Hair Foundation
HAIR CARE & BEAUTY » Scalp Conditions

The most common and widely recognized type of scalp scaling is the condition known as "dandruff". Almost everyone has experienced "dandruff" at some time-usually in the appearance of whitish to yellowish-white flakes on clothing and bedding as well as clinging to hair. The normal loss of "dead cells" from the scalp is usually imperceptible or nearly so. The cells of the epidermis (outer skin layer) of the scalp are replaced about every 27 days; the "dead" cells scale off as they are replaced by new cells. Usually, not enough cells are shed at any one time to become noticeable.

"Dandruff" is regarded as unsightly and socially embarrassing. A great many proprietary shampoos, lotions and ointments are marketed as "anti-dandruff" treatments. Although "dandruff" is the all-encompassing term for scales shed from the scalp, there are a number of different and distinct causes of scalp scaling. Some should receive medical diagnosis and treatment.

Scalp scaling becomes noticeable, and an embarrassing problem, when either there is an increase the rate of turnover in scalp epidermal cells or when the size of shed flakes and increased scalp oiliness causes dead cells to adhere together into clumps.

The most common, and usually unprogressive, type of scalp scaling (pityriasis-shedding of bran-like flakes) is a slight increase in turnover on epidermal cells, with or without an increase in scalp oiliness (seborrhea).

At various times there have been suggestions that this mild form of pityriasis is associated with microorganisms on the scalp-specifically a yeast Pityrosporum ovale. This has never been definitively established. Mild pityriasis can usually be managed with regular shampoos about once a week.

This kind of scaling can be controlled by the use of anti-dandruff shampoos. This treatment is more successful for some persons than for others and if the flake shedding is successfully managed, there is no need to consult a physician. However, many of the other conditions that cause scalp scaling require medical diagnosis and treatment.

Some of the causes are manifestations on the scalp of systemic diseases such as psoriasis or hormonal dysfunction. The size, form and color of the scalp scales can suggest a diagnosis. For example:

  • Pityriasiform (bran-like) flakes are characteristic of mild pityriasis or "dandruff".
  • Brittle flakes in several loose layers suggest psoriasis.
  • A fish-scale form suggests the skin disease ichthyosis.
  • Lichenoid scales suggest a skin disease such as lichen planus.
  • Waxy, greasy, yellowish-brown scales suggest a seborrhea.
  • Excessively heavy scaling, scalp oiliness, open lesions on the scalp, and unrelieved scalp itching are all indications to consult a physician.
  • Abnormally heavy scaling, excessive scalp oiliness, open lesions on the scalp, and unrelieved scalp itching are all indications to consult a physician.

    (For information about scalp disease from dermatologists, visit the website of the American Academy of Dermatology.

    Dandruff Control

    The moderate skin-flaking that constitutes "dandruff" for most people is easily controlled by frequent shampooing. The shampooing may be done every 1 to 3 days, depending on the frequency necessary to control excessive flaking. No special shampoo is needed for this moderate level of dandruff control.

    If excessive flaking and scaling is not controlled by shampooing with your regular product, you may want to try an over-the-counter dandruff control shampoo. There are five different basic formulas based upon their principal active ingredient. You may have to try several before you find one that works best for you. All of the dandruff control products can cause minor side effects such as skin irritation. If you have skin allergies, you may wish to check with your physician before using a dandruff control shampoo.

    Sometimes a dandruff control shampoo that relieves excessive scalp oiliness will cause excessive scalp dryness and dry-skin flaking-replacing one cause of dandruff with another. Dry-skin flaking can usually be controlled by using a hair conditioner after the dandruff control shampoo (See Healthy Hair).

    Active Ingredient Principal Anti-Dandruff Activity Brand Names
    Selenium sulfide Slows skin cell turnover (flaking)
    Antifungal activity
    Relieves itching
    Head and Shoulders Intensive Treatment Dandruff Shampoo
    Selsun Blue
    Zinc pyrithione Antibacterial
    Relieves itching
    Selsun Salon
    Head and Shoulders
    Coal-tar base Slows skin cell turnover (flaking)
    Controls excessive skin oiliness
    Removes psoriatic scales
    Relieves itching
    Neutrogena T/Gel
    Salicylic acid Slows skin dell turnover (flaking)
    Controls excessive skin oiliness
    Relieves itching
    Neutrogena T/Gel
    Ketoconazole Antifungal (Stronger formula available by prescription) Nizoral

    *Always follow instructions on the label for best results.

    From article:
    Healthy Hair: How to Keep It Healthy and Looking Good