and then once a week for the next 2 weeks.
    • Gold, silver and other metallic jewellery should be removed before use because they can be discoloured.
  • Ketoconazole
    • Should be considered for more persistent or severe dandruff.

NOTE: The results from studies on seborrheic dermatitis suggest that ketoconazole is the most effective and coal tar is the least effective of these choices.

All antidandruff shampoos can cause local scalp irritation. If this is severe, the product should be discontinued.



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