Itchy scalp and dandruff: causes, treatment

When medical professionals talk about pruritis and diffuse skin desquamation on the scalp, it means that the patient is noted to have itching and dandruff.

And these non-infectious but extremely unpleasant symptoms are observed very often and appear for several reasons. [1]

Epidemiology

According to experts at the American Academy of Dermatology, itching and dandruff usually begin to bother you at a young age with the problem spilling over into later life. And the problem is estimated to affect up to 40% of people aged 30 and older.

As a rule, statistics on the prevalence of dandruff accompanied by itchy scalp are based on foreign data: USA, UK, Canada and Australia. In this case, accurate calculations are not carried out, and an automated extrapolation method of calculation is used, which, of course, does not give the actual picture.

According to these calculations, one in five Americans has a dandruff problem: that's about 50 million people or 18.4% of the total population. The figure is the same in Australia, and approximately 18.2% in the UK and Canada. [2]

Causes of the itchy scalp and dandruff

Experts believe that the main causes of itchy scalp and dandruff are:

• in the development of skin fungal disease - seborrheic dermatitis and dandruff with excess sebum production by sebocytes; [3]
• in the reaction of sensitive skin to ingredients in hair care products or hair dyes, leading to the development of contact dermatitis;
• in increased dryness of the scalp, when itching and dry dandruff appear - due to insufficient moisture content in its horny layer, which can not fully perform the functions of protection of the epidermis.

Risk factors

Often risk factors such as:

• oily skin type and excessive sweating of the scalp;
• Bathing habits that contribute to dry skin (use of inappropriate soaps or detergents and too hot water);
• vitamin and zinc deficiencies in the body;
• excessive UV exposure;
• disorders in the hormonal sphere (in men - problems with the production of androgens, in women - with the ovaries and estrogens synthesized in them). By the way, men more often suffer from dandruff and itching, because they have more sweat and sebaceous glands in the scalp;
• immunosuppression and certain diseases, particularly Parkinson's disease, diabetes, severe renal failure, hypothyroidism, Sjögren's syndrome, and lymphomas;
• prolonged use of certain medications, such as diuretics, powerful systemic antibiotics, corticosteroids, and statins;
• prolonged stress (accompanied by an increase in the level of cortisol in the blood, resulting in disruption of the thymus gland, which provides normal immune status of the body). [4]

Pathogenesis

The pathogenesis of seborrheic dermatitis has been accurately established: the yeast-like fungus Malassezia flake or Malassezia furfur is the causative agent of seborrhea. [5]

As part of the microflora of the scalp skin, the researchers found conditionally pathogenic fungi Malassezia (previously known as Pityrosporum orbiculare). If there is no dandruff, the number of fungi does not exceed 44-46%, but when their number rises to 74-75%, significant skin desquamation is observed, and at a level of 85-87%, a superficial mycosis called seborrheic dermatitis is detected. [6]

These fungi (strains M. Restricta and M. Globosa) are lipophilic in nature, colonize the stratum corneum of the skin and hair follicles and are present in the microflora of the scalp as a commensal; they feed on saturated fatty acids produced by sebaceous glands. Under the influence of predisposing factors - high temperature, high humidity, weakening of the body's defenses and barrier functions of the skin - malassezia transform from the blastospore stage to mycelial form (in which they become pathogenic). This is when itchy scalp and dandruff appear. [7]

The cell wall proteins of the fungus are antigens, and Malassezia can act as a continuous sensitizing factor, triggering a tissue and humoral immune response that is manifested by increased production of immunoglobulins (IgE) and interleukins (IL4 and IL5). The effect of IgE on mast cells results in the release of histamine and itching. [8]

And dandruff is a consequence of the "intervention" of malassezia and the toxins and lipases produced by it, leading to increased proliferation, weakening of intercellular bonds and migration of corneocytes (dead cells) of the stratum corneum, which, rejected from it and mixed with sebum, remain on the skin and hair. [9]

Symptoms of the itchy scalp and dandruff

Detecting the first signs of dandruff is easy: many white or yellowish scales of dead skin (oily to the touch) appear on the hair, which are usually scattered all over the scalp, fall on the collar and shoulders of clothes, and the skin on the head is very often itchy. This is oily dandruff and itching.

In complicated cases of seborrheic dermatitis, yellowish or hyperemic patches (plaques) may appear at the border of hair growth, in and around the ears, in the nose area, and on the upper chest.

With dry dandruff, symptoms may increase during the cold season and subside slightly during the warm season. In addition, the scales that exfoliate in dry skin are very fine and almost white.

Itchy scalp, dandruff and hair loss are sometimes linked, although dandruff itself does not cause hair loss, both conditions share common triggers and risk factors. [10]

Complications and consequences

The most frequent consequences and complications concern histamine-associated itching: it intensifies, leading to skin combing (excoriation) and loss of the skin's defense mechanism. This facilitates deeper penetration of malassezia, where the fungi, with the help of their lipase, break down sebum into fatty acids (arachidonic and oleic acids) that increase the desquamation of keratinocytes. The process becomes cyclic and is characterized by a high recurrence rate. [11]

Also very oily dandruff and itching are complicated by the blockage of sebaceous and sweat glands of the scalp, which creates conditions for the development of fungal folliculitis (inflammation of the hair follicles).

