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Ringworm - Tinea capitis and tinea capitis treatment, and how it is different to baby cradle cap Dandruff and Dandruff treatment, or is it Baby Cradle Cap?

Dandruff or Baby Cradle Cap?

Dandruff is similar, and different, from cradle cap. While cradle cap is known as seborrheic dermatitis (specifically infantile seborrheic dermatitis), seborrheic dermatitis is only one possible cause of dandruff. In fact, although it is rare, infants can have dandruff that may not be due to cradle cap.

How is this possible? Dandruff is more like a symptom than a specific disease or disorder. There are several conditions that can cause dandruff, that is, the white, flaky, sometimes powdery scales that form on the scalp and work their way out into the hair and the environment. Dandruff is often caused by seborrheic dermatitis, but it can be caused by a number of other skin conditions as well.


Dandruff Causes

Dandruff can be caused by overly dry skin. We lose skin cells all the time. They slough off on our clothes, other objects, and into the air. The small cells are usually too small to see with the naked eye. Interestingly, much of the dust in our homes and offices is actually dead skins cells that have been shed and are drifting in air (or resting on the bookshelf). When skin is exceedingly dry, the skin sloughs off in larger collections of cells (flakes) rather than the microscopic cells.

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On the other side of the spectrum, dandruff can be caused excessive build up of oils and dead skin cells. This may occur when one does not bathe or shampoo often enough. Normally our skins cells are brushed off by the movement of our clothes, our daily activities, and when we wash ourselves. If the scalp is left relatively untouched (no shampooing, no hair brushing) the skin cells crust up until they are knocked off by air or gentle disruption. These relatively large oily sheets of skin cells are one form of dandruff.

Dead skin cells naturally fall off when they have reached the end of their life cycle. They are “born” deep within the skin and move their way toward the surface. After a certain period they are sloughed off. However, sometimes the skin will react to chemicals or other insults by shedding itself prematurely. Occasionally patients will be sensitive to a cosmetic hair product or treatment. When it is applied to the scalp, the skin becomes red, itchy, and inflamed in a process called contact dermatitis. This inflammation causes the skin to shed in moderately large pieces creating dandruff.

Sunburn on a bald and balding scalp can cause dandruff, too. In severe burns, the skin may peel off in very large sheets. The sloughed off skin is actually a blister and indicates a second degree burn (a serious burn to be avoided, for sure).

As was mentioned, seborrheic dermatitis is a common cause of dandruff. Seborrheic dermatitis causes red splotches that are greasy or waxy in appearance. On top of these red lesions, white or yellow flakes can form. When these scales or flakes slough off, they collect in the hair as dandruff. Seborrheic dermatitis not only affects the scalp but can occur anywhere that there are high concentrations of oil glands. Common sites on the head for seborrheic dermatitis are eyebrows, creases of the nose, and behind the ears. When seborrheic dermatitis occurs in these areas it is important to realize that dandruff treatments placed only on the scalp may not cure the problem if they are not also applied to these problem areas.

In truth, many different skin disorders can lead to white flakes on the scalp and in the hair. All of these could reasonably be called dandruff. Eczema, for example, can cause the skin to rub off in a fine powder or irregular scales. If some sort of eczema affects the scalp, it results in dandruff.

Psoriasis is a potentially severe disorder that can cause silvery lesions virtually anywhere on the body. The silvery lesions form scales, the top layers of which can be rubbed off and away from the skin. These scales are considered dandruff when psoriasis affects areas of the scalp.

Dandruff is fairly common and can happen to virtually anyone; however there are some groups of people that are afflicted with the symptom more than others. Dandruff usually rears its ugly head in a person’s early 20s and happens to men more often than women. If someone naturally has a very oily scalp they tend to get dandruff more often (the exception, of course, is for people that have exceptionally dry skin on their scalp as the cause of dandruff).

Dandruff has been linked to certain dietary deficiencies, too. People that do not get enough B vitamins or zinc get dandruff more often. Also, people that greatly restrict fats and oils in their diet, for whatever reason, sometimes get dandruff as a result.

Curiously, physicians and patients have noticed that certain illnesses and diseases are associated with, can cuase, dandruff. The reason for this association is not at all clear, but it happens nonetheless. For example, patients with Parkinson’s disease tend to develop dandruff even if they never have. Symptoms of Parkinson’s disease occur later in life, outside of the normal age range for developing dandruff (young adulthood to middle age). People that have recently been through a severe illness tend to develop dandruff at least for a short period of time. In general, dandruff occurs if the illness was particularly stressful or it directly affected the immune system.


Dandruff treatments

As with all dandruff treatments, the best course of action is to first identify the cause of dandruff.

Since dandruff can occur from shampooing hair too frequently or not often enough, it is important to know if either of these circumstances applies to you and which one. Unfortunately one common misconception about dandruff is that it always comes from being unclean. Shampooing too much can dry and/or irritate the scalp. Therefore if people that already wash their hair faithfully, and perhaps too much, increase the frequency of washing to treat dandruff actually can cause the dandruff to worsen.

