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Dandruff and Itchy Oily Scalp – Best Treatments by Dermatologists

August 30, 2020
Oily scalp treatment by dermatologist

Does itchy oily scalp cause hair loss? How about dandruff? It is pertinent to recognise the condition of your scalp to effectively treat and prevent hair loss.

What causes dandruff and scalp inflammation? 

Dandruff is a lay person’s term for a medical condition called seborrheic dermatitis. The term dermatitis itself was first to an inflammatory scalp disease. In this case, it is a combination of excess sebum or oily scalp, as well as the overgrowth of a yeast organism known as Malassezia furfur that is otherwise a commensal of the scalp. So healthy people also have Malassezia furfur on their skin and scalp, but in individuals who develop dandruff, there usually is an overgrowth of these organisms that leads to an imbalance of the microbiome, which is the balance of good bacteria, pathogenic bacteria, and the various yeast organisms. 

What are the symptoms of dandruff?

1. Excess production of oil or oily scalp. If you do not wash their hair, say for more than 24 hours, there can be significant itch associated with dandruff.

2. Scalp sensitivity and redness. Individuals who have dandruff, as well as scalp pimples, may actually have a concomitant disease known as scalp folliculitis. Scalp folliculitis can be caused by the same yeast organism Malassezia, or it can be due to secondary bacterial infections as well.

What factors can exacerbate dandruff?

  1. Excess sebum production, i.e. oily scalp
  2. The proliferation of Malassezia, a yeast that causes seborrheic dermatitis. There are specific genetic differences in the oil content. An individual who is prone to getting seborrheic dermatitis may have a slightly different what we call a physiochemical composition of their sebum, which seems to be more favorable for the yeast to proliferate.
  3. High humidity. In terms of environment, it is also very critical to appreciate that tropical climate, such as Singapore where you have high humidity, there is a predisposition to the development of seborrheic dermatitis. The reason is because of increased moisture such as from sweating, as well as raised temperatures from heat. These factors increase the growth of microorganisms, which includes yeast.
  4. Excessive sun exposure, exposure to environmental pollutants, and in the case of a poor diet and lifestyle can increase the amount of free radical damage that occurs on the scalp, and that leads to inflammatory processes. 

What causes oily scalp, beyond genetics? What role does diet, lifestyle play?

One’s diet has not been proven definitively to influence the development of seborrheic dermatitis. What we do know in acne is if you are taking high-fat diets, in terms of trans-fat for example, such as taking a lot of deep-fried saturated fats in your diet, it increases your production of sebum and exacerbates oily scalp conditions. If we were to postulate that the same process could be happening for the scalp, then certainly this is also a valid statement. What’s more important to appreciate is the role of a poor diet, as well as a sedentary lifestyle, in terms of one’s physiology.

The skin and the scalp have to deal with a lot of inflammation on a daily basis because it is exposed to the external environment. Sun exposure, UV exposure which is considered an immunosuppressant and environmental pollutant can cause free radical damage to the scalp. In an individual who is consuming a lot of antioxidants in their diet which tend to be plant-derived, versus an individual who does not incorporate antioxidant-rich food in their diet, the former will be better equipped to fight off these external aggressors. 

Can oily scalp lead to hair loss? 

Oily scalp on its own does not cause hair loss. However, oily scalp is often in association with seborrheic dermatitis. In seborrheic dermatitis, the process of inflammation in the scalp does cause a disruption in the hair cycle. The hair cycle can be broadly thought of as having a growth phase, which is specifically known as the anagen phase, and the falling out phase, which is the telogen phase.

When you have active inflammation on your scalp, you are accelerating the cycles. Consequently, you may be having more hair in the falling out phase, as opposed to the growing phase. This, in turn, can lead to an imbalance in the amount of hair fall, so you probably have less hair growing and more hair falling out. In that situation, you may also experience hair thinning.

Do you have male or female pattern hair loss?

