Dandruff 393023 224068411 2008-07-07T04:21:29Z Platypus222 223966 /* Treatment of fungal infection */ removed unsourced and misplaced polytar (also redlink) {{for|the album by Ivor Cutler|Dandruff (album)}} {{Infobox_Disease | Name = Dandruff | Image = | Caption = | DiseasesDB = 11911 | ICD10 = <!-- no specific code {{ICD10|Group|Major|minor|LinkGroup|LinkMajor}} --> | ICD9 = {{ICD9|690.18}} | ICDO = | OMIM = | MedlinePlus = <!-- no specific entries other than for seborrhoeic dermatitis --> | eMedicineSubj = <!-- no specific entries other than for seborrhoeic dermatitis --> | eMedicineTopic = | MeshID = }} '''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 [[cell (biology)|cell]]s to die and flake off, a small amount of flaking is normal and in fact quite common. Some people, however, either [[chronic (medicine)|chronic]]ally or as a result of certain [[induction (biology)|trigger]]s, 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 [[shampoo]]s. Dandruff is not an organism like [[lice]]; it is dead skin that accumulates on the scalp. Dandruff is unlikely to be the cause of [[hair loss]].{{Fact|date=June 2008}} Excessive flaking can also be a symptom of [[seborrhoeic dermatitis]], [[psoriasis]], [[mycosis|fungal infection]] or excoriation associated with infestation of [[head louse|head lice]]. 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. == Causes == As the '''[[Epidermis (skin)|epidermal]]''' layer continually replaces itself, cells are pushed outward where they eventually die and flake off. In most people, these flakes of skin are too small to be visible. However, certain conditions cause cell turnover to be unusually rapid, especially in the scalp. For people with dandruff, skin cells may mature and be shed in 2 - 7 days, as opposed to around a month in people without dandruff. The result is that dead skin cells are shed in large, oily clumps, which appear as white or grayish patches on the scalp, skin, and clothes. Dandruff has been shown to be the result of three required factors:<ref>{{cite journal |author=DeAngelis YM, Gemmer CM, Kaczvinsky JR, Kenneally DC, Schwartz JR, Dawson TL |title=Three etiologic facets of dandruff and seborrheic dermatitis: Malassezia fungi, sebaceous lipids, and individual sensitivity |journal=J. Investig. Dermatol. Symp. Proc. |volume=10 |issue=3 |pages=295–7 |year=2005 |pmid=16382685 |doi=10.1111/j.1087-0024.2005.10119.x}}</ref> # Skin oil commonly referred to as [[sebum]] or [[sebaceous]] secretions<ref name="pmid16382662">{{cite journal |author=Ro BI, Dawson TL |title=The role of sebaceous gland activity and scalp microfloral metabolism in the etiology of seborrheic dermatitis and dandruff |journal=J. Investig. Dermatol. Symp. Proc. |volume=10 |issue=3 |pages=194–7 |year=2005 |pmid=16382662 |doi=10.1111/j.1087-0024.2005.10104.x}}</ref> # The metabolic by-products of skin micro-organisms (most specifically [[Malassezia]] [[yeast]]s)<ref>{{cite journal |author=Ashbee HR, Evans EG |title=Immunology of diseases associated with Malassezia species |journal=Clin. Microbiol. Rev. |volume=15 |issue=1 |pages=21–57 |year=2002 |pmid=11781265 |doi=10.1128/CMR.15.1.21-57.2002|url=http://cmr.asm.org/cgi/content/full/15/1/21?view=long&pmid=11781265}}</ref><ref>{{cite journal |author=Batra R, Boekhout T, Guého E, Cabañes FJ, Dawson TL, Gupta