Our experience so far shows that dandruff can be effectively treated with laser hair therapyThis is due, on the one hand, to the five-step, individually designed and modified active ingredient complexes from treatment to treatment, the electrocosmetic procedures performed during the treatments, and the carefully designed home cleaning routine.
Dandruff (medically known as pityriasis simplex capillitii) is one of the most common scalp conditions, affecting millions of people worldwide. Although not considered a serious health problem, it can have significant psychosocial impact, causing self-esteem issues and social anxiety.
Dandruff is a complex condition caused by an intricate interplay of microbial, immunological, genetic and environmental factors. In order to select the appropriate treatment strategy, it is important to determine the type of dandruff (dry or oily) and the triggering factors.
The modern approach sees dandruff not as a simple cosmetic problem, but as an imbalance in the scalp ecosystem. Accordingly, treatment requires a holistic approach that includes antifungal treatments, anti-inflammatory approaches, restoring the balance of the microbiome, and lifestyle changes.

 The mechanism of dandruff formation
The scalp's epithelial cell turnover cycle normally takes about 28 days. In the case of dandruff, this cycle is accelerated and can be shortened to 7-10 days (Piérard-Franchimont et al., 2006). As a result, epithelial cells cannot grow and shed properly, but instead fall off the scalp in large groups as visible dandruff flakes.

 The role of the Malassezia fungus
Scientific research clearly shows that the fungus Malassezia (formerly known as Pityrosporum ovale) plays a key role in the development of dandruff. This lipophilic (fat-loving) yeast is a natural part of the normal microbiome of the scalp, but can overgrow under certain conditions.
THE Malassezia species (especially M. globosa and M. restricta) break down sebum (oil) produced by the sebaceous glands, releasing oleic acid and other fatty acids. Genomic studies by Xu et al. (2016) have shown that these fungi possess special lipase enzymes that are specifically specialized for breaking down scalp lipids.
Oleic acid and other metabolites irritate the scalp, trigger an inflammatory response, and increase the production of sebaceous cells, leading to dandruff. This connection explains why dandruff is more common in individuals with oily hair – more sebum provides more nutrients for the Malassezia fungus.

Types of dandruff

1. Dry dandruff (Pityriasis simplex)
Features:

• small, white or grayish scales
• they come off easily and fall onto shoulders and clothes
• the scalp is mostly normal or slightly dry
• mild to moderate itching
• more common in dry seasons

In dry dandruff, the sebum production of the scalp is normal or slightly reduced, but the renewal cycle of epithelial cells is accelerated. The presence of Malassezia fungus is moderate, and the inflammatory reaction is minimal. Turner et al. (2012) showed that in this case the barrier function of the stratum corneum (cornified layer) is impaired, which contributes to increased water loss and dryness.

Triggering factors:

• dry air (winter heating season),
• washing your hair too often with strong shampoos,
• mild dehydration,
• stress,
• certain vitamin and mineral deficiencies (especially B vitamins and zinc).

2. Oily dandruff (Seborrheic dermatitis)
Features:

• larger, yellowish, oily scales,
• The scales often stick to the hairs,
• the scalp is red, inflamed, and sometimes moist,
• intense itching,
• increased sebum production,
• In addition to the scalp, it can also affect the eyebrows, ears, nose wings, chest, and upper back.

Increased sebum production (seborrhea) creates an ideal environment for the overgrowth of Malassezia fungi. According to research by Borda and Wikramanayake (2015), oleic acid and other metabolites produced by the fungus trigger a strong inflammatory response, leading to the release of cytokines and interleukins. This inflammatory process further increases the production of epithelial cells and permeability barrier dysfunction.
In addition, on a healthy scalp, the bacteria Cutibacterium acnes (formerly Propionibacterium acnes) and Staphylococcus epidermidis, as well as Malassezia species, are in balance. In the case of dandruff, this balance is upset: the proportion of Malassezia species increases, while the amount of C. acnes decreases. This shift contributes to the damage of the barrier function of the scalp and the development of inflammatory processes.

 Triggering factors:

• hormonal changes (puberty, pregnancy),
• immune system weakness,
• stress,
• genetic predisposition,
• neurological diseases (Parkinson's disease),
• HIV infection,
• certain medications (lithium, gold compounds),
• fatty diet,
• overgrowth of the Malassezia fungus,
• excessive sebum production (oily scalp),
• Excessive dryness of the scalp can also cause dandruff,
• Hair care habits and products, such as irritating shampoos, hairsprays, and hair dyes, can make the scalp sensitive, which reacts by peeling.

The effect of dandruff on hair

Dandruff is not only a cosmetic problem, but can also affect the condition of the hair:

• Hair loss: Inflamed scalp and blocked hair follicles can cause temporary hair loss. Piérard-Franchimont et al. (2006) have shown that in more severe cases, the proportion of hairs in the telogen phase can increase by up to 30-50%.
• Hair breakage: Hair growing from an inflamed scalp is often weaker and more brittle.
• Darkness: In the case of a dandruff scalp, the hair may lose its natural shine and become dull in appearance.
• Fat accumulation: Due to increased sebum production, hair becomes greasy faster.

