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Flaking
of the skin on the scalp is called dandruff. Severe variety of
dandruff, characterised by redness, scaling and itching, is called seborrhoic
dermatitis. It is seen during infancy and after puberty. Factors
causing dandruff are:
-
Sebaceous gland
activity under the influence of androgens
-
Colonization with Pityrosporum
ovale, an yeast like fungus
-
Inflammatory
response
Precipitating/exacerbating
factors include:
- Stress
- Obesity
- Diet rich in sugars,
processed and refined grains
- Excessive
perspiration
- Certain medications
(neuroleptics)
- Neurological
disorders like Parkinsonism, cerebro vascular accidents
- Acute Medical
illness
- Immunocompromised
state
Clinically, dandruff
manifests as greasy flaking of the scalp, sometimes associated
with redness and itching and acne-like rash (Pityrosporum folliculitis) on
the face, back and chest. On the face, seborrhoic dermatitis is
manifested as redness and scaling on the inner side of the eye brows,
glabella, sides of the nose, beard region and around the ears. Sometimes
this can lead to scaling, swelling and itching of the eyelid
margins.
Course: Severity
of dandruff keeps varying, often aggravated by
stress, tiredness and exposure to sunlight. In chronic cases, there is some
degree of hair loss which is reversible. Dandruff may accelerate the onset of
male pattern baldness. It can also sometimes cause pigmentation on the
face.
Control measures: Regular hair wash (2-3 per
week), avoidance of diet rich in sugar and processed and refined food, avoidance of too much of hair oil
and avoidance of stress. A diet rich
in vitamins (biotin) and essential fatty acids is useful.
Treatment should
be done in consultation with a dermatologist and includes antifungal
shampoo and shampoos containing coal tar, selenium sulfide or zinc pyrethione. In the presence of severe scaling, salicylic acid
preparations are used and in the presence of redness, mild
anti-inflammatory preparations are prescribed. Oral antifungals are
given in case of extensive, severe disease and associated with acne-like
rash. Regular treatment is needed for many years.
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