Health : Help for my dandruff !

The Mirror Health Jun - 27 - 2014 , 04:45

Dear Mirror Doctor, I am a 38-year-old woman and I have been battling with dandruff. It makes my hair itch so bad that I keep sticking combs in even at the office.

I have tried some shampoos but it always comes back.

Please can you enlighten me on the causes of dandruff, how to prevent it, and who can help me comprehensively deal with my condition?

Dear worried woman, Dandruff (seborrheic dermatitis or seborrhea) is a very common skin condition that nearly all people experience at one point in their lives regardless of age or ethnicity.

It affects not just the scalp, but also the ears, eyebrows, sides of the nose, beard, and less commonly the central (often hair-bearing) part of the chest.

Dandruff can affect any hair-bearing area or an area with even very small hair follicles.

The usual onset occurs with puberty, peaking at age 40 with reduced severity among older people. It is seen in infants as "cradle cap." In the teen years it has been called "druff" for short.

Some people are simply more prone to dandruff, and others experience periodic clearing cycles and periodic flare-ups of the condition.

Dandruff typically looks like dry, fine flaky skin on the scalp, sometimes with areas of pink or red inflamed skin. Many individuals have no scalp symptoms but simply complain of white flakes on their shoulders, particularly noticeable on dark clothing. More advanced cases may cause intense itching, burning, and unstoppable scratching.

Despite the high prevalence of seborrheic dermatitis, little is known about its etiology. However, several factors (e.g., hormone levels, fungal infections and nutritional deficits are associated with the condition.

The possible hormonal link may explain why the condition appears in infancy, disappears spontaneously, then reappears more prominently after puberty. A more causal link seems to exist between seborrheic dermatitis and the proliferation of yeast found normally on the human scalp called Malassezia species.

A causal relationship is implied because of the ability to isolate Malassezia in patients with seborrheic dermatitis and by its therapeutic response to antifungal agents. A similar link has been suggested in studies of patients with seborrheic dermatitis that is associated with acquired immunodeficiency syndrome (AIDS).

An altered essential fatty acid pattern may be important in the pathogenesis of infantile seborrheic dermatitis.

Malassezia organisms are probably not the cause but are an adjunct linked to a specific immune cell (T-cell) depression, increased sebum levels, and an activation of the specific immune pathway.

Persons prone to this dermatitis also may have a skin-barrier dysfunction.

Because seborrheic dermatitis is uncommon in preadolescent children, and tinea capitis is uncommon after adolescence, dandruff in a child is more likely to represent a fungal infection in children with suspected dandruff. A fungal culture should be completed for confirmation.

The diagnosis of seborrheic dermatitis is usually made on clinical grounds, based on a history of waxing and waning severity and by the distribution of involvement upon examination.

A skin biopsy may be needed in persons with other similar conditions to distinguish between them.

Various medications may flare or induce seborrheic dermatitis and your letter was silent on any long-term medications you were on.

Dandruff may also be triggered or made worse by poor hygiene and infrequent shampooing and washing. The immune system may also play a part in dandruff.

Although mild dandruff is a very common condition in many people with a normal immune system, severe dandruff is more common in people with some chronic illnesses such as Parkinson' s disease or a compromised immune system as in advanced HIV/AIDS.

Common triggers of dandruff include the following:

• Increased oil production

• Oily skin

• Oily scalp

• Poor hygiene

• Weather (hot and humid or cold and dry)

• Infrequent washing or shampooing

• Poor immune system

• Chronic illness

• Emotional or mental stress

Some people are more prone to dandruff, and dandruff tends to be a chronic or recurrent disorder with periodic ups and downs.

Although it is not curable, it is generally quite easily controlled with proper skin and hair hygiene. In babies, cradle cap usually clears after a few months. It may recur later in life as typical dandruff.

Severe dandruff may be a very difficult and frustrating condition. An ongoing combination treatment of multiple shampoos, washes, and creams and lotions may be required to treat resistant cases. Overall, dandruff treatments are very safe and effective. The best shampoo choices include Nizoral, zinc pyrithione, selenium sulfide, and tar-based shampoos.

A trial of systemic antifungals are given in very extreme cases.

To prevent dandruff, there may be the need for frequent shampooing or longer lathering. Discontinuance of hair spray or hair pomades is an advantage.

Please see a Dermatologist for planning and treatment of your condition as it seems very severe.