Dear Readers,

Joanna is a 17-year-old high school student who attends an institution in Kingston. She reports on her "hair", which, she says, causes her great embarrassment at times. Joanna has had a bad case of dandruff for a long time. She finds it very distressing to have to always be brushing flakes off her shoulders and clothing.

Joanna says that sometimes she uses a comb and scrapes her scalp and combs out her hair until there are no new flakes visible, but within a very short time, the problem recurs. She has been using a shampoo recommended to her by a pharmacist, but the problem persists. She asks Lifeline what she can do to get rid of dandruff.

Dandruff, also known by the medical name of seborrheac eczema, is a very common scalp disorder. It is marked by flaking of the skin over the scalp and may also involve flaking of the eyebrows and at the ears. Dandruff occurs in parts of the body with high sebum production and would also include such areas as the face, chest, under arms, skin folds such as stomach overhang, or beneath the breasts.

This condition isn't contagious, rarely serious, but can be embarrassing and, at times, difficult to treat. Usually, however, it can be controlled.

There are several possible causes of dandruff. These include:

Dry skin. Flakes from dry skin are smaller and less oily than flakes from other causes of dandruff.

Oily skin. When oily skin becomes irritated, dandruff often occurs, resulting in greasy skin covered with white to yellow flakes. This oily eczema can affect the face, scalp, eyebrows, behind the ears, armpits, upper chest, and groin regions.

Not shampooing hair often enough. When not shampooed often enough, there can be a build-up of oil and dead cells over the scalp, resulting in dandruff.

Shampooing too often can also cause dandruff as too many products can irritate the scalp.

A yeast-like fungus, Malassezia furfur, lives as a commensal on the scalp of most people. At times it can irritate the scalp and cause an increase in the scalp skin cells, which die and form dandruff.

People with other skin conditions such as psoriasis or chronic eczema may have a scalp inflammatory process occurring, which results in the build-up of dead cells, which form thick scales on the scalp.

Sometimes sensitivity to hair products such as hair dyes can cause an allergic reaction with a red, itchy scalp.

Seborrhea (dandruff) can occur during infancy, causing "cradle cap", and adults of all ages can develop seborrhea, especially on the scalp and face. Factors that make persons susceptible to dandruff (seborrhea) include:

People with a weakened immune system caused by HIV or who are undergoing chemotherapy can experience quite severe dandruff.

Dandruff is usually seen in young adults and may continue through to middle age. It does not occur as often in older people.

Males tend to experience dandruff more often than females because of increased amounts of male hormone, testosterone, and because of larger oil-producing glands.

The fungus, Malassezia Furfur, feeds on scalp oil, so excessively oily skin and hair make the person more prone to the fungal activity, cell overproduction, and dandruff.

Diets lacking in zinc, B vitamins, and certain fats may encourage dandruff.

However, the majority of people with dandruff are completely healthy with no known disease!

Treatment of dandruff can be attempted using some over-the-counter products before it is necessary to consult a physician. Treatment is directed at controlling skin inflammation. This can be achieved in two ways:

1. Use of steroid-based creams, lotions, and oils, which reduce inflammation.

2. By reducing the scalp fungal yeast infection Malassezia, which causes the build-up of scales.

Some useful over-the-counter products are:

1. Shampoos, including:

Tar products (Neutrogena T/gel.);

Head and Shoulders shampoo (similar to zinc pyrithione);

2. Shampoos containing salicylic acid (Neutrogena T/Sal);

Selsun Blue ( selenium sulfide);

Ketoconazole shampoo

(Nizoral).

These shampoos can be used once to three times a week until the dandruff disappears. When one shampoo no longer works well, switch to another.

3. over-the-counter steriod preparation, e.g. hydrocortisone ointment;

4. Anti-fungal creams, e.g. clotrimazole or miconazole, can also be applied to the affected area twice daily until the seborrhea disappears.

When the condition recurs (and it can), the treatment will need to be used once again. Most people, however, only need to retreat now and then when the scalp becomes itchy or dandruff is again noticeable.

When the readily available, over-the-counter products don't work, then it's time to have the condition assessed by a family physician or dermatologist. Prescription-strength shampoos and steroid preparations, which are stronger, can then be used to treat the condition.

Write to:

LIFELINE,

PO Box 1731,

KGN 8

AJM