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Dandruff (Seborrheic Dermatitis)
These lectures are not meant to replace your physician and are simply provided as
a free educational service to all our visitors. If you feel that you have a
skin problem, please see your doctor.
Seborrheic dermatitis is a common chronic skin condition affecting the scalp
and areas of skin where oil glands are abundant. In its mildest variety, called
"dandruff", it affects the scalp and shows mainly shedding of scales with
itching. More severe varieties include a troublesome oiliness of the hair and
scalp, sores, greasy scales, crusts, and pimples in the scalp. Other areas of
the skin can be and are often affected. Here we see the condition on areas of
the forehead near the hairline, the eyebrows and the eyelid margins, the sides
of the nose, in and around the ears, the central chest, belly button, and
genitals.
The cause of seborrheic dermatitis is not well understood. It is not contagious
nor due to any infectious agents. There is some relationship between this
condition and a skin disease called psoriasis. In fact, some individuals with
severe cases of seborrheic dermatitis are later found to have psoriasis. The
production of flakes of skin which shed from the scalp is a normal condition,
as is the production of oil from the oil glands. For some reason, the over
production of either or both of these materials is found in most cases of this
condition.
Whenever there is a lot of oil and scale on the skin or scalp, the bacteria and
yeasts which are normally present on the skin surface have more nourishment and
thrive. In the same way that when a horse eats hay changes the hay and produces
a waste product, surface organisms produce changes in the oil as they "eat" it
and the flakes of skin. These waste products are an irritant to the skin and it
becomes itchy, red and inflamed. The skin tries to get rid of this irritant in
two ways: it makes more oil as if attempting to "wash away" the irritation and
it increases the rate of skin production attempting to "shed off' the irritant.
This adds more nourishment for the bacteria and yeasts and actually makes the
condition worse. Unless you do something to decrease this oil and scale
production, or to remove them, the bacteria and yeasts from the area, the
condition will persist.
Hormones also play a role in this condition. Since the amount of oil flow is
controlled by changes in certain hormones, any circumstance that affects these
hormones can make seborrheic dermatitis worse. Such things as nervousness,
stress, normal control pills and aging changes are factors here.
Unfortunately, there is no way to totally stop the condition forever. The
treatment of this condition is directed at the control of troublesome symptoms.
As long as the treatment program is followed, most patients achieve improvement
and control.
The cornerstone of scalp treatment is frequent washing with shampoos to
mechanically remove scale and oil, bacteria and yeasts. The medications in
shampoos also put chemicals on the scalp to slow the growth rate of bacteria
and yeasts as well as to loosen scales and slow down their rate or formation.
Because certain hair styles may be difficult to maintain with the frequency of
washing needed to keep the condition under the best control, when an individual
decides that cosmetic needs are more important than the treatment
recommendations, they should recognize that they will get less than ideal
treatment results.
The use of most cosmetics, hair dressings, sprays, scalp oils, conditioners,
dyes or rinses for the scalp may cause more problems to diseased scalp than
help. Of course it is recognized that people will use these items - but it is
recommended that anything that is greasy or will occlude the scalp be avoided.
TREATMENT IS FOR CONTROL, NOT FOR CURE. AS THE CONDITION ALLOWS, TREATMENT CAN
BE REDUCED TO THE LEAST AMOUNT OF MEDICATIONS AND SHAMPOOS THAT KEEPS YOU
COMFORTABLE. BUT WHEN SYMPTOMS ONCE MORE INCREASE, YOU WILL HAVE TO RESUME MORE
INTENSIVE TREATMENT.
For more on Common Skin Disorders,
click here.
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