 

The immune system of the scalp plays a key role in the development of dandruff. Wikramanayake et al. (2019) showed that the composition and activity of immune cells on the scalp with dandruff are altered:

• Increased Th17/Th1 response: Specific subsets of T cells (Th17 and Th1) are activated, which produce pro-inflammatory cytokines.
• Antimicrobial peptides: Levels of certain antimicrobial peptides (e.g. LL-37, β-defensins) are increased, indicating the activation of the scalp's defense mechanisms.
• Mast cell activation: Mast cell activation contributes to itching and inflammatory reactions.

This altered immune response may partly explain why dandruff can be exacerbated by stress, as stress affects the functioning of the immune system.

 Environmental and lifestyle factors

a) Climatic conditions
Dandruff often worsens in the winter and improves in the summer. Low humidity in the winter can dry out the scalp, while the natural antifungal effects of sunlight in the summer can help suppress the Malassezia fungus (Grimalt, 2007) and reduce dandruff.

b) Nutrition
Diet can have a significant impact on dandruff:

• Deficiency of B vitamins: Deficiency of biotin (vitamin B7) and pyridoxine (vitamin B6) in particular can worsen symptoms.
• Zinc deficiency: Zinc plays an important role in cell renewal and regulating inflammatory processes.
• Omega-3 fatty acids: A diet rich in omega-3 fatty acids may reduce inflammation.
• High sugar and carbohydrate intake: Can increase sebum production and feed fungi.

c) Stress
Stress can worsen dandruff through several mechanisms:

• increases sebum production,
• affects the immune response,
• changes the pH value of the scalp,
• increases scratching, which causes further irritation.

Schwartz et al. (2013) showed that chronic stress-induced cortisol elevation directly affects the epithelial cell renewal cycle and sebaceous gland function.

d) Hair care habits
Improper hair care can aggravate dandruff and the presence of dandruff:

• Washing your hair too often: It can strip your scalp of its natural oils, which can lead to increased sebum production as compensation.
• Washing your hair too infrequently: Allows sebum and dead skin cells to accumulate.
• Strong, drying shampoos: They can irritate the scalp and upset its natural pH balance.
• Too much styling product: It can build up on the scalp and clog hair follicles.

In some cases, dandruff is not a problem in itself, but rather a symptom of other skin conditions. It is worth highlighting two important conditions in which dandruff or similar symptoms may appear:

• Seborrheic dermatitis: This dermatological condition is practically a more severe, inflammatory form of oily dandruff, in which red, inflamed patches form on the scalp, accompanied by yellowish, oily dandruff flakes.

• Psoriasis: Psoriasis is an autoimmune skin disease that causes thick, silvery-white, scaly plaques to form on the skin, with inflamed, red-bordered lesions underneath that can form a scaly surface similar to dandruff.

Our experiences with laser hair therapy

Our experiences so far confirm our previous posts about laser hair therapy: laser hair therapy has brought significant improvement in the treatment of dandruff in all of the guests treated so far. The active ingredient complexes that are individually designed and applied to each individual also contributed to this. We examine the dandruff scalp – with particular attention to the presence of the Malassezia fungus – with a microscope and a microcamera. Under UV light, the plaques deposited near the follicles and the more pronounced fungal colonies become even more visible. We support the five-phase treatments of laser hair therapy with home care products. After just a few sessions, we have experienced significant improvement thanks to the synergistic effect of laser hair therapy and the active ingredient complexes.

Sources:

1. Xu, J., Saunders, CW, Hu, P., et al. (2016). Dandruff-associated Malassezia genomes reveal convergent and divergent virulence traits. Proceedings of the National Academy of Sciences, 113(33), 9304-9309.
2. Borda, LJ, & Wikramanayake, TC (2015). Seborrheic Dermatitis and Dandruff: A Comprehensive Review. Journal of Clinical and Investigative Dermatology, 3(2), 10.13188/2373-1044.1000019.
3. Piérard-Franchimont, C., Xhauflaire-Uhoda, E., & Piérard, GE (2006). Revisiting dandruff. International Journal of Cosmetic Science, 28(5), 311-318.
4. Schwartz, JR, Messenger, AG, Tosti, A., et al. (2013). A comprehensive pathophysiology of dandruff and seborrheic dermatitis – towards a more precise definition of scalp health. Acta Dermato-Venereologica, 93(2), 131-137.
5. Clavaud, C., Jourdain, R., Bar-Hen, A., et al. (2013). Dandruff is associated with disequilibrium in the proportion of the major bacterial and fungal populations colonizing the scalp. PLoS One, 8(3), e58203.
6. Turner, GA, Hoptroff, M., & Harding, CR (2012). Stratum corneum dysfunction in dandruff. International Journal of Cosmetic Science, 34(4), 298-306.
7. Wikramanayake, TC, Borda, LJ, Miteva, M., & Paus, R. (2019). Seborrheic dermatitis—Looking beyond Malassezia. Experimental Dermatology, 28(9), 991-1001.
8. Grimalt, R. (2007). A practical guide to scalp disorders. Journal of Investigative Dermatology Symposium Proceedings, 12(2), 10-14.
9. Manuel, F., & Ranganathan, S. (2011). A new postulate on two stages of dandruff: a clinical perspective. International Journal of Trichology, 3(1), 3-6.
10. DeAngelis, YM, Gemmer, CM, Kaczvinsky, JR, et al. (2005). Three etiologic facets of dandruff and seborrheic dermatitis: Malassezia fungi, sebaceous lipids, and individual sensitivity. Journal of Investigative Dermatology Symposium Proceedings, 10(3), 295-297.