On the other hand, not washing hair frequently enough can lead to a greasy dandruff. In this case, increasing the frequency of washings may help. It may be best to start your dandruff treatment journey (and it can feel like a journey sometimes since there might be a fair bit of trial and error over a longish period of time) by changing your shampoo and the way you wash your hair. When you shampoo, massage your scalp. Use your fingernails to break up any skin cells and flakes that may have collected. Also, make sure the detergent that you use penetrates and dissolves oils on the skin. Give your shampoo time to work on your hair and on your scalp.

If a dry or an oily scalp is not your problem and dandruff persists, you can move on to shampoos that are specifically designed to treat dandruff. In the case of seborrheic dermatitis, which will be the cause of most cases of dandruff, it can be treated in most cases with topical treatments.

There are many different types of dandruff treatment shampoos and, unfortunately, successful dandruff treatment usually requires that you keep trying various products until you find the one that works for you. In order to save money, it is best to approach your dandruff treatment systematically. That means giving each type of shampoo enough time to work to find out if it is going to work and then moving on to another type if one does not work. How long should a shampoo be tried before it can be considered a failure and dropped for the next one? You should give each shampoo that you are trying at least two weeks of daily use before you give up on it. Three weeks of consistent use is probably best.

Also, the shampoo should be used every day until the dandruff subsides. It should be left on the scalp for at least five minutes each time. After it works (assuming it works) the shampoo should be used twice a week. Your normal shampoo can be used on the days you are not using the dandruff shampoo.

In order to go about dandruff treatment systematically, it is important to know the difference between the various active ingredients in each shampoo. It will take a bit of label reading to make sure you are not repeating an active ingredient that you tried previously (and which failed).

Zinc pyrithione, in dandruff treatment shampoos like Head and Shoulders, has been shown to kill fungi and bacteria when used on the scalp. In some, seborrheic dermatitis is associated with a particular fungus on the scalp and zinc pyrithione can reduce the amount of this fungus.

Shampoos with coal tar or coal tar extract can slow down the rate at which skin cells divide, die, and slough off. One of the more popular brand name coal tar shampoos is Neutrogena T/Gel. Dandruff treatment shampoos with coal tar in them can be irritating to the skin and, since they need to be left on for five to ten minutes each time, can irritate the scalp. This leads some people to stop using the shampoo before they give it a fair trial.

A dandruff treatment shampoo that also slows the rate at which skin cells move through their life cycle is one that contains selenium sulfide. Selsun Blue is a common example of a selenium product. Selenium may also have antifungal properties. It is important to note that selenium shampoos can change the color of hair, particularly in people with light hair (blonde or gray) and in those that have chemically dyed hair. Read and follow the directions on the bottle carefully and rinse completely.

There are a number of natural products that are sold to sufferers of dandruff but one seems to be rather effective in some patients. Tea tree oil or Melaleuca alternifolia can be used as a topical dandruff treatment directly or it can be found in some shampoos. The Austrailian tea tree leave extract has antibacterial and antifungal properties. It may take a little more searching to find a shampoo with tea tree oil, but as you are doing your systematic treatment protocol, it may be worth a trial if you can find it.

Rather than relying on shampoos that have some antifungal activity, antifungal shampoos or creams can be used directly. Nizoral, for instance, contains the antifungal drug, ketoconazole. A shampoo with a low concentration of this drug is available over-the-counter though higher concentration preparations are available by prescription. Monistat, Lotrimin, and Lamisil are available as creams or solutions and are an effective dandruff treatment for some people.

More persistent and severe cases of dandruff are treated with steroid creams and shampoos. Fluocinolone acetonide is an example of a steroid shampoo while hydrocortisone is the prototypical steroid cream. While many of these are available without a prescription, they are not usually considered the first line treatment for dandruff. Anyone moving to this form of treatment should consult the help of a dermatologist or primary care physician.

Another dandruff treatment option that should be directed by a physician is the use of topical medications that contain benzoyl peroxide. These agents are effective in some cases, but benzoyl peroxide tends to bleach the hair. While this may not be noticeable in people with blonde or gray hair, brunettes and redheads may wish to try a different dandruff treatment. Brand names of benzoyl peroxide containing treatments are Benzac and Desquam-X. Again, these are usually considered dandruff treatments of last resort.

If your dandruff is caused by psoriasis it can be more difficult to cure. Coal tar dandruff treatment shampoos may help in dandruff due to psoriasis; however the topical psoriasis treatments are different than the typical dandruff treatments. If you suspect or know that you have psoriasis, you should consult a physician to discuss your options for treatment, including dandruff treatment.

It may make sense to start with the most mild or least expensive shampoo first and work your way to more intense or expensive products. It is difficult to know which dandruff treatment will be best for you before you start the process, but once you find a product that works, stick with it. Be aware, though, that a dandruff treatment may seem to stop working after a certain period of time. If this occurs, try another dandruff product for a few weeks—give you scalp a break from the original shampoo. You can then return to the primary dandruff shampoo and it should work once again. If it does not, you may need to begin your systematic search again because your cause of dandruff may have changed.

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ABOUT THE AUTHOR: Michael T. Spako is an M.D. who chose to pursue a medical writing career instead of a doctors practice. I am pleased to have him as the principal writer for this cradle cap treatment site, and look forward to his further contributions. Donald Urquhart, Psychologist, Editor.

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