Dandruff and itching scalp

About dandruff

Dandruff (pityriasis capitis) is the term used to describe simple scaling of the skin on the scalp. About 50 per cent of the population suffers from dandruff at some point in their life. Regular washing with an anti-dandruff shampoo is useful in the treatment of dandruff.

Why dandruff occurs

The top layer of the skin is constantly being shed and renewed. This usually goes unnoticed when the cells are shed one at a time. Inflammation of the scalp may cause cells to stick together. When large clumps of cells are shed, visible flakes may be seen on the shoulders especially when wearing dark clothing or on the scalp as the hair traps the scaling skin.

Itching scalp

Itching scalp, with or without scaling, is very common. It may occur in middle-aged people, for no obvious reason. The usual response is to scratch, and this will often cause scratch marks and little crusty sores throughout the scalp. Dandruff can cause itching scalp. There are also a number of less common skin conditions that can present as itching in the scalp.

Seborrhoeic dermatitis

Seborrhoeic dermatitis is the name given to a red, itchy, scaly reaction in the scalp. It can be considered a more severe form of dandruff, except the scale is more marked and the scalp is often inflamed. It can be very itchy and can affect other parts of the body, including the face, eyebrows, beard and central chest area.

Symptoms of seborrhoeic dermatitis

Symptoms of seborrhoeic dermatitis develop gradually and may include:

• dry or greasy diffuse scaling of the scalp. This is the most usual presentation.
• yellow-red scaling on those areas of the body that are generally affected in severe disease – along the hairline, behind the hair, on the eyebrows, on the bridge of the nose, in the creases between the nose and the lips inside the ears, over the sternum (middle of the chest), on the underarms and groin areas.

Causes of seborrhoeic dermatitis

Seborrhoeic dermatitis affects areas with high densities of large oil glands. The inflammation is caused by the body’s reaction to a yeast on the scalp and to products that break down oil produced by the oil gland.

Cradle cap

Cradle cap is a form of seborrhoeic dermatitis that occurs in newborns. It may not be the same disease as in adults. It results in a thick, yellow-crusted scalp lesion.

Other symptoms can include:

• splits in the skin and behind the ears
• red facial pustules
• stubborn nappy rash.

Older children can develop thick, stubborn plaques on the scalp, measuring one to two centimetres across.

Factors that can affect seborrhoeic dermatitis

The incidence and severity of seborrhoeic dermatitis seems to be affected by:

• other illnesses – for example, people with neurologic disease (especially Parkinson’s disease, stroke and paralysis) or HIV may have severe seborrhoeic dermatitis
• emotional or physical stress
• genetic factors
• seasonal – seborrhoeic dermatitis is usually worse in winter
• parkinson’s disease and AIDS both increase the risk and severity of Seborroic dermatitis.

Psoriasis can cause itching scalp

Psoriasis is a relatively common skin condition that affects about three per cent of the population. It is often confined to the scalp, elbows and knees. While seborrhoeic dermatitis tends to involve almost all the scalp, psoriasis often occurs in small, localised patches of redness with quite prominent thick scaling.

Because psoriasis may only occur on the scalp, it can be mistaken for a severe case of dandruff or seborrhoeic dermatitis. Psoriasis has a genetic link – there is often a family history of the condition. It may be triggered by some form of stress.

Treatment for dandruff and itching scalp

Regular washing of the scalp with a medicated shampoo may be all that is required to relieve itching scalp.

The most common anti-dandruff shampoos contain one or more of:

• zinc pyrithione or zinc omadine
• selenium sulphide
• piroctone olamine – this is the most recent addition to the medicated shampoos. It is known as a 'second generation' anti-dandruff agent. It is less toxic than zinc pyrithione and is therefore safer for family use
• antifungal agents
• tar – shampoos containing tar have been used for years, usually for more severe scalp conditions. In the past, the scent of the tar-based shampoos made them less acceptable. However, newer preparations are well tolerated and simple to use.

If the dandruff is severe, or refractory to shampoo treatments then, topical corticosteroid lotions can provide symptomatic relief.

How often to use medicated shampoos

How often you need to use medicated shampoos will depend on how severe your dandruff is and what treatment you are using. Always read the directions on the shampoo pack before using it. Some products are mild enough to be used every day, while others should only be used once a week. Over time, you will work out how often to use the shampoo to keep your dandruff under control.

Typically, those with a scaly scalp should be shampooing everyday. Infrequent shampooing may result in scale build-up and thus make symptoms worse. Most antidandruff shampoos are now rinse on-rinse off. It takes 5 to 10 washes for dandfuff to clear.

A conditioner may be used to prevent excessive drying from frequent washing. Matching antidandruff conditioners increase the effect of the shampoo by five to 10 per cent while unmatched conditioners may inactivate the shampoo. In general, it takes five to 10 washes to clear up dandruff.

Where to get help

• Your GP (doctor)
• Pharmacist
• Dermatologist
• The Australasian College of Dermatologists Tel. (02) 8765 0242