In a second scenario where you get oily scalp, it is because you are already having hair fall. This is very specific to individuals who are suffering from male or female pattern hair loss. If you have seen images of men who have the classical male pattern hair loss, you notice that the scalp has a little bit of a shiny tone to that. The reason is not that their hair follicles are dead, they are alive. However, the hair follicles over time have become miniature, in a process we call miniaturization.

The hair follicles are associated with oil glands. While the hair shaft itself is now very tiny and almost invisible towards the end stage of male pattern hair loss, the oil glands are still equally active. Hence, the original amount of oil that the body was producing in order to lubricate the hair shaft is now in excess because there is hardly any hair left for the oil to lubricate. That can lead to a phenomenon where you have excess oil production and hence the oily scalp.

Does nutrient deficiency lead to hair loss?

Whether one can eat your way to a healthy scalp, I think it’s important to address firstly, does nutrient deficiency lead to hair loss? It is extremely rare in the developed world that one’s diet is specifically lacking in what we call micronutrients. As it is, hair loss supplements are actually not evidence-based, unless there is a documented deficiency.

Right now, supplementation folic acid and vitamin D are only recommended for high-risk groups, such as during pregnancy or in infancy. However, it is a very widespread practice for many dermatologists and non-dermatologist doctors who are treating hair loss to prescribe supplements. The important thing to note here is that there is really no solid evidence that micronutrient deficiency is in a large proportion of our cases of hair loss. If you’re talking about scalp disease, there is no evidence at all.

Can you eat your way to a healthier scalp?

Our skin and scalp are very much dependent on, first of all, your biological age, as well as external environmental effects that cause this chronological aging. Having a diet that’s rich in antioxidants can help to combat and slow down this aging process. If you do suffer from a scalp disease or have hair fall, modifying your diet is not going to help. For patients who are thinking of taking biotin supplements or other natural supplements in hope of achieving some remedy for the scalp and their hair problems, it’s very important to note that while generally supplements are considered harmless, HSA and in the U.S. the FDA, are often not involved in reviewing supplements for either safety or efficacy.

There have also been reports of inadequate active ingredients, bacterial contamination, heavy metal, and toxin contamination of supplements. It is important to highlight that one should not be focusing on a dietary modification to achieve a healthy scalp and healthy hair, but it is certainly important to include antioxidant-rich food in your diet for purposes of general wellbeing, as well as organ function. 

What are the common scalp problems in Singapore/Malaysia?

People living in the tropics tend to suffer from seborrheic dermatitis, and scalp folliculitis, which is essentially pimples on the scalp. Scalp folliculitis can be caused by the same yeast organism Malassezia, or it can be due to bacteria on the surface of the scalp. The common scalp problems seen in Singapore and Malaysia are due to our climate. Our climate is tropical, which means that it creates a very specific skin and scalp microenvironment.

There is increased retention of sweat because of the low evaporation rates owing to the environmental humidity. Young people who tend to be more active or say athletes or individuals involved in outdoor work may find that they sweat more. For scalp problems or the conditions associated with microorganism growth, these are much more prevalent in tropical regions and in susceptible individuals.

What would you recommend for individuals who are living in the tropics for healthy scalp and hair?

What I would recommend is to wash their hair daily. Scalp hygiene isn’t about going to a spa or having a hair treatment. But it’s really on a daily basis, you need an efficient way to cleanse your scalp. So the function of a cleanser is to emulsify dirt, oil, grime on the surface of your skin, on your scalp in this case, and physically rinse it off with water. Individuals or high-risk groups who are prone to scalp conditions include, for example, athletes, manual laborers who are working outdoors in the humidity. For them, it may be wise to incorporate active ingredients that prevent fungal or bacterial infections in their shampoo.

In the treatment of seborrheic dermatitis, we often use the active ingredients zinc pyrithione, salicylic acid in over the counter antidandruff shampoos. The concentration of active ingredients is also very important for efficacy. For individuals who have a history of recurrent seborrheic dermatitis, prescription shampoo that contains an antifungal agent, such as ketoconazole, may be required for longterm use and maintenance. 

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