Dandruff 

Dandruff also called seborrhea is a common scalp condition typified by the appearance of dead skin flakes in the hair. Although it is not anything serious, the sight can be unpleasant and the affected person may feel embarrassed by it.  A person of any age can be affected. It tends to recur throughout life. Fortunately, the condition can be controlled. ^{[1] [2]}

Epidemiology

Dandruff is common. About half of the world population is estimated to have it at least once in their lives. It usually occurs after puberty and continues until middle adulthood years. Males are more frequently affected. ^[1]

Causes

Several causes have been postulated to cause dandruff. One of these is having a dry skin. A person is more prone to develop such skin during winter season particularly when air is cold and rooms are overheated. Another possible cause is an irritated, oily skin. Not regular washing of the hair with shampoo may also lead to dandruff as oils and skin cells from the scalp may accumulate. The condition can also occur with other skin disorders such as psoriasis and eczema. Some individuals can be sensitive to hair care products like mousse and hair gel which can lead to irritation and scaling scalp. Emotional stress is also proposed to be a likely cause. ^{[3] [1]}

Signs and Symptoms

The symptoms are often readily observable. The typical manifestation is the appearance of whitish flakes of dead skin along the hair and shoulders usually spotted out on dark clothing. The person frequently complains of an itchy, scaling scalp. This is often worse during fall and winter seasons. ^[3] Some may notice initially a dry facial skin.  There can be rashes on certain areas such as in the eyebrow, ear and nose areas. ^[2]

Diagnosis

Diagnosis is relatively easy. This is often done by looking at the symptoms and asking questions about how they appear. Atypical cases may need more evaluation through laboratory exams like skin scrapings. ^[2]                      

Treatment

Main treatment is anti-dandruff shampoo. If symptoms persist, steroid medications in the form of creams are advised. Patients with severe cases may be prescribed with oral steroids such as prednisone. ^[2]

References:

1.      http://www.nhs.uk/conditions/dandruff/Pages/Introduction.aspx

2.      http://www.emedicinehealth.com/dandruff/article_em.htm

3.      http://www.mayoclinic.com/health/dandruff/DS00456/DSECTION=causes

Efficacy of Alternative and Other Treatments According to GRADE* Ranking:

Sodium Bicarbonate Paste (Baking Soda):

Recommendation: No recommendation (There is insufficient evidence to support claims that sodium bicarbonate paste is able to help treat dandruff. More studies needed)

Grade of Evidence: Very low quality of evidence

Coal Tar:

Recommendation: No recommendation (There is insufficient evidence to support claims that coal tar is able to help treat dandruff. More studies needed)

Grade of Evidence: Very low quality of evidence

Tea Tree Oil [1, 2]:

Recommendation: Weakly in favor (Studies show that tea tree oil may be helpful in treating dandruff)

Grade of Evidence: Low level of evidence

Selenium Sulfide Shampoo [3, 4]:

Recommendation: Weakly in favor (Studies show that selenium sulfide shampoo may be helpful in treating dandruff)

Grade of Evidence: Moderate level of evidence

Piroctone Olamine (Octopirox) [5, 6]:

Recommendation: Weakly in favor (Studies show that Piroctone Olamine is effective in treating dandruff)

Grade of Evidence: Moderate level of evidence

* www.gradeworkinggroup.org

Summary References

Treatments:

1. https://nccih.nih.gov/health/tea/treeoil.htm

2. http://www.ncbi.nlm.nih.gov/pubmed/12451368
3. http://www.ncbi.nlm.nih.gov/pubmed/8245236

4. https://www.nlm.nih.gov/medlineplus/druginfo/meds/a682258.html

5. http://www.fda.gov/ohrms/dockets/dailys/04/oct04/101904/04n-0050-rpt0001-E-03-Hoechst-vol7.pdf 

6. http://www.researchgate.net/publication/5352664_Simultaneous_determination_of_four_anti-dandruff_agents_including_octopirox_in_shampoo_products_by_reversed-phase_liquid_chromatography