AK |title=Malassezia Baillon, emerging clinical yeasts |journal=FEMS Yeast Res. |volume=5 |issue=12 |pages=1101–13 |year=2005 |pmid=16084129 |doi=10.1016/j.femsyr.2005.05.006}}</ref><ref name="deangelis">{{cite journal |author=Dawson TL |title=Malassezia and seborrheic dermatitis: etiology and treatment |journal=Journal of cosmetic science |volume=57 |issue=2 |pages=181–2 |year=2006 |pmid=16758556 |doi=}}</ref><ref>{{cite journal |author=Gemmer CM, DeAngelis YM, Theelen B, Boekhout T, Dawson Jr TL |title=Fast, noninvasive method for molecular detection and differentiation of Malassezia yeast species on human skin and application of the method to dandruff microbiology |journal=J. Clin. Microbiol. |volume=40 |issue=9 |pages=3350–7 |year=2002 |pmid=12202578 |doi=10.1128/JCM.40.9.3350-3357.2002}}</ref><ref>{{cite journal |author=Gupta AK, Batra R, Bluhm R, Boekhout T, Dawson TL |title=Skin diseases associated with Malassezia species |journal=J. Am. Acad. Dermatol. |volume=51 |issue=5 |pages=785–98 |year=2004 |pmid=15523360 |doi=10.1016/j.jaad.2003.12.034}}</ref> # Individual susceptibility Common older literature cites the [[fungus]] ''[[Malassezia furfur]]'' (previously known as ''Pityrosporum ovale'') as the cause of dandruff. While this fungus is found naturally on the skin surface of both healthy people and those with dandruff, it was discovered that a scalp specific fungus, ''[[Malassezia]] globosa'', is the responsible agent.<ref>[http://news.bbc.co.uk/2/hi/health/7080434.stm BBC NEWS | Health | Genetic code of dandruff cracked<!-- Bot generated title -->]</ref> This fungus metabolizes [[triglycerides]] present in sebum by the expression of lipase, resulting in a lipid byproduct [[oleic acid]] (OA). Penetration by OA of the top layer of the epidermis, the [[stratum corneum]], results in an inflammatory response in susceptible persons which disturbs [[homeostasis]] and results in erratic cleavage of stratum corneum cells.<ref name="deangelis" /> Rarely, dandruff can be a manifestation of an allergic reaction to chemicals in hair gels/sprays, hair oils, or sometimes even dandruff medications like [[ketoconazole]]. There is no convincing evidence that food (such as sugar or yeast), excessive [[perspiration]], or climate have any role in the pathogenesis of dandruff. However, certain oily foods or excessive intake of 'junk food' can trigger the appearance of dandruff . {{Fact|date=May 2008}} == Seborrheic dermatitis == Flaking is a symptom of [[seborrheic dermatitis]]. Joseph Bark notes that "Redness and itching is actually seborrheic dermatitis, and it frequently occurs around the folds of the nose and the eyebrow areas, not just the scalp." Dry, thick, well-defined lesions consisting of large, silvery scales may be traced to the less common [[psoriasis]] of the scalp. Seasonal changes, stress, and immuno-suppression seem to affect seborrheic dermatitis. == Treatment of fungal infection== There have been many strategies for the control of dandruff. Simply increasing shampooing will remove flakes.