Traditional Chinese Medicine – Dandruff

Herbs and Treatment for Dandruff and Seborrheic Dermatitis

Dandruff, or its more severe cousin seborrheic dermatitis, is a skin condition affecting the scalp, face, and in severe cases even the body. Symptoms range from mild flaking, which as many as 50% of people have at one time or another, to the more extreme manifestations of inflammatory seborrheic dermatitis which presents with intense redness, thick yellow crusts, itching, and even oozing from the scalp, hairline, and face.

Seborrheic dermatitis and other skin diseases are an especially interesting area of study now, when so much scientific inquiry is directed toward understanding the microbiome that lives in our bodies and skin. The microbiome is the ecosystem of microorganisms composed of good bacteria, bad bacteria, yeasts, and fungi that live in and on us, their interplay with each other, and their relationship with us and effect on our immune response.

It turns out that the microbial flora that has been much discussed in relation to the gut may also exist in the skin. In other words, the skin too needs to have a good balance of microorganisms in order to stay healthy, maintain barrier function, and prevent inflammatory over-reactions from the immune system. The scalp and face present a unique microbiome, rich in sebaceous glands which secrete the oily / waxy lubricating substance known as sebum. Of course, we want to have just the right amount of sebum to keep the skin and hair pliable and luxuriant. Too much sebum gives an oily complexion and sets the stage for yeast and bacteria to proliferate, and too little produces fine flaking and dry, brittle skin and hair. Modern habits of over-washing with harsh chemical shampoos and detergents, and an overly sweet, oily, processed diet can throw off the balance further.

Many of the microbiological findings regarding the ecosystem of the scalp, and what may go wrong with it, correlate quite neatly with the observations and treatments of Traditional Chinese Medicine (TCM). Let’s look at two of the most common presentations of seborrheic dermatitis and the TCM approach to their treatment.

Damp Heat and Toxin Type

This is the most severe presentation of seborrheic dermatitis, accompanied by an excess of sebum, with oily yellow crusts in the hair, at the hairline and on the face, in the eyebrows, around the nostrils, and in the beard and stubble area on men. There is great redness, burning and itching, and the condition exacts a significant psychological toll. If it is particularly bad, there will be oozing of sticky liquid, or pustules.

In TCM, these symptoms are a classic presentation of ‘Damp Heat and Toxin’. Anything oily, greasy, or weepy denotes too much ‘Damp’, while the angry redness / inflammation is ‘Heat’. ‘Toxin’ is further identified simply by the degree of severity, stubbornness, and persistence of the inflammation, and the fact that it has spread beyond the hair to the face.

An excess of ‘Damp’ also predisposes the body to yeast, and indeed this is the case, confirmed by microbiological testing of the scalp of seborrheic dermatitis sufferers. Malasezzia yeasts, which normally live on us harmlessly, begin to proliferate, feasting on the sebum. Interestingly, sebum is a saturated fat. The Malasezzia yeasts break it down to unsaturated fat, an essential fatty acid called Oleic acid, commonly found in olive oil and other “healthy” oils. But ironically, it is only once the sebum has been turned to Oleic acid that the trouble starts – the immune system of seborrheic dermatitis sufferers reacts nefariously to this type of oil in the scalp, perhaps because it’s not the type of fat normally found there; it begins to produce the red, crusty, angry reaction described above.

It is for this reason that I ask patients with this condition not to use any oil on their scalp or face; many use oil in an attempt to gently dissolve and lift the crusts. No coconut, olive, sesame, or any other oil whatsoever should be applied for this ‘Damp Heat’ type; nor beeswax salves or ointments. The same rule applies to babies with the oily type of cradle cap, which is another symptom of seborrheic dermatitis.

Instead, we use a herb and mineral anti-fungal cream to control the yeasts. This is a great example of knowledge from Western medicine (i.e. the existence of the yeasts in the scalp) being used to enhance TCM treatment. Had I relied on TCM alone I would never have thought to use anti-fungal cream on the scalp and face, and adding the cream has been of huge benefit in my treatments for this type of seborrheic dermatitis.

Nonetheless, internal treatment is still the ultimate path to a cure. A favourite formula is Huang Lian Jie Du Tang (Coptis Decoction to Relieve Toxicity). This priceless herbal combination is anti-inflammatory, anti-fungal, and anti-bacterial; it also has a broad range of applications for all kinds of stubborn skin diseases. However, it is extremely bitter and may cause digestive upset unless some of the constituent herbs are processed by toasting before being added to the rest of the formula. Sometimes it needs to be modified with the addition of other herbs so that it does not become overly drying and push the scalp from one extreme to the other. This formula is definitely not a good candidate for self treatment and should always be used under qualified supervision.

With this type of seborrheic dermatitis, the hair should be washed often, and occasional use of coal tar or selenium sulfide shampoo is also beneficial in order to get some symptom relief while the internal herbs are addressing the root of the problem.

Dietary therapy is very important for any inflammation of the head and face: no hot or damp foods should be eaten, which means avoiding shellfish, salmon, fish oils, oil supplements of all kinds, avocado, nut butters, lamb, barbecue, rich greasy dishes of all kinds, gooey sauces, tropical fruits, vinegar, kombucha, sugar and all sweeteners, alcohol, cigarettes, raw garlic, ginger, and hot spices. Patients often do not realize how much these items are aggravating their condition until they stop ingesting them.

This three pronged approach – internal, external, dietary – is incredibly effective and the results are very gratifying. At that point, one can assume from the disappearance of symptoms and normalized sebum production that the microbiome of the scalp and face have returned to a normal balance, and yeasts and bacteria reduced to harmless levels.

Hot Blood and Wind Type

While this type of skin disorder may present itself with profuse flaking and redness and bloody scratch marks from severe itching, it lacks the oily skin and thick yellow crusting and oozing that presents in the previously described ‘Damp Heat and Toxin’ type. ‘Hot Blood and Wind Type’ is primarily a hot and dry pattern, and I suspect one where yeast overgrowth plays a smaller part. I do not use anti-fungal cream for this type, but rely mostly on internal herbal medicine, and perhaps herbal washes, to treat the condition.

Cooling and lightly moisturizing herbs such as raw Rhemannia and Scrophularia roots, as well as Wind (for flakes and itch) herbs such as Tribulus fruit, Dictamnus bark, and Clematis root work very well. If there is spread on the face, or pustules, we add Toxin-relieving herbs such as wild Crysanthemum or Sophora root, which may also have some effect on the bacterial overgrowth of certain strains of Staphylococcus that are also present in the seborrheic dermatitis scalp.

With this type of condition, the scalp should be washed less often with gentle, mild, non-medicated shampoos. The same dietary therapy applies as above.

This is a faster presentation to treat, but it tends to relapse more readily as it seems to be aggravated by emotional / psychological stress and agitation. Sometimes it is useful to use herbs that calm the spirit concurrently, such as crushed mother of pearl.

Sometimes seborrheic dermatitis co-exists with other conditions, chiefly psoriasis (when it is called sebo-psoriasis), rosacea, folliculitis, or acne. All of these variants can be equally well treated by Traditional Chinese Medicine by paying close attention to each individual’s exact presentation. For home treatment, the diet mentioned above is helpful across the board.