Diagnostics of the itchy scalp and dandruff

First of all, the doctor (dermatologist or trichologist) records the patient's complaints, collects anamnesis and visually, as well as using a dermatoscope examines the skin of the scalp. Diagnosis is described in more detail in the publications:

• Skin examination
• Diagnosis of itchy skin

Differential diagnosis

If there is the slightest doubt - in order not to miss the possible presence of atopic dermatitis, lichenoid pityriasis, psoriasis of the scalp and other dermatologic pathologies - a differential diagnosis with the identification of the cause of dandruff by laboratory examination of a sample of exfoliated cells or skin scrapings. [12]

It should be emphasized that dermatologists insist on the need to distinguish between dandruff and dry scalp (since most people find it difficult to tell the difference). It is true that it is possible to have both dandruff and dry scalp at the same time, but dandruff associated with the dermatomycete Malassezia furfur is considered to be quite intense itching and oily dandruff, which appear in people with an oily scalp and increased oiliness of the hair itself. [13]

Treatment of the itchy scalp and dandruff

What should I do if I have dandruff and itching? Be patient and start treatment.

In solving this dermatological problem, the main focus is on topical treatment aimed at counteracting the activated fungal microbiota (Malassezia furfur), as well as slowing down the proliferation and keratinization of skin cells.

Antifungal remedies for dandruff and itching are presented in several forms of release:

• shampoos for itching and dandruff, which contain pharmacological antimycotics (groups of imidazole or triazole derivatives), keratolytic substances (salicylates), as well as zinc and selenium. For example, these are special shampoos Seboderm, Nizoral, Mycosoral (with ketoconazole); Dermazol Plus (with ketoconazole and zinc pyrithione); Sulsena (with selenium sulfide and salicylic acid); shampoos with tar and others.; [14], [15]
• topically applied (topical) products, for more information see. - Ointment for seborrheic dermatitis, and Ointment for dandruff; [16], [17]
• Tablets for dandruff and itchy scalp, in particular systemic antimycotic drugs of the azole group against seborrheic dermatitis (Itraconazole, Fluconazole) - Tablets for skin fungus, as well as antihistamine drugs - Tablets that relieve itching. [18]

As for oral antifungals, they are prescribed when topical antimycotics do not cope with their task. Thus, Itraconazole (other trade names - Itracon, Itrazol, Itramicon, Orungal) is taken once a day, one to two capsules (0.1-0.2 g) after meals, the minimum course is one to two weeks. It should be borne in mind that this drug can not be used to treat children, pregnant and lactating women, with pronounced pathologies of the stomach, heart and kidneys. Its side effects include dizziness and tinnitus, nausea and vomiting; headaches, joint, muscle and epigastric pain; problems with intestinal and liver function; allergic urticaria and others. [19]

It is also important to take vitamins such as beta-carotene (vitamin A), ascorbic acid (vitamin C) and pantothenic acid (vitamin B5), pyridoxine (B6), biotin (B7), niacin (PP), and tocopherol (vitamin E).

Some effective remedies are offered by homeopathy (in individualized dosage): Armoracia sativa, Badiaga, Kali sulphuricum, Phosphorus, Thuja occidetalis, Graphites, Lycopodium clavatum, Natrum muriaticum, Sanicula, Calcarea carbonica, Calcarea sulphu, Medorrhinum. [20]

Home remedies for dandruff and itching

For those who prefer folk treatment - using natural remedies, masks for dandruff and itching can help:

• Hair masks from lemon
• Aloe hair mask
• A henna mask

Following Ayurveda, you can try to cleanse the skin on the head with onion juice, in the antibacterial properties of which no one doubts, but in this case the main benefit is the presence of sulfur and vitamin B6 in onions.

Antiseptic essential oils for dandruff and itching have a positive effect: rosemary oil, lemon oil and tea tree oil, which can be added to shampoo and any hair mask for oily dandruff and itching. And to get rid of dandruff with dry skin recommended essential oils of eucalyptus, lavender and grapefruit. [21], [22]

In addition, when bothersome itching and dry dandruff, at home you can carry out a very simple but effective procedure using sesame oil as a base. It is necessary: two tablespoons of warm oil mixed with a few drops of essential oil (of the above) and lemon juice, apply to the skin, massaging for about 10 minutes, cover the head with a hot towel (for a quarter of an hour), remove the towel and let the oils well moisturize the skin overnight (wash the head in the morning). This procedure should be done every other day for a week.

It is recommended after each washing of the head to rinse it with water and vinegar (per 2 liters - 150 ml). Regular or apple cider vinegar for dandruff and itching not only helps to clean clogged pores and hair follicles, but also restores the pH-balance of the scalp, reducing the growth of fungal infection.

Strengthen the effect of vinegar can be aspirin - acetylsalicylic acid (which is an exfoliant): crush into powder two tablets of aspirin, mix with a tablespoon of vinegar and apply to the scalp (massaging the skin with fingers), stand for about half an hour and wash the head properly.

But to use laundry soap for dandruff and itching trichologists categorically do not recommend. The normal pH of the skin on the head is closer to acidic (5.4-5.6), and fungal microorganisms do not like it; the pH of laundry soap is alkaline (at the level of 11-12), so washing the head with such soap violates the acid mantle of the skin.

Herbal treatment

No one guarantees that herbal treatments will help with dandruff and itching, but herbalists claim that decoctions of certain herbs - when used over a long period of time - can help with this problem.

So, herbs that help with dandruff: Cypress narrow-leaved (willow tea), burdock (root), fenugreek (seeds), chamomile (flowers), bearberry, horsetail, yarrow, red clover.

Apply herbal decoctions externally, thoroughly wetting the skin of the scalp with a tampon (comb dividing the hair into rows).

Prevention

The main preventive measures for the appearance of dandruff and itching can be considered:

• adhering togeneral principles of hair and scalp care;
• the right care for oily hair;
• drinking enough water;
• A balanced diet that ensures that the body is supplied with the necessary substances;
• Eating nuts and seeds that are high in alpha-linoleic acid, zinc and selenium, which are important for a healthy scalp.

Forecast

For most people, dandruff is a chronic condition that goes away and comes back again. So experts are not optimistic about the final elimination of dandruff and itchy scalp.