Dandruff never ends, is there no way to cure it?

Reviewer: Zhang Shuyuan, Chief Physician, Beijing Huayi Integrated Traditional Chinese and Western Medicine Dermatology Hospital

Many people in life are troubled by dandruff. They wash their hair every day, so why is there never-ending dandruff?

Xiaofang, 6 years old, has a lot of dandruff at a young age, and also has symptoms of hair loss and hair breakage. This situation has lasted for half a year. During this period, Xiaofang used anti-dandruff shampoos produced by major regular manufacturers, but still could not control the dandruff.

Her mother took her to see a doctor and found out that she was infected with tinea capitis, which can cause permanent hair loss in severe cases.

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What is tinea capitis? What are the types of tinea capitis?

Tinea capitis is a disease caused by fungal infection of the scalp or hair. Depending on the pathogenic bacteria and infection symptoms, tinea capitis can be divided into white ringworm, black spot ringworm, yellow ringworm and kerion.

There are three relatively professional classification methods for tinea capitis in medicine:

1. Depending on whether there is an inflammatory reaction in the clinical manifestations of tinea capitis, it is divided into inflammatory tinea capitis and non-inflammatory tinea capitis.

2. Tinea capitis is divided into external infection and internal infection according to the different ways in which pathogenic fungi invade the hair.

3. Tinea capitis is divided into Microsporum capitis and Trichophyton capitis according to the type of pathogenic fungi.

Tinea capitis is also a common cause of dandruff and hair loss in adults and children, especially in children. This is because the fatty acid content in children's scalp sebum is low and their resistance to fungi is low.

How is tinea capitis transmitted? What are the main pathogens of tinea capitis in my country?

The pathogens of tinea capitis are mainly Microsporum, Trichophyton and Epidermophyton, all of which are superficial pathogenic fungi, including Microsporum canis, Microsporum ferrugineum, Trichophyton philadelphica, Trichophyton rubrum, Trichophyton mentagrophytes, etc.

These pathogens can be transmitted not only through direct contact with soil, animals or people infected with dermatophytes, but also indirectly through contact with clothes and other items used by patients.

With the passage of time, changes in the environment and improvements in people's living standards, the common pathogenic bacteria of tinea capitis in my country are also changing.

In the early 1980s, Trichophyton thunbergii and Microsporum ferrugineum were the main pathogens of tinea capitis; in the late 1980s, Trichophyton mentagrophytes and Trichophyton rubrum were the main pathogens of tinea capitis.

From the late 1990s to the present, the common pathogens of tinea capitis in most parts of my country are Microsporum canis and Trichophyton mentagrophytes. These two types of tinea mainly parasitize on pet cats and dogs. When people come into contact with sick animals, infection will occur.

What are the symptoms of various types of tinea capitis?

1. Ringworm

White ringworm is commonly known as "hair-eating ringworm". Grayish-white scaly patches can be seen on the scalp. They are round or oval in shape, with clear boundaries, and expand into patches over time. White ringworm generally does not have an inflammatory reaction, but sometimes mild itching occurs. The lesions often stop expanding and increasing after half a year, and are in a relatively static state. They can heal themselves after puberty. If white ringworm does not develop secondary infection, it is not easy to leave scars and will not cause baldness.

Tinea capitis is the most common type of tinea capitis in my country. It often affects children, especially preschoolers, and can break out in places such as kindergartens and primary schools.

2. Black spot ringworm

The area of ​​scalp lesions caused by black dot ringworm is smaller than that of white ringworm, but the number is larger, the inflammatory reaction is mild, and it may be accompanied by mild itching.

After the onset of the disease, the hair will break off as soon as it grows out of the scalp, and its stump will remain at the mouth of the hair follicle, appearing as a small black dot. Patients with a longer course of the disease may be left with scars after recovery, and symptoms of baldness may appear in patches.

3. Yellow ringworm

Yellow ringworm is commonly known as "ringworm head" and is mainly seen in children, but it also occurs in adults and teenagers. Pustules or blisters appear at the hair follicle openings at first, and gradually form yellow ringworm scabs the size of soybeans on the scalp. If secondary infection occurs, there will also be a bad smell.

Patients with pityriasis often have dry, dull, uneven hair and an itchy scalp. Over time, the hair follicles and scalp of the patient will shrink, forming large scars and permanent baldness.

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4. Kerning

Kerningia often evolves from white ringworm and black spot ringworm. It is a suppurative state, often accompanied by a more serious inflammatory reaction. The typical manifestation of kerningia is one or more round, dark red, infiltrative or raised inflammatory masses on the scalp, with clusters of small follicular pustules on the surface, which can discharge a small amount of pus when squeezed; the hair in the affected area is loose and easy to pull out, and there may be varying degrees of pain and tenderness; scars are often formed after healing, which can lead to permanent baldness.

In recent years, the incidence of kerion has been on the rise. Its clinical manifestations are sometimes atypical, especially when it occurs in adults, and it is easy to be misdiagnosed.

How to prevent and treat tinea capitis?

The goals of tinea capitis treatment are to eliminate the pathogenic bacteria, resolve inflammation as quickly as possible, minimize scarring, and block transmission [1].

Treatment is mainly oral or topical antifungal drugs. At the same time, the patient's contaminants and the surrounding environment need to be disinfected to prevent reinfection and spread. The following four methods can be used:

1. If a family member suffers from tinea capitis, preventive measures such as drying, scalding, boiling, and fumigating the patient's clothes, hats, pillows, quilts, etc. should be taken to disinfect them.

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2. If the patient has the habit of cutting hair at home, the contaminated haircutting tools should be disinfected and the hair, scales, scabs, etc. carrying bacteria should be burned.

3. If you have pets at home, infected animals and other close contacts that may be the source of infection need to be examined and treated.

4. Children are a high-risk group for tinea capitis. Kindergartens and primary schools should educate children on relevant health knowledge. School doctors should pay attention to checking the health of students and provide immediate treatment for any children found to prevent the spread of the disease.

When the amount of dandruff on your head increases abnormally, you must be alert to whether it is tinea capitis and seek medical attention in time. If obvious symptoms have already appeared, you need to take medication under the guidance of a doctor and take targeted treatment. Do not take medication at will or buy unknown shampoos to prevent more serious consequences.

References

[1] Zeng Yuefen, Li Hongbin. Prevalence and diagnosis and treatment status of tinea capitis in children. Dermatology and Venereology, 2022, 44(3): 222-225.