How is dandruff treated?
The aim of treatment is to reduce the level of the yeast pityrosporum ovale on the scalp.
Dandruff responds well to the use of medicated, anti-fungal shampoos, especially those containing, in order of effectiveness:
Ketoconazole
Selenium sulphide
Zinc pyrithione
Coal tar
Sometimes dandruff can be treated and prevented by using a good quality shampoo such as those sold by hair salons.
If dandruff does not disappear after a few weeks using a good shampoo, an anti-dandruff shampoo may solve the problem.
Shampoos normally contain one of five active ingredients: salicylic acid, coal-tar, zinc pyrithione, selenium sulfide and sulphur. These shampoos are non-prescription and the ingredients are approved for use by the United States Food and Drug Administration (FDA). Well known over-the-counter brands include Head and Shoulders, Selsun Blue, Tegrin, Sebutone or Neutrogena T/Gel or T/Sal.
A newer anti-fungal product containing Ketoconazole was approved in 1997 by the FDA in USA for over-the-counter sale in the form of Nizoral A-D shampoo.
It is available in the UK over the counter at most chemists. This medication can be helpful for particularly difficult cases, according to some pharmacists.
It should be noted there has been some concern over the use of Ketoconazole when using particular cholesterol-lowering drugs known as statins. Both medications compete for the same metabolism pathway via the liver and when Ketoconazole is taken orally, the toxicity of the statin can be increased.
Theoretically, there may be a small effect using Nizoral shampoo as a topical product on the skin, so use of this product should probably be avoided if a statin is used, or doctor’s advice sought.
A compound called selenium, found in several shampoo products, is highly effective in controlling dandruff. The shampoo should be left on at least five minutes before being thoroughly rinsed. The hair and scalp should be shampooed with this type of shampoo at least once a week.
Also highly effective in treating dandruff is zinc. A lot of anti-dandruff shampoos contain zinc pyrithione which seems to be very good at clearing the problem.
A zinc vitamin supplement taken daily is excellent for the skin and hair.
When used in conjunction with a zinc based shampoo the problem of dandruff should be kept at bay. Another supplement being given a lot of press at the moment regarding skin care is beta carotene, which is also claimed as being extremely beneficial to the hair and scalp.
If necessary, shampoo daily with these shampoos, lathering well and making sure the lather remains on the scalp for 5 minutes before rinsing to allow the active ingredients to work.
Take care with tar-based shampoos as they can stain light-coloured or grey hair and make the scalp more sun-sensitive. Anti-dandruff shampoos can make the hair brittle and weak, so use of a good hair conditioner is recommended.
When dandruff has cleared, begin using a good quality shampoo and rotate the use of the anti-dandruff shampoos as necessary. Some sufferers may need to try a range of anti-dandruff shampoos to gain best results, or rotate between various products, as continued use of one product seems to lose effectiveness over time.
If dandruff or itchy scalp persists for 3 weeks or the scalp becomes irritated or severely itchy, seek advice from a doctor. Prescription medication or creams may be able to help when over-the-counter shampoos do not.
In severe cases dermatologists will prescribe a special ointment or lotion to treat the problem. It is generally agreed that drugstore products which contain zinc pyritheone or selenium sulfide are the most effective in ridding the scalp of dandruff flakes.
For instance, if shampoos aren’t working an application of 1 % - 2.5 % hydrocortisone cream once or twice a day may be effective.
If this too proves ineffective, a coal-tar preparation left on overnight may work. Sometimes a stronger corticosteroid preparation may then be recommended.
Lithium succinate ointment has also been proved to improve symptoms of dandruff.
A patchy, inflammatory scalp disorder not responding to usual treatments should have mycological samples sent for laboratory analysis to rule out Tinea capitis.
In addition to antifungal activity, several other mechanisms have been identified. Zinc pyrithione decreases the turnover of the rapidly dividing epidermal cells. Coal tar has antiseptic, antipruritic (anti-itching), and exfoliating properties.
If a scalp shows signs of redness, swelling, scabbing, or gooeyness - accompanied by flakes, in all likelihood there could be another scalp disease involved like psoriasis or ringworm.
Dandruff can be also be due to nutritional deficiencies. It is recommended a person gets adequate amounts of vitamins B6, B12, F and selenium in their diet.
With any of these symptoms it is important to see your health care provider immediately!
Traditional Dandruff Shampoos
One of the best known treatments for dandruff for years was Head & Shoulders. The new dandruff shampoos have changed quite a bit and have become a lot more sophisticated.
Pantene make a good dandruff shampoo.
The best approach is to pick a product and try it. If the product works and is successful at controlling your dandruff, continue to use it.
It is important to remember that there is no known “official” cure for dandruff. Once you have the problem the best that you can hope for is management and control.
When using a retail dandruff product it is recommended that this product will need to be used continually.
Once dandruff shampoos or products are discontinued, the dandruff will return. Thorough cleansing of the scalp and the hair will keep dandruff flakes out of sight for up to three days. It takes the scalp up to three days before it can generate a new batch of flakes.
A key point to remember is to select the mildest shampoo possible. Although detergent based shampoos will clean the hair and scalp well, they often cause drying which will make the flaking worse.
