2017 HCHB_digital

Dandruff
Dandruff is a common condition in which numerous small flakes of dry skin are
shed from the scalp and are visible in the hair or on the shoulders. Dandruff
affects around 15%–20% of the population.
Dandruff may be caused by hair products, over or under-shampooing, not
enough hair brushing, a poor diet, illnesses such as Parkinson's disease or HIV,
a weakened immune system, stress, or an overgrowth of the yeast Malassezia.
Malassezia feeds on the natural oils of the scalp and excretes a fatty acid
byproduct which irritates the scalp causing flaking and itching and a faster-thannormal
shedding of skin cells. Skin cells are shed as quickly as every two to seven
days, as opposed to people without dandruff, who shed only monthly.
Certain skin conditions (such as dry skin, psoriasis, or eczema/dermatitis)
can also cause dandruff. Seborrhoeic dermatitis of the scalp is a severe form
of dandruff which causes larger, greasier flakes than other causes of dandruff.
Seborrhoeic dermatitis usually affects skin on other parts of the body as well,
such as the eyebrows (see Dermatitis and Eczema).
Dandruff is more common after puberty and is rare in children, although
newborns may get a form of dandruff called cradle cap (see Dermatitis and
TREATMENT OPTIONS
Category Examples Comments
Medicated shampoos
Antifungal shampoos
Topical applications
Mild cleansing shampoos
Natural / herbal products
/ supplements
[GENERAL SALE]
eg, zinc pyrithione (Head &
Shoulders Dry Scalp),
eg, coal tar (Neutrogena T Gel,
Sebitar Scalp Treatment)
eg, piroctone olamine (Sebamed
Anti-Dandruff Shampoo)
eg, selenium sulphide (Selsun Blue
Shampoo range)
[GENERAL SALE]
eg, ketoconazole 1% (Nizoral Blue
1%, Sebizole Dandruff 1%)
[PHARMACY ONLY MEDICINE]
eg, ketoconazole 2% (Nizoral 2%,
Sebizole Dandruff 2%)
[GENERAL SALE]
eg, Coco-Scalp*
eg, lauryl polyglucose (Dermasoft
Moisturising)
Apple cider vinegar, calendula,
coconut oil, licorice, tea-tree oil
eg, Hopes Relief Shampoo
Medicated shampoos usually contain either zinc pyrithione, salicyclic acid, selenium sulfide or coal tar, or a
combination.
All reduce the rate of epithelial skin cell turnover, relieving scaling and itching. Selenium sulfide and zinc pyrithione
also have an antifungal effect although it is not as strong as ketoconazole or ciclopirox.
When using coal tar-based products it is important to use the accompanying rinse/conditioner as this helps remove
the coal tar smell. Coal tar also makes the scalp more susceptible to sunburn and can stain clothes. Coal tar
treatment products may also discolour blonde, grey, or white hair.
Piroctone olamine has antifungal and antibacterial properties.
Selenium sulfide can discolour hair and metallic jewellery as well as stain clothes.
Strictly use as directed on the label or by a doctor. Avoid the eyes. Most products are highly toxic if swallowed, so
keep products out of reach of children. Discontinue use if scalp irritation or stinging occurs.
Ketoconazole and ciclopirox are broad spectrum antifungals which stop the growth of the yeast Malassezia. They are
often successful when other treatments have failed.
Use according to the instructions on the packet. Generally the 1% ketoconazole product is for regular use, up to
twice a week, while the 2% strength is used twice a week for two to four weeks, with at least a four-week gap
before repeating the course. There is more evidence of an effect for the 2% formulation.
Ciclopirox is used in a similar way and is as effective and well tolerated as ketoconazole; however, dandruff may
relapse faster on discontinuation.
Ketoconazole and ciclopirox shampoos may occasionally cause discolouration of white, grey or artificially coloured or
damaged hair. Mild cleansing shampoos can be used in between shampooing with antifungal products.
Coco-Scalp contains coal tar, sulphur and salicylic acid in a coconut oil base. This product has a combined
antifungal and keratolytic (sloughs off dead skin cells) action. Apply to affected areas of scalp and remove
after one hour using warm water and a shampoo. Repeat the process daily for three to seven days. Not
suitable for children under six.
Lauryl polyglucose provides gentle yet effective cleansing without irritation. The neutral pH of 5.5 helps preserve the
protective acid mantle of the scalp. May benefit eczema sufferers.
Apple cider vinegar and tea-tree oil have antifungal properties. Coconut oil aids in the removal of dandruff, and also
moisturises and strengthens hair. Aloe vera and calendula help calm itchy, sensitive scalps. Daily shampooing with a
tea-tree oil shampoo may help reduce dandruff.
Products with an asterisk have a detailed listing in the Dandruff section of OTC Products, starting on page 234.
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Page 52 HEALTHCARE HANDBOOK 2017-2018 Common Disorders