Itchy scalp and dandruff: causes, treatment

When doctors talk about pruritis and diffuse desquamation of the skin on the scalp, this means that the patient has itching and dandruff.

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

Epidemiology

According to the American Academy of Dermatology, itching and dandruff usually start to bother at a young age with the transition of the problem to later in life. And this problem is estimated to affect up to 40% of people aged 30 and over.

As a rule, the statistics of the prevalence of dandruff accompanied by itching of the scalp is based on foreign data: the USA, Great Britain, Canada and Australia. At the same time, exact calculations are not carried out, but an automated extrapolation calculation method is used, which, of course, does not give an actual picture.

According to such calculations, one in five Americans have problems with dandruff: this is approximately 50 million people, or 18.4% of the total population. The same figure in Australia, and in the UK and Canada - about 18.2%. [2]

Causes of the itchy scalp and dandruff

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

• in the development of a fungal skin disease -  seborrheic dermatitis and dandruff  with excessive production of sebum 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 stratum corneum, which cannot fully perform the functions of protecting the epidermis.

Risk factors

Often, risk factors such as:

• oily skin type and increased head sweating;
• bathing habits that contribute to dry skin (use of unsuitable soaps or detergents, as well as too hot water);
• lack of vitamins and zinc in the body;
• excessive UV exposure;
• hormonal disorders (in men - problems with the production of androgens, in women - with the ovaries and estrogen synthesized in them). By the way, men are more likely to suffer from dandruff and itching, as they have more sweat and sebaceous glands in the scalp;
• immunosuppression and certain diseases, in particular, Parkinson's disease, diabetes, severe renal failure, hypothyroidism, Sjögren's syndrome, lymphomas;
• long-term use of certain drugs, such as diuretics, powerful systemic antibiotics, corticosteroids, statins;
• prolonged stress (accompanied by an increase in the level of cortisol in the blood, as a result of which the thymus gland, which ensures the normal immune status of the body, is disrupted). [4]

Pathogenesis

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

In the composition of the microflora of the skin of the scalp, researchers found opportunistic fungi Malassezia (formerly known as Pityrosporum orbiculare). If there is no dandruff, then the number of fungi does not exceed 44-46%, however, with an increase in their number to 74-75%, significant peeling of the skin is observed, and at a level of 85-87%, superficial mycosis is detected, called seborrheic dermatitis. [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 commensals; They feed on saturated fatty acids produced by the 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 are transformed from the blastospore stage to the mycelial form (in which they become pathogenic). That's when itchy scalp and dandruff appear. [7]

Fungal cell wall proteins are antigens, and Malassezia can act as a continuous sensitizing factor, inducing a tissue and humoral immune response that is manifested by increased production of immunoglobulins (IgE) and interleukins (IL4 and IL5). As a result of the action of IgE on mast cells, histamine is released, and itching occurs. [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 connections and migration of corneocytes (dead cells) of the stratum corneum of the skin, which, being rejected from it and mixed with sebum, remain on the skin and hair.. [9]

Symptoms of the itchy scalp and dandruff

It is easy to detect the first signs of dandruff: 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 clothing, and the skin on the head itches very often. This is oily dandruff and itching.

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

With dry dandruff, symptoms may increase in the cold season and subside slightly in the warm season. In addition, the scales that flake off when the skin is dry are very small and almost white.

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

Complications and consequences

Most often, the consequences and complications relate to histamine-associated pruritus: it intensifies, which leads to scratching of the skin (excoriation) and loss of the protective mechanism of the skin. This facilitates deeper penetration of malassezia, where the fungi, with the help of their lipase, break down sebum into fatty acids (arachidonic and oleic), which increase the desquamation of keratinocytes. The process becomes cyclical and has a high recurrence rate. [11]

Also, very oily dandruff and itching are complicated by blockage of the sebaceous and sweat glands of the skin 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) fixes the patient's complaints, collects an anamnesis and visually, as well as using a dermatoscope, examines the skin of the scalp. More diagnostics are described in the publications:

• Skin examination
• Diagnosis of pruritus

Differential diagnosis

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

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

Treatment of the itchy scalp and dandruff

What to do with dandruff and itching? Be patient and start healing.

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

Antifungal agents for dandruff and itching are represented by 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 , Mycozoral (with ketoconazole); Dermazole plus  (with ketoconazole and zinc pyrithione); Sulsena (with selenium sulfide and salicylic acid); shampoos with tar, etc.; [14], [15]
• externally applied (topical) remedies, for details see -  Seborrheic dermatitis ointment , as well as  Dandruff ointment ; [16], [17]
• pills for dandruff and itching of the head, in particular, systemic antimycotic drugs of the azole group against seborrheic dermatitis (Itraconazole, Fluconazole) -  Tablets for skin fungus , as well as antihistamines -  Tablets that relieve itching . [18]

As for oral antifungals, they are prescribed when topical antimycotics do not cope with their task. So, Itraconazole (other trade names - Itracon, Itrazol, Itramikon, Orungal) is taken once a day, one or 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 cannot be used to treat children, pregnant and lactating women, with severe pathologies of the stomach, heart and kidneys. And among its side effects are dizziness and tinnitus, nausea and vomiting; headache, joint, muscle and epigastric pain; problems with the work of the intestines and liver; allergic urticaria, etc. [19]

In addition, it is 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), tocopherol (vitamin E). ).

Some effective remedies are offered by homeopathy (in individually set 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 an alternative treatment using natural remedies, masks for dandruff and itching can help:

• Lemon hair masks
• Aloe hair mask
• Henna mask

Following Ayurveda, you can try to cleanse the skin on your head with onion juice, 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.

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

In addition, when itching and dry dandruff bother you, you can carry out a very simple but effective procedure at home, using sesame oil as a base. Required: mix two tablespoons of warm oil with a few drops of essential oil (from those mentioned above) and lemon juice; apply to the skin, massaging for about 10 minutes; wrap your head with a hot towel (for a quarter of an hour); remove the towel and let the oils moisturize the skin well during the night (wash your hair in the morning). This procedure should be done every other day for a week.

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

You can enhance the effect of vinegar with aspirin - acetylsalicylic acid (which is an exfoliant): grind two aspirin tablets into powder, mix with a tablespoon of vinegar and apply to the scalp (massaging the skin with your fingers), hold for about half an hour and wash your hair properly.

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

Herbal treatment

No one guarantees that herbal treatment will help with dandruff and itching, but connoisseurs of medicinal plants claim that decoctions of certain herbs - with their long-term use - will help to cope with this problem.

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

Herbal decoctions are applied externally, thoroughly moistening the skin of the scalp with a swab (dividing the hair into rows with a comb).

Prevention

The main measures to prevent the appearance of dandruff and itching can be considered:

• compliance with the general principles of hair and scalp care ;
• proper  care for oily hair ;
• drinking enough water;
• a balanced diet that provides the body 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 either goes away or comes back. So experts do not undertake to give an optimistic forecast regarding the final disposal of dandruff and itching of the head.