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2017 HCHB_digital

Dandruff Dandruff is a

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. Significant learning opportunity: Wound care Your new Group 3 CPD project Page 52 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION Eczema). It is not infectious and is not caused by bad hygiene, although infrequent hair washing can contribute to its severity. Dandruff tends to come and go over time. The condition may be worse in autumn and winter when indoor heating can contribute to dry skin and people are not exposed to as much sunlight (UVA is effective at counteracting the effects of the yeast). Initial assessment Examine the scalp to ensure that the symptoms the customer is describing are the result of dandruff. A pink inflamed-looking scalp with greasy-looking flakes is most likely seborrhoeic dermatitis (see Dermatitis and Eczema), or the presence of thick silvery scales may indicate psoriasis (see Psoriasis). Both should be referred to a pharmacist. Ask about any concurrent skin conditions and if symptoms seem related to the recent use of hair products. Treatment Dandruff is usually very responsive to treatment but often returns after treatment stops. Mild cases usually respond to daily shampooing with a gentle cleanser. More noticeable cases will require regular and ongoing treatment with a medicated or antifungal shampoo. The majority of treatment products have antifungal properties which control the presence of the yeast Malassezia. Reduction in this yeast reduces the presence of fatty acids thereby reducing the flaking and the itch of Malassezia-associated dandruff. Dandruff is more of a cosmetic problem than a medical problem. Advice for customers • Regular hair washing (at least twice weekly) with a mild cleansing shampoo will reduce flakes. However, treatment shampoos have a more dramatic effect on reducing flakes. »» Follow directions exactly as directed on the shampoo label. If the product irritates or burns your scalp, rinse it away thoroughly and do not use it again. Refer to the pharmacist to help choose a different product. »» If one product does not appear to work, relief may be gained by using a different type of anti-dandruff product. »» Do not use dandruff products if skin is broken, and avoid contact with eyes. • Avoid wearing dark clothes while dandruff is particularly bad. • Stress may trigger dandruff or worsen existing symptoms. Take time out to relax and try to manage stress. • Cut back on the use of styling products. Hair sprays, styling gels, mousses and hair waxes can all build up on the hair and scalp. • Eat a healthy, well-balanced diet. • A little bit of sun on the hair is good for dandruff but avoid overexposure. Wear a hat if outside for prolonged periods to avoid sunburn. • Tea-tree oil is a natural antiseptic, antibiotic and antifungal agent. Daily shampooing with tea-tree oil shampoos has been shown to reduce the Refer to PHARMACIST The following questions aim to identify customers who would benefit from further input from a pharmacist. Your initial assessment or a caregiver's history may have already provided some answers. Decide if any further questions still need to be asked and refer any “yes” answers to a pharmacist. • Does the person have any other health conditions (eg, immunosuppression, is pregnant or breastfeeding)? • Does the scalp look red or have sores or crusts on it? • Does the scalp feel lumpy or irregular? • Are the symptoms confined to just the scalp or do they extend to other parts of body (such as eyebrows, forehead or ears)? • Is the person an infant or young child or elderly? • Is there any hair loss? • Has there been any recent use of new hair products (such as shampoo, hair spray, gel or dye)? • Have anti-dandruff shampoos been tried before without success? • Does the person have any allergies to topical medicines? incidence of dandruff. »» The oil may cause allergic reactions in some people. • Treatment reduces symptoms but does not cure the problem long term – customers may need to repeat treatment periodically. Visit ELearning to start your project www.pharmacytoday.co.nz Facilitated by Dr Alesha Smith Page 53

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