Dandruff is big issue in modern population. It is not only an esthetically problem caused by shedding of dead skin cells from the scalp. It’s related with health problems. Dandruff is a common scalp disorder affecting 40% of the population.If it is not treated in right way dandruff can cause some of the major hair loss problems like Male pattern baldness, Female pattern baldness, Telogen Effluvium and  Alopecia Areata.

Cause

Sebaceous glands and hair follicles disorder. Excessive shedding of dead skin cells (dandruff) usually appears on sebaceous glands rich areas know as seborrheic zones.

Seborrheic zones are:

• scalp and eyebrows
• nasolabial folds
• mentolabial furrow
• sternal area
• inter scapular
• periumbilical
• inguinal
• sacral and perianual region

Seborrheic zones

Human body has about 300000 sebaceous glands that produce 1,5-2g of sebum. In cases of unbalanced sebaceous glands secretion, dandruff may occur in combination with increasing level of fungus caused Malassezia or Pityrosporum.

Pityrosporum Ovale

Is a fungus. Ovale is normal resident of human healthy human skin found in 90% of healthy people. As the fungus requires fat to grow, it is most common in areas rich with sebaceous glands-on the scalp, face and upper part of the body.When the fungus grows too fast, the natural renewal of the cells are disturbed and dandruff occurs with itching. When itching, dandruff combines with red skin discoloration seborrhoic dermatitis manifests.

 Other dandruff co-factors

• Stress
• Climate changes, (in summer symptoms disappear, in winter symptoms are becoming worse)
• Diet habits (alcoholism, zinc deficiency, biotin deficiency, high calories food, tobacco)
• Family inheritance
• Low immunity (AIDS patients, people suffering from cancer and diabetes, people under imunosupressive treatment)
• Neurological diseases (peripheral nerve damage, Parkinson’s disease, other central nervous system disorder)
• Hormonal influence (androgens increase the sebum secretum and thereby skin shedding, estrogen reduces sebaceous glands production)
• Iatrogenic factors (hormonal preparations, contraception, synthetic progestics, corticostereoids, tranquilizers-increase sebum execution, cytostatics, synthetic anti androgen and estrogen reduce sebum production)
• Autonomic nerve system influence (sympaticus, parasympaticus)
   

Definition: Rapidly skin cells dying manifested by appearing whitish flakes in hair.

Types of dandruff:

• Dry dandruff
• Oily dandruff

DRY DANDRUFF

Is characterized by the appearance of the small, light and dusty skin flakes visible on hair and clothing.

Cause

• Disorder of pH balance of the scalp, reduced acidity
• Aggressive hair shampoos
• Low quality hair products
• Aggressive hair treatments that dry out the scalp (hair coloring, hair blow drying, hair straightening products,etc.)
• Fungi proliferation (Pityrosporum ovale), fatigue, stress

Symptoms

• Scaly skin (rapid accumulation of skin cells that accumulate)
• Itchy scalp (inflammation caused by fungus multiplication)
• Skin redness (occurs rarely – usually in severe skin inflammation and in scalp seborrhea)

Therapy

Shampoo uses a combination of ingredients to control dandruff. Keratolytic agents such as salicylic acid and sulphur loosen the attachments among corneocytes (skin cells) and allow them to get washed off.

• Medical shampoos containing sulphur that has keratoytic and antimicrobial activity.Selenium sulfide containing shampoos control dandruff due to its anti Malasezzia effect rather by its anti proliferative effect. It reduces cell turnover, and has anti-seborrheic effect as well as cytostatic effect on skin cells. Possible side effects- excessive oiliness

• Shampoos with coal tar and minerals. Slows down skin cells production and has anti-inflammating effect (kertial shampoos contain zinc)

• Imidazole shampoos –stops fungal growth and survival (Imidazol, ketoconazoll, ichtiol, myconazol)

• Natural herbal products with antiflammating antifungal effect (klorane phyt)

Directions of use

Shampoos are usually used during 6-week period, hair is washed two times per week. Before hair rinsing leave shampoo for 3 minutes then washout. Usually combined with hair lotions.Anti dandruff lotions need to be rubbed into the scalp without hair rinsing. (Squanorm lotion, Ketonazol lotion)

Vitamin products – biotin, vitamin B, minerals.

In period between washing your hair with therapeutic (anti dandruff shampoos) it’s advisable to use mild baby shampoos, pH neutral shampoos.

