Dandruff is one of the most misunderstood aspects in scalp disorders. Broadly speaking, depending on the cause we can classify them into three types. We can call them the good dandruff, the bad dandruff and the ugly dandruff.

The first type i.e. the good dandruff is usually caused due to dryness or oiliness of the scalp. Dry dandruff is just dryness of scalp. Typically it starts during winter appearing as dry powdery scales on the scalp. Sometimes, it is associated with hair loss as well, but being seasonal by nature, both the dandruff and hair loss are quite often mild and temporary.

Oily dandruff is nothing but the oil secretion on the scalp. Every scalp secretes its own natural oil called sebum. When the head is scratched this oily grimy sebum comes out as white substance in the finger nails and is often mistaken as dandruff.

It usually does not cause any hair loss or scalp damage and therefore qualifies as the ‘good dandruff’. A hair care regime involving the right shampoo and correct method of washing is enough to deal with this type of dandruff.

The bad dandruff refers to scalp infections. When the oil or sebum secretion on the scalp accumulates or stagnates for too long, it starts attracting fungal infections. These fungi find sebum as a good source of food and therefore grow very easily on an oily scalp. Here the dandruff flakes are more severe and accompanied by itching, irritation and boils on the scalp.

Directly or indirectly the infection then affects hair growth leading to hair loss and sometimes considerable baldness. Such cases do not respond to hair care alone and usually need medical care. When correctly medicated, they respond well to treatment and the hair loss resulting from it can also be controlled.

The third variety i.e. the ugly dandruff refers to scalp diseases like psoriasis and seborrheic dermatitis. The dandruff in such cases is stubborn and keeps re-appearing in spite of repeated shampooing. It is the worst form of dandruff wherein there are large flakes on the scalp almost resembling pieces of skin. This condition can worsen considerably and spread to the face, ears, nose corners and other parts of the body, leading to much distress and therefore qualifies as the ‘ugly dandruff’.

This type of persistent dandruff can be unhealthy for the scalp and can affect the hair roots causing hair loss. The hair loss can be severe enough to cause bald patches or diffuse thinning on the scalp. This type of dandruff requires early medical intervention.

Indi-Chini, Dandruff-bhai!
A recent survey of several countries worldwide revealed that 70% Indians suffer from dandruff, making it along with the Chinese, the highest incidence in the world.

When to seek medical help for dandruff ?

The different types of dandruff can be rated with respect to each other on a scale of 1 to 10. Some conditions start from one end of the scale and progressively become worse as they reach towards the ten, ending up as severe dandruff. Therefore if you have dandruff, the best thing to do is to use a good anti-dandruff shampoo and wait for about a fortnight. If the dandruff goes away after using the anti-dandruff shampoo, no further treatment is required. However if the dandruff keeps re-appearing in spite of repeated shampooing or has persisted for a long time or is accompanied with severe hair loss, then chances are the condition has progressed to the “bad dandruff” or further stages, in which case it needs to be medically treated.

To choose the right anti-dandruff shampoo you need to understand whether your scalp is dry or oily. A blotting paper test can help you understand your scalp type. Skip shampooing for 2 days in a row, press a piece of blotting paper against the scalp for about 20 seconds. Remove the paper and assess the size of the wet patch on the blotting paper. If the size is negligible, the scalp is dry. If the size is bigger, almost the size of a finger tip or even bigger then it suggests an oily scalp. Generally people who sweat profusely also tend to have an oily scalp. Once the scalp type is known, following the correct hair care becomes easy.

How is dandruff diagnosed ?

An indiscriminate use of medicated shampoos for too long can make the dandruff resistant. Therefore if the dandruff seems persistent, it is better seek medical help and identify the condition correctly.

A Tricho Analysis can help to differentiate between the various types of dandruff. It can identify the type of scalp infection and the extent to which it has affected your scalp and the hair roots.

How can dandruff be prevented ?

1) Avoid scratching the head

2) Avoid sharing personal items

3) Clean helmets regularly

4) Do not skip on hygiene

5) Use the right shampoo

Avoid scratching the head

Some people have an itchy scalp or tiny pimples on the head which make them scratch the head repeatedly. Some have the habit of finger-combing their hair all the time.

Most of these things are done by reflex, not realizing that the hands are a big source of germs. For example we touch door knobs, keyboards, cell phones, shake hands with other people, exposing our hands to contamination. And then we pass it on to the scalp each time we scratch the head.

Avoid sharing personal items

Combs, pillow covers, helmets, hair bands are things which come in touch with your scalp, some of them for long periods of time. If they are contaminated, they can easily transfer the infection to your scalp.

This is especially true for people who stay in the same house or room-mates who share the house and belongings and end up eventually sharing their scalp infections too. A similar thing occurs in frequent travelers. Even the best of hotels fall short on laundry standards. For instance, a sting operation carried out by a popular news channel sometime back, showed high fungal growth in pillow covers and beddings of some of the top-notch hotels in India.

Clean helmets regularly

Clean the outside and inside of the helmet regularly. Wear a cotton scarf before wearing the helmet.

The scarf absorbs most of the sweat and can be put for washing daily, something that can’t be done with helmets. Also avoid sharing helmets.

Do not skip on hygiene

During winters, a lot of people simply stop washing their heads. This is especially true for people who need to leave their homes early in the morning like BPO workers and school children.

While it is completely understandable and there are genuine concerns of catching a cold in this weather, some level of hygiene is essential. Consider washing the scalp in the afternoon when it is relatively warmer.

Use the right shampoo

Fungal infections develop from a combination of excess sebum on the scalp and exposure to contaminated objects. One of the easiest ways to prevent scalp infections is to follow a correct hair care which keeps the sebum in check and prevents the growth of various bacteria and fungi on the head.

The cornerstone of such hair care is regular washing with the correct shampoo. A correct shampoo is one which gives enough detergent action enabling the locking and removal of sebum molecules from the scalp. Thus contrary to popular belief that detergent based shampoos are harmful, it is these shampoos that provide enough cleansing action and help in preventing dandruff and fungal infections from developing.

How is dandruff treated ?

Treatment varies depending on the type of infection or allergen involved. Depending on the severity, oral medications or external applications or both are advised. Treatment may involve shaving off the head for better accessibility and absorption of the medication.