Dandruff is a common medical complaint especially amongst women. It may very well be a symptom of another underlying health concern, which is why it is important to get a proper diagnosis

There are a number of possible causes for a scaly scalp. Contrary to the stigma, dandruff is not caused by poor hygiene. Although less frequent washing of hair can cause or worsen scaling. In most instances, dandruff is caused by dry hair and dry scalp, leading to excessive shedding.

Majority of women at some point in their lives will experience some form of itching or scaling of the scalp. There are many reasons for this and these may include; dandruff or irritation from hair care products, less frequent washing of hair while frequently applying oils to hair. It has been reported that black women wash their hair almost every two weeks compared to Caucasian/Asian women who tend to wash their hair every other day, this may be due to fear and the inconvenience of disrupting their hairstyles like weaves, braids or plats. This form of practice certainly needs to be reviewed if one is suffering from dandruff or scaly scalp.

Underlying skin and hair conditions that can cause a scaly scalp:

1. Seborrhoeic dermatitis:An inflammatory condition of the skin that also affects the scalp. When occurring on the scalp it is called Seborrhoeic Capitis.Seborrhoeic capitis presents with a range of symptoms from a mild flaky scalp to a thick greasy yellowish scale that may cover the whole scalp. It is important to note that, the use of hair care extensions has been directly associated with Seborrhoeic dermatitis.

2. Psoriasis: A common condition that causes a dry thick silvery adherent scale especially along hairline and above ears. Psoriasis can be severe and affect whole scalp, often flakes will be seen on the shoulders, neck and on clothes
3. Tinea capitis (scalp ringworm): Localized areas of scale to the affected patch. Commonly seen in children but tinea capitis can very well occur in adults
4. Eczema: Dry itchy white scale, affecting the entire scalp, patient can have isolated scalp eczema or other lesions of eczema elsewhere in the body.
5. 5. Irritant contact dermatitis: Recurrent use of hair products may cause inflammation or irritability to the scalp leading to dandruff. Chemical relaxers, hair dyes, heat dryers can cause an irritant contact dermatitis of the scalp leading to eczematous reactions, chemical burns, dryness and severe scaling. Also the use of hair extension (weaves, artificial extensions) has been shown to have a direct relationship with an itchy and scaling scalp.

        6.Malassezia infection: Closely linked to Seborrhoeic Dermatitis, Another cause of dandruff lies in the naturally occurring yeast microbes (Malassezia) that form part of the scalp. Due to an overproduction of sebum, they flourish and overpopulate. This leads to irritation, as mentioned above, which also causes flaking and shedding of yellow scabs or white flakes of skin.

   It is therefore very important to address any excessive scaling of the scalp with urgency. Without addressing the underlying cause, the condition may persist and grow in severity. Underlying conditions if they are left untreated can cause significant disease, scarring of the scalp and eventually hair loss.

   It is therefore very important to get a diagnosis for your scale.

   What are the symptoms of dandruff?

   • Dandruff commonly present with itching and dryness of the scalp. Those battling dandruff will be aware of white flakes of skin on the scalp, in the hair, and on the shoulders.
   • There may thickened areas of the scalp and hair
   • If other areas of the body are affected especially the nose, the eyebrows, the hairline, the ears, and the center of the chest or back showing excessive shedding of skin. Think of conditions like Seborrhoeic Dermatitis, Psoriasis or Eczema.
   • In babies, most commonly newborns, dandruff is common and presents as a scaly yellow flaking on the scalp or cradle cap (seborrhoeic capitis)and is generally harmless, self-correcting in the first year of life without treatment.

   How dandruff is treated

   While it is important to keep to a good washing routine, beware of drying out the scalp with excessive washing as this will lead to further irritation and exacerbate the problem.

   Wash the hair regularly once a week for African hair (black hair), twice a week for Caucasian or Asian hair.

   Typical therapy includes medicated shampoos containing:

   • Coal tar – to slow the regeneration and shedding of skin cells. (Don’t go overboard with coal tar can be irritating and stain hair – not advised for blonde hair)
   • Selenium sulphide and zinc pyrithione – to reduce fungal growth and slow down cell turnover to reduce build-up and shedding.
   • Salicylic acid – (scalp scrubs) exfoliates dead skin cells before they build up and shed.
   • Ketoconazole or Ciclopirox olamine – an antifungal treatment to reduce the growth of malassezia.

   You may need to experiment with a few until you find one that works for you.

   Using a conditioner after shampooing can help relieve dryness

   Should symptoms continue after using anti-dandruff shampoos, make sure to consult a qualified dermatologist.