It is a popular name given to a non-inflammatory increased scaling of scalp where scaling (desquamation) is visible and active.It is a precursor of seborrhoeic Dermatitis & progression is though redness, greasiness, irritation and increased scalp scaling.Mostly it’s a cosmetic problem with flaking of scales on scalp, also involving face and shoulders.Dandruff is also associated with acne or may be part of psoriasis.Seborrhoeic Dermatitis may also involve the eyebrows, eyelids, ears, nasolabial creases, lips, axillae, umbilicus, sternum, groin & buttocks; and generally has crusted pink or yellow patches of various shapes & sizes, with remissions and exacerbations.In infants, yellowish a brownish scales are seen an scalp, which are adherent & called “Cradle Cap”A common yeast Pityrosporum ovale, is found to be abundant in dandruff patients. Patients of Dandruff have to be approached from cosmetic angle to the treatment of related disorders.
Patient’s History / Examination:-
An inquiry into – Severity, pruritus, frequency of hair washing / shampooing & seasonal variation is pertinent. Also history of medication (Arsenic, Gold) Dietary deficiencies (Vitamin B Complex), Acne, Alcoholics, Psoriasis, HIV, Epilesy, Diabetes esp.in (Obese People), Malabsorption disorders, are asked for A simple visualization of scales, (yellowish, greasy / dry), under a magnifying lens is sufficient to gauge extent & severity of dandruff. An examination for associated alopecia (baldness) of scalp, secondary infection, eczematisation and type of scaling is in order. A scraping (KOH) of scales & rarely biopsy is required.
Classification of Dandruff:-
It can be graded based on degree of scaling on a scale ranging from 0 to 10. A practical grading into mild, moderate and severe forms is done on basis of severity of scaling, itching & evidence of inflammation, acne & seborrhea.
Mild / Grade -I: -
Visible fine scaling, non itchy, non-inflammatory – of pure Cosmetic Importance.
Moderate / Grade: II:-
Larger scaling with itching, mild inflammatory changes, with diffuse alopecia a acne or seborrhea.
Severe / Grade III: -
Severely inflammatory, severe pruritus, thick scales, with. associated seborrhoeic dermatitis / psoriatic origin
Principles of Treating Dandruff :-
1. Patients Education & explanation :- regarding
a) Emphasis that dandruff can generally be suppressed with regular treatment for years – permanent cure may not be there.
b) Cosmetic nature of disorder.
c) Seasonal Variation i.e. increases in winter & reduction in summer.
d) Importance of frequent washing of hair and scalp (to eliminate loose scales).
e) Avoid unnecessary use of excessive hair oil (greasy scaling), but minimal application at night to soften scales for easy dislodgement by shampoos.
f) Use of conditioner shampoos if dry scalp & shampoo for oily hair in those with greasy scalps.
2. Medical therapy is started with topical agents to control dandruff – lotion or shampoo formulations.
3. Systemic therapy started as a second line of therapy for resistant cases, very severe forms or if related to Psoriasis & seborrhoeic dermatitis
4. Specific therapy for associated conditions eg. Secondary infection, eczematisation & diffuse alopecia – are co- prescribed