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Skin Care
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| Dandruff (also called scurf and historically termed Pityriasis capitis) is due to the excessive shedding of dead skin cells from the scalp. As it is normal for skin cells to die and flake off, a small amount of flaking is normal and in fact quite 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. Dandruff is not an organism like lice; it is just dead skin that accumulates in the scalp. Dandruff is unlikely to be the cause of hair loss. Dandruff is a condition of less severity than seborrheic dermatitis. If it is left untreated, the patient will not experience any further symptoms. Although some patients may complain of a minor itching from time to time, its effects are entirely cosmetic. It does not cause or result from inflammation, and it is not allergic in origin. Dandruff is a global phenomenon and many people find that dandruff can cause social or self-esteem problems. Treatment may be important purely for psychological reasons. |
Dandruff
| Etiology Abnormal Cell Turnover they have lost their nuclei and gained keratin, a tough substance. This process ensures that outer skin can withstand the various minor environmental assaults to which it is exposed. In other words, we are encased in a layer of dead, keratinized cells that act to protect the living environmental assaults to which it is exposed. In other words, we are encased in a layer of dead, keratinized cells that act to protect the living tissues beneath them. The time frame required for stratum germinativum cells to lose their nuclei and become optimally keratinized is 25-30 days. For the most part, normal cell shedding is not noticed, and causes no symptoms. Proponents of the cell turnover etiology of dandruff and seborrheic dermatitis assert that, for some patients, cell turnover is accelerated. In dandruff, cell turnover is commonly 13-15 days. Seborrheic dermatitis may result from a cell turnover of only 9-10 days. The FDA OTC Review panel, in a 1982 report on dandruff and seborrheic dermatitis, stated, "The cause of dandruff stated, "The cause of dandruff has not been clearly defined, but it is known to involve an increase in the rate of epidermal turnover. This rapid transit of cells to the surface does not allow for complete keratinization of new cells. transit of cells to the surface does not allow for complete keratinization of new cells. Fungal Etiology A great deal of research on dandruff and seborrheic dermatitis has centered on the possible causative role of fungi. In 1873, a researcher affected with seborrheic dermatitis of the beard isolated an organism that was also noticed in 1874 by a researcher named Malassez. The fungus carried the name of the latter investigator for decades, being known as Malassezia furfur. While many other names have been used for this organism, current practice is to call it by a name it was given in 1913, Pityrosporum ovale. This lipophilic yeast is known to be a normal inhabitant of human skin (follicles). Although the fungal etiology was once widely believed, it fell into disrepute for two reasons. One is that there were no antifungals powerful enough to eradicate the condition. Another is that corticosteroid therapy seemed to produce benefit, leading to the conclusion that cell hyperproliferation might be the root cause. In 1984, however, a researcher reviewed the literature, coming to the conclusion that P. ovale fulfilled all of Koch's postulates for dandruff and seborrheic dermatitis. Coupled with the efficacy of ketoconazole in those conditions, medical opinion has slowly begun to swing back toward the fungal etiology. Current treatments for dandruff and seborrheic dermatitis may in fact be effective through dual antifungal approaches, if in fact the cell turnover theory has any validity. |