We recommend to use mild shampoos after finishing anti dandruff treatment to preserve scalp balance. Combs with close teeth can be used before washing hair to remove dandruff.

OILY DANDRUFF (itchy scalp)

Oily dandruff is characterized by scaly scalp. Skin cells (dandruff) fit tightly to the skin scalp. Sebeceous gland produce too much of sebum. The composition of the sebum is more fluid sticks tightly to the skin.Skin looks shiny as the oiled. It leaves greasy track on your fingers and leads to multiplication of fungi and bacteria that are normally found on skin. Particularly important is the fungi Malessezia. Itching and skin redness appears consequently.

Cause

• Genetic heritage
• Hormonal disbalance
• Stress
• Greasy and spicy food
• Alcohol
• Aggressive hair products and treatment

Symptoms

• Scaly scalp
• Larger and yellow scales
• Shells stick to the hair and difficult to remove
• Oily scalp
• Oily and heavy hair
• Itching
• Redness

Therapy

• Therapeutic shampoos that contain ingredients that slow peeling of the stratum. Corneum of the scalp and substances for removing stubborn shells.

• Zinc pyrithiose shampoos – heal the scalp by lotions normalizing the epithelial. Keratinization or sebum production or both. They also reduce yeast level.

• Coal tar shampoos (Anti-inflammantory effect, slow down skin cells)

• Zinc pyrithiose products (Regulates keratinization and sebum production, salicylic acid containing products. Keratinolytic agent useful in removing scaly hyperkeratotic skin.It decreases cell to cell  adhesum  among corneocytes. The best products are combination of salicylic and zinc pyirithine  or salicylic and coal tar.

 Lotions:

•  Zinc pyirithine
•  Salicylic
•  Coal tar
•  Steroid lotions

Vitamin products

Diet – avoiding fatty and high caloric food, strong spices and alcohol

Anti stress therapy (relaxation,yoga, spending time in nature)

ITCHY SCALP

Is a symptom that can be found in various health conditions and diseases.It is necessary to know that the exact cause of the itchy scalp to be able to treat the scalp.Same diseases and health conditions primarily affect other organs or body parts, not affecting the scalp. Itchy scalp is just one of the accompanying symptoms.

 

Causes

• Seborrhea
• Seborhoea capits
• Fungal infections
• Mycoss (Pytirosporum Ovale or Malessezia, Tinea capitis)
• Allergic reactions
• Contact dermatitis, Allergic dermatitis (reaction to a substance)
• Parasites (hair lice, tick)
• Virosis (small pox, herpes)
• Healing scar often causes itching
• Follicles (hair follicle inflammation caused by bacteria – Staphylococcus aureus, Streptococcus epidermids)
• Sunburn
• Neurogeneic excoriation (abrasions) -because of uncontrollably scratching- mental disorder
• Dry scalp, dry dandruff
• Dirty hair (lack of hair scalp hygiene, accumulated scalp oil, increased level of fungi)
• Skin cancer (wound that doesn’t heal for long time-carcinoma basocellulare, suspicious mall or pigmentation-melanoma)
• After having a bath in a sea water or pool (chlorine or sea salt irritation)

Dandruff healing is long term process. Previously mentioned anti-dandruff products are very effective. Correct selection of shampoo and lotion are necessary to achieve results. We have to choose correct shampoo depending on the type of your hair and skin-dry or oily.

For some types of shampoos, effect is visible already after the first washing of your hair, and others need longer time for visible effect. It’s important to say that each person reacts differently to treatment. Some people need to wait for visible results little bit longer.

Usually results are visible after six weeks of treatment in most people.The best anti dandruff shampoo is the one that is combination of antifungal substance and substance for easy removal of dandruff. Sometimes dandruff can appear again, and sometimes the shampoos that were effective earlier are not efficient any more.

That is not reason for worry. It happens because the scalp got used to this shampoos and had become resistant to treatment. In that case you just have to change the shampoo or lotion. Use therapeutic shampoos twice a week, because antifungal ingredients accumulate on the scalp and they are effective for three days.

Some dermatologists recommend for faster result to use swimming caps after shampooing your hair or plastic foil and to leave on for a hour. After one hour wash out your hair. In periods between using therapeutic products, use mild, pH neutral shampoos to keep the scalp balance and also after finishing 6-week treatment.

