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Dandruff
Classification and external resources
ICD-9 690.18
DiseasesDB 11911

Dandruff (also called scurf and historically termed Pityriasis capitis) is the shedding of dead skin cells from the scalp. Dandruff is sometimes caused by frequent exposure to extreme heat and cold. As it is normal for skin cells to die and flake off, a small amount of flaking is normal and common. Some people, however, either chronically or as a result of certain triggers, experience an unusually large amount of flaking, which can also be accompanied by redness and irritation. Most cases of dandruff can be easily treated with specialized shampoos.

Excessive flaking can also be a symptom of seborrhoeic dermatitis, psoriasis, fungal infection or excoriation associated with infestation of head lice.

Those affected by dandruff find that it can cause social or self-esteem problems. Treatment may be important for both physiological and psychological reasons.[1]

Contents

Causes

As the epidermal layer continually replaces itself, cells are pushed outward where they eventually die and flake off. In most people, these flakes of skin are too small to be visible. However, certain conditions cause cell turnover to be unusually rapid, especially in the scalp. For people with dandruff, skin cells may mature and be shed in 2–7 days, as opposed to around a month in people without dandruff. The result is that dead skin cells are shed in large, oily clumps, which appear as white or grayish patches on the scalp, skin and clothes.

Dandruff has been shown to be the result of three required factors:[2]

  1. Skin oil commonly referred to as sebum or sebaceous secretions[3]
  2. The metabolic by-products of skin micro-organisms (most specifically Malassezia yeasts)[4][5][6][7][8]
  3. Individual susceptibility

Common older literature cites the fungus Malassezia furfur (previously known as Pityrosporum ovale) as the cause of dandruff. While this fungus is found naturally on the skin surface of both healthy people and those with dandruff, it was later discovered that a scalp specific fungus, Malassezia globosa, is the responsible agent.[9] This fungus metabolizes triglycerides present in sebum by the expression of lipase, resulting in a lipid byproduct oleic acid (OA). Penetration by OA of the top layer of the epidermis, the stratum corneum, results in an inflammatory response in susceptible persons which disturbs homeostasis and results in erratic cleavage of stratum corneum cells.[6]

Rarely, dandruff can be a manifestation of an allergic reaction to chemicals in hair gels/sprays/shampoos, hair oils, or sometimes even dandruff medications like ketoconazole.

There is some evidence that food (especially sugar and yeast), excessive perspiration, and climate have significant roles in the pathogenesis of dandruff.[citation needed]

Seborrheic dermatitis

Flaking is a symptom of seborrhoeic dermatitis. Joseph Bark notes that "Redness and itching is actually seborrheic dermatitis, and it frequently occurs around the folds of the nose and the eyebrow areas, not just the scalp." Dry, thick, well-defined lesions consisting of large, silvery scales may be traced to the less common psoriasis of the scalp.

Seasonal changes, stress, and immuno-suppression seem to affect seborrheic dermatitis.

Treatment

Shampoos use a combination of ingredients to control dandruff. Salicylic acid (used in Sebulex) removes dead skin cells from the scalp and decreases the rate at which these cells are created. Zinc pyrithione kills pityrospora. Selenium sulfide or Ketoconazole achieves the results of both salicylic acid and zinc pyrithione.[10]

Simply increasing usage with normal shampooing will remove flakes.[11] However, elimination of the fungus results in dramatic improvement. Regular shampooing with an anti-fungal product can reduce recurrence.

Soothing preparations may contain Sodium bicarbonate (baking soda),[12] and coal tar based products.[13]

The most common antifungal agents used are Zinc pyrithione,[14] Selenium sulfide and Ketoconazole[15] Other products used include Tea tree oil[16] and Piroctone olamine (Octopirox).[17]

Anti-fungal/anti-dandruff shampoos containing ketoconazole have been shown to be more effective than zinc pyrithione.[18] Although a 1981 study reported selenium sulfide as being the most effective of the tested shampoos at treating dandruff,[19] a 1999 comparative study concluded that ketoconazole was the most effective antifungal agent.[20] (Although ketoconazole had been approved by F.D.A. in 1981,[21] it was not approved for topical use in a shampoo until 1990,[22] and was therefore not included in the 1981 study.)

