Flakes of skin from the scalp dotting the collar can be the source of much angst. This problem is common, chronic and primarily cosmetic. Although it could be uncomfortable, since it could make the scalp itch, it is not contagious. It is just difficult to get rid of.

These flakes of dry scalp, though an eyesore, are a sign of the skin exfoliating- a normal function. This exfoliation is a feature of the lifecycle of skin cells, and the white flakes are fragments of the uppermost layer of skin- the superficial stratum corneum, which have been shed as part of the process.

Some amount of flaking is normal but excessive flaking is not. There are several causes for this condition.

Causes of excessive flaking

Skin renewal is a continuous process. In order to stay healthy, new cells are produced and old ones are shed. When this renewal cycle speeds up, the patches of dead skin cells get dislodged into the hair- making for an unsightly situation. There could be several reasons for the excessive flaking. And, correspondingly, several courses of treatment.

A common misconception is that dandruff is caused by poor hygiene. Not true. Dandruff is not caused by improper hygiene, but the flakes may become less apparent after a wash, since the build-up of oils and skin cells will drop off after shampooing.

Often, dandruff is caused by the overgrowth of a yeast-like fungus known as malassezia. This fungus grows on the scalp of most people and it thrives on skin oils, making those with oily scalps more susceptible to dandruff. Oleic acid, a metabolic by-product of this fungus, produces an increased turn-over of skin cells, which in turn causes those unwanted white flakes.

  • Oiliness, by itself, could also cause dandruff when the oily sebum secreted by the scalp accumulates. Irregular or improper shampooing is generally the reason for this pile-up and the sebum combines with the dead skin cells and dirt to form itchy flakes.
  • Dandruff can also be caused by a dry scalp. Especially during the winter when hair tends to get washed with warm water. The heat in the water dries out the hair and scalp, making it flaky. Flakes of dandruff caused by dry skin are generally less oily and smaller in size than those caused by other triggers. And there is no redness and inflammation.
  • Skin conditions like seborrheic dermatitis, which is associated with an increase in the growth of yeast on the skin, also causes dandruff. It causes the scalp and face to become greasy, red, scaly and itchy. The flakes of skin could be white or yellowish.
  • Another type of fungal infection which causes dandruff, is scalp ringworm – known as tinea capitis. It is characterised by severe itching of the scalp and bald patches in the areas where the fungus lives.
  • Contact dermatitis is an allergic reaction and sensitivities to certain chemicals used in products. Products like hair colour, hair spray, gel or mousse often trigger the reaction. Excessive production of skin cells, in these conditions, leads to scaly skin, which when shed combines with dirt and sebum to cause flaky and itchy dandruff.
  • Skin ailments like psoriasis cause an increase in dandruff. Psoriasis gives rise to crusty patches of skin which are red, flaky and have silvery scales.
  • Eczema also makes the skin red, flaky and dry. In addition, it also gets itchy, making the flaking more obvious when scratched.
  • Hormonal changes and stress have been known to stimulate dandruff production. As also neurological conditions- like Parkinson’s disease, suppression of the auto-immune system, and chronic conditions like strokes.

Tackling the flaking

The treatment of dandruff may take some trial and error to arrive at the optimal solution.

Mild cases of dandruff may clear out with regular shampooing using a gentle cleanser. If ineffective, a specialized shampoo may be required for that stubborn dandruff. The choice of shampoo will depend on the cause of the dandruff. Some expertise may be required to determine the most suitable product since each has its distinct mode of action.

Shampoos containing zinc pyrithione are antifungal and antibacterial. They help tackle the dandruff-causing fungus and seborrheic dermatitis.

Whereas a shampoo containing selenium sulphide retards the growth of the problematic skin cells on the scalp. It slows down the dying of skin cells.

Salicylic acid in shampoos help scrub off the scale but may make the scalp dry and exacerbate the flaking.

Tar-based shampoos may be useful for dealing with psoriasis and seborrheic dermatitis by slowing down the rate at which cells die and flake off.

Those containing ketoconazole target fungus. Ketoconazole may work even when other shampoos have failed, since it is a broad-spectrum antifungal agent.

Apart from shampoos there are also cortisone-based creams and lotions which are aimed at reducing skin inflammation. For the fungus, anti-yeast lotions are used to deter its proliferation.

There are a whole host of home remedies that also help defend against dandruff- the application of curd, lemon, salt, garlic or apple cider vinegar. Aspirin, baking soda or mouthwash. Coconut oil, olive oil or tree-tree oil. Or aloe vera.

Cutting back on styling products, such as hair sprays, gels, mousses, has also proven to be effective. Apart from triggering contact dermatitis, these products build up on hair and scalp causing oiliness, and the fungus thrives on the oils contained in them.

If the dandruff does not clear out with over-the-counter shampoos and home remedies or if the scalp becomes red or swollen, a visit to the dermatologist is called for. The dermatologist will do a thorough examination of the scalp and, if the causes are not apparent, will perform a scalp biopsy to determine the root cause of the dandruff.

Don’t let the effects cascade.

Timely medical intervention is essential, especially since conditions like seborrheic dermatitis could also affect areas like the eyebrows, sides of the nose, back of the ears, the breast done, groin and armpits.

There is also the temporary hair fall associated with dandruff since the hair follicles get damaged when the scalp is scratched due to the itching.

Further, flakes of dandruff fall on the face as well, blocking pores and increasing the likelihood of a breakout of pimples. The forehead, where the hair often touches the skin, is the most susceptible area.

Regardless of what causes your specific dandruff condition, there’s nothing that the right advice cannot clear. Talk to your dermatologist and be confident that you will get the weight of dandruff off your shoulders.

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