Published in Panorama
Dandruff and Hair Loss
Dandruff and hair loss are two of the commonest conditions affecting the “crowning glory” anywhere in the world, more particularly in this region due to its climatic conditions. Though hair fall as such is more or less same in both men and women, as per international studies, 80% of women globally, are suffering from male-pattern baldness, though the extent of the problem may vary. While it is normal to lose about 90-110 strands of hair and also regain a similar amount everyday, losing more than this quantity of hair or not being replenished with as much, may be deemed as hair fall or hair loss, says Dr.R.Soman, Dermatologist, Al Musalla Medical Centre.
What exactly is dandruff and how does it happen in some individuals and not in others? Seborrhea is the condition in this region, which manifests on the scalp as dandruff. Dandruff is basically a flaking of the skin of the scalp. The surface of our body is continuously shedding dead skin cells as a natural process. But in dandruff, these cells get shed abnormally at an excessive rate. In fact, some of these old cells which give way to new ones, may not be entirely dead! While dandruff may be said to occur as a result of excess production of sebum or oil by the oil glands in the scalp, a certain fungus is believed to trigger the condition. The Pityrosporum ovale fungus which is ever present in our body and scalp, increases abnormally in some individuals, thus giving rise to dandruff.
Dandruff is a skin problem not confined to the scalp alone but can occur in other parts of the body. Wherever there are hair follicles, there are sebaceous glands and wherever these glands are present, seborrhea can occur. It is classified as a kind of eczema and can occur on the scalp, back of the ear lobe in its folds, at the nasal fold and it can occur on the central part of the chest and back.
How does it differ from what we commonly know as eczema? Unlike other eczema, dandruff is considered to be triggered by a particular fungus, clarifies Dr.Soman.
Dandruff and hair loss can happen to anyone at any age, though it is commonest in individuals after puberty, in individuals who have an oily skin. But infants also can be affected by a type of dandruff called cradle cap. These children are born with scaly scalp and it is possible that they develop seborrhoic dermatitis or dandruff which occurs in adults, later in life.
While dandruff is basically a genetic condition, various other factors can precipitate dandruff on the scalp. But this does not always imply a heredity factor is involved. The problem can be aggravated due to environmental and hormonal factors, poor health and hair hygiene, allergies, excessive sweat, climate, humidity, faulty diet and stress. Also, the condition can be disease and drug induced in people who are already suffering from some other disease or disorders. While diet per se does not contribute directly to the problem, a healthy and balanced diet helps to maintain a very good turnover of the skin and promotes healthy hair growth. Certain foods can aggravate the condition but this depends on individuals because it is suggestive of an allergic component to the problem, explains Dr.Soman.
Some people may be prone to dandruff in winter because the skin become dry during this season. Besides, indiscriminate use of hair products, excessive use of hair dryers, use of helmets and tight head gear for prolonged time period, may also aggravate existing dandruff conditions.
The commonest manifestation of dandruff is scaling with occasional itching. The scales are usually small, round and whitish and may occur anywhere on the scalp, on the eyebrows, the beard and can spread to the neck and shoulders. However, in more severe cases the scales are flaky and there could be redness and itching on the scalp. There may also be rashes along the eyebrows and hives of the nose, on the chest and back in the worst cases of dandruff. The itching may induce incessant scratching of the affected areas which in turn may lead to infection. When there is severe dandruff on the head, it could fall on the face and forehead, leading to folliculitis or small pimple like boils in these areas. But these acne-like conditions disappear once the dandruff itself clears.
Is hair loss always a consequence of dandruff? Hair fall is a result of dandruff, but dandruff alone is not the cause of hairfall, explains Dr.Soman. Stress plays a major role in hair loss. Besides, any form of severe infection can also result in hair loss. For instance, two to three weeks following typhoid, one can experience hair fall. Similarly, pneumonia and severe gastro-intestinal infection can also lead to falling hair. Of course, hair fall caused by such infection will be very temporary in nature and once the person returns to normalcy, hair fall will also stop. Another very common reason for hair fall may the indiscriminate use of hair products, sub standard shampoos and excessive use of hair dryers. Fungal infection of the scalp, thyroid disorders, iron deficiency, genetic factors, surgery, delivery, trauma, hormonal imbalances, violent rubbing of hair with the towel after a hair wash are other conditions which may contribute to hair loss to varying degrees.
Are some specific diagnostic measures required to be taken to confirm dandruff?
We may need to check for thyroid or other hormonal problems if no apparent symptoms are manifest, explains Dr.Soman.
Unfortunately, dandruff can only be controlled and managed, not cured. Dandruff can only be managed and controlled but not cured. And this may be done by maintaining healthy skin by partaking of a balanced and nutritious diet that is rich in fresh fruits and vegetables, particularly greens. As far as treatment and management of dandruff is concerned, it is best done by using anti-fungal shampoo that is specifically aimed at managing dandruff, something that minimizes flake formation. Such a shampoo would have tar or salicylic acid as its active ingredient. These agents reduce the thickness of the skin and remove debris faster. However, since both tar and salicylic acid are pretty strong, these shampoos should not be used daily, but only twice or thrice a week.
Some tips on keeping dandruff under control
• It is important to wash the scalp frequently.
• Application of anti-fungal cream is very important.
• Anti-inflammatory, non-steroidal medicines may need to be taken, upon prescription.
• Mild steroid creams may have to be used intermittently, again upon prescription.
• Where stress and other disease conditions are the underlying factors, these have to be appropriately addressed.
• If an individual is suffering from male pattern baldness, appropriate hormonal treatment may be necessary.
• If we suspect the involvement of some other hormonal factors, we need to remedy the underlying cause.
What about surgical line of treatment for hair fall?
Yes, hair implantation has been successful. But after sometime if the person is developing baldness around that area, then it is of no use. So implantation cannot prevent baldness from occurring unless the hair fall stops completely, emphasizes Dr.Soman.