Dandruff is a common problem. In medical term, dandruff is called seborrhoeic dermatitis. Dandruff can affect any age group, but usually starts from adolescence. Patients who suffer from mental problems such as Parkinson’s disease, polio and paralysis; and patients with immune problems, such as HIV infection may suffer more.

The exact cause of dandruff is still unknown. The main theory on the cause of dandruff is infection by a fungus called Malassezia.

Symptoms and signs

Dandruff can be seen as white, flaky scales on the scalp.  For most patients, the dandruff that falls on the shoulders is a major problem as it is visible to others. Some patients also experience scalp itchiness. Dandruff does not cause hair loss, as believed by many. Hair loss occurs when patients pull their hair to relieve the itchiness.

Severe dandruff can cause redness of the scalp. In severe cases, other areas can be involved, such as the eyebrows, beside the nose (nasolabial folds), middle of the chest and the back.

In infants, seborrhoeic dermatitis can cause thick adherent plaque on the scalp, and this is known as cradle cap. It can also cause redness around the neck, armpits and groin.

Complication

Scalp itchiness and excessive flakes on the scalp may result in embarrassment and reduced self-confidence.

Treatment

Dandruff can be treated, but the problem may recur.

Patients who are affected by dandruff can wash their scalp and hair with anti-dandruff shampoo. Anti-dandruff shampoo that contains selenium sulphide (e.g, Selsun) or ketoconazole, which is an anti-fungal (e.g, Nizoral) is the common anti-dandruff shampoo used. Shampoo which contains anti-fungal agent can control Malassezia population on the patient’s scalp. However it should only be used for a certain period of time as fungus is not the cause of persistent dandruff. Keratolytics can be used to soften the scales on the scalp and behind the ears.

Redness and inflammation on the scalp, face, chest and back can also be treated with steroid creams.

Patient must understand that the disease can be controlled, but there is a possibility of recurrence.

Prevention

Stress and constant occlusion of the scalp can cause worsening of the dandruff. Patients need to reduce the level of stress and avoid wearing tight garment on the scalp, such as a tight helmet or cap to prevent the disease from worsening. Patients also need to use the shampoo regularly to control the disease. However, the use of anti-fungal shampoo for a period of many years is not recommended.