<ref>{{cite web |author=Mayo Clinic |title=Dandruff |url=http://www.mayoclinic.com/health/dandruff/DS00456/DSECTION=1 |date=2006-11-27 |publisher=Mayo Clinic |accessdate=2007-03-28}}</ref> However, elimination of the fungus results in dramatic improvement. Regular shampooing with an anti-fungal product can reduce recurrence. {| class="wikitable" | '''Active ingredient''' || '''Example of product''' |- | Sodium Bicarbonate || Baking Soda |- | [[Zinc pyrithione]]<ref>{{cite journal |author=Warner RR, Schwartz JR, Boissy Y, Dawson TL |title=Dandruff has an altered stratum corneum ultrastructure that is improved with zinc pyrithione shampoo |journal=J. Am. Acad. Dermatol. |volume=45 |issue=6 |pages=897–903 |year=2001 |pmid=11712036 |doi=10.1067/mjd.2001.117849}}</ref> || [[Head & Shoulders]], Johnson and Johnson ZP-11, Clinic All Clear, [[Pantene Pro V]], Sikkai Powder |- | [[Ketoconazole]]<ref>{{cite journal |author=McGrath J, Murphy GM |title=The control of seborrhoeic dermatitis and dandruff by antipityrosporal drugs |journal=Drugs |volume=41 |issue=2 |pages=178–84 |year=1991 |pmid=1709848 |doi=}}</ref> || [[Nizoral]], or Fungoral |- | [[Selenium sulfide]] || [[Selsun Blue]], Vichy Dercos Anti-Dandruff shampoo, other varieties of [[Head & Shoulders]] |- | [[Tea tree oil]]<ref name="pmid12681088">{{cite journal |author=Prensner R |title=Does 5% tea tree oil shampoo reduce dandruff? |journal=The Journal of family practice |volume=52 |issue=4 |pages=285–6 |year=2003 |pmid=12681088 |doi= |url=http://www.jfponline.com/Pages.asp?AID=1437}}</ref> || Himalaya Anti-dandruff shampoo |- | [[Tar]]<ref name="pmid10773717">{{cite journal |author=Piérard-Franchimont C, Piérard GE, Vroome V, Lin GC, Appa Y |title=Comparative anti-dandruff efficacy between a tar and a non-tar shampoo |journal=Dermatology (Basel) |volume=200 |issue=2 |pages=181–4 |year=2000 |pmid=10773717|doi=10.1159/000018362}}</ref> || [[Neutrogena T/Gel]] |- | [[Piroctone olamine]] ([[INCI]])<ref name="pmid16149717">{{cite journal |author=Dubini F, Bellotti MG, Frangi A, Monti D, Saccomani L |title=In vitro antimycotic activity and nail permeation models of a piroctone olamine (octopirox) containing transungual water soluble technology |journal=Arzneimittel-Forschung |volume=55 |issue=8 |pages=478–83 |year=2005 |pmid=16149717 |doi=}}</ref> || Octopirox |- |} Anti-fungal/anti-dandruff shampoos containing [[ketoconazole]] have been shown to be more effective than zinc pyrithione.<ref name="pmid12476017">{{cite journal |author=Piérard-Franchimont C, Goffin V, Decroix J, Piérard GE |title=A multicenter randomized trial of ketoconazole 2% and zinc pyrithione 1% shampoos in severe dandruff and seborrheic dermatitis |journal=Skin Pharmacol. Appl. Skin Physiol. |volume=15 |issue=6 |pages=434–41 |year=2002 |pmid=12476017|doi=10.1159/000066452}}</ref> Ketoconazole is the most effective antifungal agent according to one study.<ref>{{cite journal |author=Bulmer AC, Bulmer GS |title=The antifungal action of dandruff shampoos |journal=Mycopathologia |volume=147 |issue=2 |pages=63–5 |year=1999 |pmid=10967964|doi=10.1023/A:1007132830164}}</ref> == See also == *[[Hair care]] ==References== {{Reflist|2}} {{Diseases of the skin and subcutaneous tissue}} [[Category:Hairdressing]] [[Category:Dermatology]] [[Category:Head and neck]] [[ca:Caspa]] [[cs:Lupy]] [[de:Hautschuppe]] [[es:caspa]] [[fr:Pellicule (dermatologie)]] [[ko:비듬]] [[id:Ketombe]] [[is:Flasa]] [[it:Forfora]] [[nl:Hoofdroos]] [[ja:頭垢]] [[pl:Łupież]] [[pt:Dermatite seborréica]] [[ro:Mătreaţă]] [[ru:Перхоть]] [[fi:Hilse]] [[sv:Mjäll]] [[vi:Gàu (da đầu)]] [[tr:Kepek]] [[zh:头皮屑]]