[Modern management of dandruff]

Abstract

Dandruff is a common complaint and is suffered by as many as 50% of the population at some time during their life and cause significant discomfort. The condition is generally characterized by the presence of flakes on the scalp and in the hair, and by itch. The symptoms can vary, and the severity can range from mild scaling, similar to dry skin, to severe scaling. Its prevalence and severity is greatest in young men, with children and older individuals suffering less frequently. It is commonly aggravated by changes in humidity, trauma (e.g., scratching), seasonal changes, and emotional stress. Dandruff responds to everyday shampooing and a longer period of lathering. Use of hair spray or hair pomades (gels) should be stopped. Salicylic acid, tar, selenium, sulfur, and zinc all are effective in shampoos and may be alternated. Overnight occlusion of salicylic or urea oil may help to soften thick, scalp plaques. The common causative agent is now accepted to be the lipohilic yeasts Malassezia spp. (previously Pityrosporum) which is increased in the scaly epidermis of both dandruff and seborrhoeic dermatitis sufferers. Selenium sulfide, imidazoles or ciclopirox olamine shampoos may help by reducing Malassezia scalp reservoirs. The wide range of antifungal shampoos available provides safe, effective and flexible treatment options for dandruff.