HOW TO PREVENT DANDRUFF

• Wash your hair regularly-fungi are fed with lipids (fat) produced by sebaceous glands, hair washing removes excessive sebum and fungi.
• Maintain hair comb hygiene, do not use other people’s comb or brushes because of accumulation of fungi on combs’ teeth or hair brush
• Do not expose your hair to aggressive hair treatment (bleaching, hair straightening)
• Avoid products containing alcohol, it dries out your scalp and hair, that brings to imbalance of sebaceous glands secretion and fungi proliferation
• Do not expose your hair to heat during blow drying and washing your hair
• Seawater has the positive effects on your skin due its minerals, removes hair oil (fat), stimulates hair restoration. But it also has the negative effects – dries out your hair and bleaches the hair color
• It’s recommended to use swimming cap in pools (chlorinated water disrupts the scalp balance, occurrence of fungi is possible)
• Sun-positive effects: ultraviolet rays have bacterial effect but the negative effect of the excessive exposure is skin cancer (melanoma, carcinoma busollecune, sun burns). Balanced diet enriched with vitamins and minerals (vitamin B complex, iron,zinc, selenium)
• Comb (brush) your hair regularly – hair is aerated, lipid layer is removed, scalp circulation is improved

SKIN DISORDERS ASSOCIATED WITH DANDRUFF

• Seborrhea

• Sebostasis

• Psoriasis

• Mycoses (fungal infection, dermatophytosis) – Pityrosporum Ovale, Tinea capits)

SEBORRHEA

Definition: Excessive sebum secretation which is autosomal dominant inherited. It occurs quite often in 70% of people.

Cause: inheritance, genetic

Seborrheic co-factors

See other dandruff co-factors

Categories:

• Dry seborrhea (Seborrhea sicca)
• Oily seborrhea (Seberrhea oloes)

Predilection seborrheic locations

Scalp, area behind the ears, nasolabial folds, chin area, sternal area between the shoulder blades, navel area,unguinal region, anal area, keratosis of pilosebaceus mouth (thickening of sebaceous glands mouth near the hair) resulting with comedones – black jades in hair follicles openings.

Hair is not visible in such hair follicles seborrhea is usually associated with dust flaking called pityriasis seborrhoides.

Pityriasis sicca-fine, dry, whitish flakes of dandruff visible on clothes

Pityriasis steatides (oleosa) – larger, fatty dandruff scales, yellow sticky deposits

Simultaneous occurrence of seborrhea,a and androgenic baldness is result of androgen hormones influence. Seborrhea is often accompanied with excessive sweating (hyperhidrosis).

SEBOSTASIS

Is a condition of decreased sebum secretion. It often affects members of family and occurs in 10% of people, may appear in combination with neurodermitis and ichtyosis. Skin and hair are dry because of low sebum production. Sweating can also be reduced. Change are usually visible on the forearms on the side parts of the body and lower legs. Dry, finely scaly skin of the body and scalp can also be present – dry dandruff. Itching also occurs.

PSORIASIS

 Is a chronic inflammatory skin illness with increased level of epidermal proliferation. It manifests with reddish spots covered with silvery scales. Psoriasis is very common condition and appears in 1-5% of global human population. It occurs more often in certain families. Genetic factor is significant. Psoriasis is usually located around large joins such as elbows, knees and also on scalp. Gluteal region and on the fingers and the nails.

Fungal infection (mycosis, dermatophytosis)

Dermatophytosis or tinea are fungal infections of the stratum corneum of the skins, nails and hair with ability of keratin degradation. The most common pathogens of fungus diseases are fungi called Pityrosporm ovalle (Malessezia) and gender of Tripophyton. Trichophythosis capilitii or tinea capits (Fungus trichophyton).

Categories:

• Tinea capits superficialis – surface layer
• Tinea capits profunda – deeper layer

Tinea capits superficialis

Can be confused with baldness. Scalp is covered with single or multiple foci coin size with dandruff or shells of skin. Hair is unevenly broken and lose their luster and color. Within focal areas we can find zones of hair that is not broken. It can appear on chin – Tinea barbae.

Tinea capits profunda

Most often affect men and children in contact with animals.

Tinea capits profunda

At the beginning you can see pustules and perifolicla ingredients in infected area that crossover during the time in abscess (purulent bladder) It looks as spherical protrusion From which air sheds out. On the pressure the pulse and blood content flows out. Eventually a thick scabs are created that heal the scar.

Therapy

Topical and systematic antimycotics (antifungal products).