See also

References

  1. ^ "A Practical Guide to Scalp Disorders". Journal of Investigative Dermatology Symposium Proceedings. 2007-12. http://www.nature.com/jidsp/journal/v12/n2/abs/5650048a.html. Retrieved 2009-02-06. 
  2. ^ DeAngelis YM, Gemmer CM, Kaczvinsky JR, Kenneally DC, Schwartz JR, Dawson TL (2005). "Three etiologic facets of dandruff and seborrheic dermatitis: Malassezia fungi, sebaceous lipids, and individual sensitivity". J. Investig. Dermatol. Symp. Proc. 10 (3): 295–7. doi:10.1111/j.1087-0024.2005.10119.x. PMID 16382685. 
  3. ^ Ro BI, Dawson TL (2005). "The role of sebaceous gland activity and scalp microfloral metabolism in the etiology of seborrheic dermatitis and dandruff". J. Investig. Dermatol. Symp. Proc. 10 (3): 194–7. doi:10.1111/j.1087-0024.2005.10104.x. PMID 16382662. 
  4. ^ Ashbee HR, Evans EG (2002). "Immunology of diseases associated with Malassezia species". Clin. Microbiol. Rev. 15 (1): 21–57. doi:10.1128/CMR.15.1.21-57.2002. PMID 11781265. PMC 118058. http://cmr.asm.org/cgi/content/full/15/1/21?view=long&pmid=11781265. 
  5. ^ Batra R, Boekhout T, Guého E, Cabañes FJ, Dawson TL, Gupta AK (2005). "Malassezia Baillon, emerging clinical yeasts". FEMS Yeast Res. 5 (12): 1101–13. doi:10.1016/j.femsyr.2005.05.006. PMID 16084129. 
  6. ^ a b Dawson TL (2006). "Malassezia and seborrheic dermatitis: etiology and treatment". Journal of cosmetic science 57 (2): 181–2. PMID 16758556. 
  7. ^ Gemmer CM, DeAngelis YM, Theelen B, Boekhout T, Dawson Jr TL (2002). "Fast, noninvasive method for molecular detection and differentiation of Malassezia yeast species on human skin and application of the method to dandruff microbiology". J. Clin. Microbiol. 40 (9): 3350–7. doi:10.1128/JCM.40.9.3350-3357.2002. PMID 12202578. 
  8. ^ Gupta AK, Batra R, Bluhm R, Boekhout T, Dawson TL (2004). "Skin diseases associated with Malassezia species". J. Am. Acad. Dermatol. 51 (5): 785–98. doi:10.1016/j.jaad.2003.12.034. PMID 15523360. 
  9. ^ BBC NEWS | Health | Genetic code of dandruff cracked
  10. ^ "Relief From Dandruff". http://www.thirdage.com/skin-hair-nails/relief-from-dandruff. Retrieved 2008-11-15. 
  11. ^ Mayo Clinic (2006-11-27). "Dandruff". Mayo Clinic. http://www.mayoclinic.com/health/dandruff/DS00456/DSECTION=1. Retrieved 2007-03-28. 
  12. ^ Use of Baking Soda as a Fungicide in Plants, By George Kuepper, Raeven Thomas, and Richard Earles, NCAT November 2001
  13. ^ Piérard-Franchimont C, Piérard GE, Vroome V, Lin GC, Appa Y (2000). "Comparative anti-dandruff efficacy between a tar and a non-tar shampoo". Dermatology (Basel) 200 (2): 181–4. doi:10.1159/000018362. PMID 10773717. 
  14. ^ Warner RR, Schwartz JR, Boissy Y, Dawson TL (2001). "Dandruff has an altered stratum corneum ultrastructure that is improved with zinc pyrithione shampoo". J. Am. Acad. Dermatol. 45 (6): 897–903. doi:10.1067/mjd.2001.117849. PMID 11712036. 
  15. ^ McGrath J, Murphy GM (1991). "The control of seborrhoeic dermatitis and dandruff by antipityrosporal drugs". Drugs 41 (2): 178–84. doi:10.2165/00003495-199141020-00003. PMID 1709848. 
  16. ^ Prensner R (2003). "Does 5% tea tree oil shampoo reduce dandruff?". The Journal of family practice 52 (4): 285–6. PMID 12681088. http://www.jfponline.com/Pages.asp?AID=1437. 
  17. ^ Dubini F, Bellotti MG, Frangi A, Monti D, Saccomani L (2005). "In vitro antimycotic activity and nail permeation models of a piroctone olamine (octopirox) containing transungual water soluble technology". Arzneimittel-Forschung 55 (8): 478–83. PMID 16149717. 
  18. ^ Piérard-Franchimont C, Goffin V, Decroix J, Piérard GE (2002). "A multicenter randomized trial of ketoconazole 2% and zinc pyrithione 1% shampoos in severe dandruff and seborrheic dermatitis". Skin Pharmacol. Appl. Skin Physiol. 15 (6): 434–41. doi:10.1159/000066452. PMID 12476017. 
  19. ^ Rapaport M (1981). "A randomized, controlled clinical trial of four anti-dandruff shampoos". J. Int. Med. Res. 9 (2): 152–6. PMID 7014286. 
  20. ^ Bulmer AC, Bulmer GS (1999). "The antifungal action of dandruff shampoos". Mycopathologia 147 (2): 63–5. doi:10.1023/A:1007132830164. PMID 10967964. 
  21. ^ http://www.medicinenet.com/ketoconazole/article.htm
  22. ^ http://www.accessdata.fda.gov/scripts/cder/ob/docs/obdetail.cfm?Appl_No=019927&TABLE1=OB_Rx







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