Dandruff II

Are you sick of those little white flakes that litter your shoulders , especially when you wear dark clothes ?
Are you envious when you see Pooja Batra’s or Ajay Jadeja’s gorgeous, shiny & clean tresses ?
Do you always search the shelves for another Anti dandruff shampoo ?

Don’t Panic ! DANDRUFF, an ubiquitous ailment that afflicts atleast 50% people over the world. The prevalence and severity of dandruff in a particular area is dependant upon the availability of various antidandruff preparations! In this part of the world there is definitely no dearth of treatments for dandruff. Every time you put on that telly we see well renowned personalities shaking their glorious manes to favour one or another antidandruff shampoos.

What exactly is ‘Dandruff” ?
Dandruff, also known medically as Pityriasis simplex is a near – physiological scaling of the scalp, in other words it is an ‘Active’ end of normal scalp shedding.

In a normal scalp the skin undergoes regular maturity, and the topmost layer is seen to contain only 3700 immature cell /sq cm. Whereas in cases of dandruff afflicted scalp we see 25000 immature cells/sq cm. This disorder is seen more often in adolescence & adult life, suggesting influence of androgenic hormones & sebaceous activity. Also suggested since the 19th century is the role of a yeast called Pityrosporum ovale. This is supported by the fact that anti yeast or anti fungal drugs are of prime importance in treatment of dandruff & show wonderful results. What remains controversial is whether it is the yeast which causes dandruff or is it an inherent overstimulation of scalp that flakes and the yeast is just incidental !

Now we come to another very important point, Pathological dandruff or scaling of the scalp is also seen in a more severe disorder called. Seborrheic Dermatitis. This disease affects those areas of the body which have a high population of sebaceous glands namely the scalp, face & trunk. Contrary to the name there is no direct relation between increased sebum formation & seborrheic dermatitis. It is postulated that there may be a difference in the sebum content or its retention which causes irritation & inflammation. It differs from simple dandruff in the fact that it is inflammatory & on examination of the scalp & skin a dermatologist can easily see red, itchy & scaly patches. The scales are more greasy, of a different colour & bacterial infection may also supersede. This condition calls for a more aggressive therapy as opposed to simple dandruff. Itching and Hair fall is associated with both conditions . Detachment of scales from the scalp can cause aesthetically unpleasant deposits on the collar and shoulders. Acneiform eruptions over the shoulders, back & chest are associated with dandruff too. These are boils which look like acne but are not ! Treatment of the basic condition causes these boils to go away. Scaling of the scalp is also seen in Psoriasis, certain Fungal infections, as a non specific reaction to trauma or infections, as a side effect of certain drugs and also following certain applications to the scalp. Treatment is preceded by a thorough examination & good history taking. The dermatologist needs to see, think , consider the finances and then treat ! This last point may seem absurd but its true . Depending upon the cause the dandruff the condition is either completely treatable or its controllable, but needs a long term maintenance therapy !

Therapies & Efficacy.
Dandruff in its milder form calls for treatment which can control the disease at the lowest possible cost and inconvenience to the patient. Here we have proprietary over the counter & supermarket shampoos such as Selsun, Head & Shoulders, Pantene etc which contain Zinc Pyrithione or Selenium Sulphide. Selenium Sulphide kills the yeast as well as has an effect on cell division in the scalp, whereas Zinc Pyrithione is cytotoxic & has antimicrobial action. The conditioners added into these preparations decrease the tangling, fly away phenomenon making it easy to comb hair in the’ wet phase’ without breakage and enabling the scales and deposits to be easily ‘ brushed out’. Cetrimide or Savlon washes are also effective and relatively economical to use though they may not always give a desired cosmetic after effect.

Where medicated shampoos are concerned it is purely within the Dermatologists realms ! I for one am always looking at various preparations individually & evaluating them not only as per their fast efficacy but also in terms of ‘ PATIENT ACCEPTIBILITY’. This term includes , how comfortable the patient is after using the shampoo in terms of perfume, luster, hair gloss & manageability. Not less important is the cost of the preparation , its quality & last but not the least is the demand nowadays for ‘ NATURAL’ products.

The range of anti dandruff products is extensive. There are shampoos which contains salicylic acid, which causes disruption of the bonds that hold together the ‘Scales’ , thus enabling them to be washed away. . Regular use controls the scaling, has an anti fungal effect & reduces itching. Good preparations also maintain hair lustre & condition by virtue of the base which is complementary to the action of salicylic acid. Coal Tar, another well known remedy for dandruff was earlier available in very ‘messy’ preparations which stank & discolored clothes. Coal tar by itself has an antimitotic effect and regulate normal skin formation. Today phamaceutical preparations such as Ego Sebitar , Neutrogena, Freederm, Stiefel, Ionil Tar , Mark Birch, Phyto have managed to supersede the cosmetic unacceptibility of tar & made them a household name. ‘Phyto And Mark Birch preparations use natural tar extracts & plant preparations to satisfy both the doctor & patient whims. Other anti dandruff preparations like Eubos, Gentinor, Ducray etc utilize anti dandruff pharmaceutical preparations which are research oriented and effective. In addition as an alternative to topical steroid preparations certain pharmaceuticals offer doctors alternative intensive scalp therapies such as a Hydrating exfoliating gel, a dandruff treatment lotion of plant extracts to soothe the scalp & Chaulmoogra oil, the beneficial effects of which on the scalp skin is well documented in medical journals .Also the patients are happy to be not using medicines for prolonged periods of time.

Anti fungal remedies of dandruff.
Here the crown goes to Janssen, the makers of Nizoral shampoo, which makes it unnecessary for systemic therapy unless the condition is very severe. Used once or twice a week Nizoral as a shampoo is sufficient to control Seborrheic Dermatitis. Sometimes it becomes necessary to use oral antifugals like Itraconazole, Fluconazole, econazole etc.

Anti inflammatory drugs like topically applied Steroidal preparations are at times indispensible, especially to control inflammation, itching & hair fall. Rarely do we need to use systemic steroids as well !

As you can well gather from my write-up an unifying explanation for this common ailment……Dandruff ….remains elusive but treatment modalities are many. So do take stock of your scalp , visit a dermatologist if necessary , wash away those flakes & then swish your hair with the confidence & style that you deserve!

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