Tuesday, 26 July 2011


Published in Panorama

When Crowning Glory becomes a source of Embarrassment

Dandruff and hair loss are two of the commonest conditions affecting the “crowning glory” and also extremely difficult problems to solve. Dandruff and hair loss can happen at any age but is most commonly occurs in individuals, after puberty, that is after the age of 12, say Drs.Jyotish G, Dermatologist, Prime Medical Centre and Sarasu Phillip, Skin Specialist, Shams Specialist Medical Centre, Dubai.

However, a form of dandruff known as cradle cap occurs in newborns and infants, reveals Dr.Jyotish. “This is a type of dandruff with which several children are born where they have scaly scalp. There are chances that these children, in later life will develop sebbohric dermatitis, the kind of dandruff seen in adults.”

What is Dandruff and how is it caused? Simply stated, dandruff or dry flaky scalp is an itchy, irritating and persistent skin disorder of the scalp that can seldom be got rid of completely by way of cure, says Dr.Jyotish. While it is natural and normal for the surface of our body to shed dead skin cells continuously, in dandruff, this shedding of dead skin takes place at an excessive rate; in fact, the old skin which gives way to replacement skin, may not be completely dead.

Dr.Jyotish explains, “Clinically, one may say that dandruff is the result of an excessive production of sebum on the scalp. Having said that, it is generally agreed by skin specialists today that dandruff is associated with a tiny fungus called Pityrosporum ovale or P. ovale which is present on our body and scalp all the time. When this fungus increases abnormally in number, dandruff results.”

A multitude of factors can precipitate dandruff on the scalp. These factors may be external or internal says Dr.Jyotish. Poor health and hair hygiene, hormonal imbalance, excessive perspiration, heredity, emotional stress and tension, faulty diet, allergies, may all contribute to the problem. Clarifying on the dietary habits, Dr.Jyotish opines, “It’s not that some dietary deficiency can lead to dandruff, but a good diet always maintains a very good turnover of the skin and healthy hair growth as well.”

Continuing on the contributory factors, Dr.Jyotish explains, “Some people who are immuno-suppressed and are already on some kind of treatment for the immuno-deficiency, like people who have HIV, they can have an extreme variety of dandruff. They may on some hormone treatment or taking antibiotics for a very long time; they may be people suffering from some other illness as well.”

On the effect of weather on dandruff, Dr.Jyotish is emphatic, “Some people do get it during the winter time because the skin becomes dry. However, an oily scalp also supports the growth of P.ovale though in this instance, it has a tendency to stick to the scalp rather than appear as flakes.”

Use of indiscriminate hair products, excessive use of hair dryers, tight head gear, infrequent shampooing, inadequate rinsing also may aggravate the condition, opines the Specialist.

How does dandruff manifest itself and what can it lead to at its worst? Dr.Jyotish is reassuring, “The common symptom 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. In more severe cases the scales may be flaky and there could be redness and itching on the scalp and rashes even along the eyebrows and hives of the nose, on the chest and back, at its worst. The itching can produce constant scratching, which in turn may lead to infection. Dandruff can produce folliculitis which is just like acne. This happens when you have a lot of dandruff on your hair which falls on the forehead and face. This tends to make for small pimple like boils on the forehead. However, once the dandruff clears, this will also go. Another result of dandruff is hair fall. Except that it can be socially a very embarrassing condition, thereby affecting a person cosmetically, emotionally or psychologically, dandruff itself cannot lead to any serious or systemic problem. ”

What about prevention of dandruff? “There is really nothing to prevent it,” emphasizes Dr.Jyotish. But generally it helps if you maintain good skin by having a diet rich in fresh fruits and vegetables, especially greens. Dandruff can only be managed and controlled but not cured.”

How does one manage and treat dandruff? The best treatment would be to use specific anti-fungal shampoo at the earliest so that the build up of these flakes is minimized, says Dr.Jyotish. In severe forms, strong anti-fungal shampoo with tar as the essential ingredient should be used. “Majority of the so-called anti-dandruff shampoo do not really work. The only ingredient you should look for in these kinds of shampoos, is tar or salicylic acid. Both these components are have3 the ability to bring down the thickness of the skin as well as remove the debris, faster. The anti fungal shampoos should be applied to the scalp and left for 5 minutes before being washed off. But these shampoos which contain tar and salycylic acid are quite strong; hence they can’t be used on a daily basis. Using them twice or thrice a week for some week and then stopping would be ideal.”

Hair loss or fall, the other common disorder of the scalp, does not result from dandruff alone. While it is normal and natural for a healthy individual to lose between 50-100 hair everyday, anything beyond this would be considered a definite hair loss, agrees, Dr.Sarasu. As with dandruff, hair loss too most likely occurs after puberty and there are several factors that can lead to it. “While stress is a major culprit, fungal infection of the scalp, iron deficiency, thyroid disorders, genetic factors, surgery, delivery, trauma, hormonal imbalances, violent rubbing of hair with the towel after a hair wash are other conditions involving hair loss.”

Explaining the correlation between these factors and hair loss, Dr.Sarasu says, “However rough you are with your hair, it does not fall during pregnancy since the increased production of hormones during this period, protect the normal course of hair fall. However, once you deliver and the hormone level return to the pre-pregnancy state, all the hair that you would have normally lost during that nine month period, will now start falling! And there’s no way you can avoid this from happening.”

“Similarly, explains, Dr.Sarasu, “the extreme stress and trauma associated with surgery or a major illness results in substantial hair loss later. There are three stages to hair growth: the growing stage, resting stage and the falling stage. When there is a high level of stress on any account, hair which is at the growing stage, stops growing. A few weeks later when it is time to fall, it falls. The hair does not fall at the time when surgery takes place or when you are undergoing the stressful period; rather the fall occurs 6-8 weeks later.”

Drug induced hair loss occurs when a patient is taking medication for certain ailments, explains Dr.Sarasu. Chemotherapy for the treatment of cancer and other drugs can cause severe hair loss.

Male-pattern baldness is the commonest cause of hair loss in men, reveals Dr.Sarasu. “In these men, heredity may be the main reason where men have a receding front line. Women too may develop the condition but in the case of females, it not the front line receding, rather there’s hair loss on the vertex of the head. The hair becomes thin over the entire scalp.”

Treatment of hair loss first and foremost requires identifying the underlying cause, says Dr.Sarasu. Where tension, stress, illness, trauma, et al are the triggers, treating these conditions would stem the fall. In other situations, remedial measures may work to a lesser or greater extent depending upon the cause and severity of the condition. Suitable anti fungal topical applications, good diet rich in essential nutrients, fresh fruits and vegetables would all contribute to easing the problem and maintaining healthy hair, according to the specialist. Where treatment with topical applications and oral medicines fail, one may look at surgical options, says Dr.Sarasu.


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