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GMJ POSTER PROCEEDINGS

GULF MEDICAL JOURNAL

PREVALENCE AND FACTORS ASSOCIATED WITH SELF-


REPORTED DANDRUFF AMONG ADULTS IN GULF MEDICAL
UNIVERSITY, AJMAN, UAE
Reza Ul Karim1*, Azam Jansher1, Mohammed Bhyat1, Adam Samman1, Kamil Pillay1, Shatha Al
Sharbatti2
1Third-year Medical Students, 2Professor and HOD, Community Medicine Department, Gulf Medical University, Ajman, UAE
*Presenting Author

ABSTRACT
Objective: The study aims to: (i) determine the prevalence of self-reported dandruff among
students, staff, and faculty members of Gulf Medical University, Ajman, UAE; and (ii) understand
how socio-demographic characteristics, personal hygiene and environmental factors are each linked
to self-reported dandruff.
Materials & Methods: The study was cross-sectional. A self-administered questionnaire was
distributed to the participants. The responses were used to assess the prevalence of self-reported
dandruff among students, staff and faculty members in relation to three categories: socio-
demographic characteristics, hair care practice, and environmental factors. Our sample size was 717
(37.9% males and 62.1% females).
Results: Of the 717 participants in the study, 328 (46%) had dandruff. The prevalence of self-
reported dandruff was higher among participants aged 20 years or above (p ≤ 0.001). The prevalence
was more among males than females (p ≤ 0.001). The proportion of self-reported dandruff cases was
the highest among participants from Southeast Asia (p ≤ 0.001). About 55.7% who used shampoo
less than four days/week reported to have dandruff (p ≤ 0.001). Nearly 56.8% who used mineral
water to wash their hair had dandruff (p ≥ 0.05). Around 56.1% who combed their hair more than
seven times/week reported to have dandruff (p ≤ 0.001). Results showed a significant link between
the type of hair products used and dandruff (p < 0.001); 68.2% who used hair oil also reported to
suffer from dandruff (p ≤ 0.001). The occurrence of dandruff was higher among participants who
were more exposed to sunlight (p ≥ 0.05). About 48.5% who did jobs/studies outdoor had dandruff
compared to 45.5% of those who worked/studied indoor (p ≥ 0.05). A higher number of
participants who reported to have dandruff lived inland (p ≥ 0.05). The proportion of dandruff cases
was lower among participants who reported to cover their head when outside (p ≥ 0.05).
Conclusion: Our study revealed that overall participants who did not take proper care of their hair
had a higher chance of having dandruff; environmental factors also contributed to scalp condition.
Keywords: Prevalence, factors, dandruff, Ajman, UAE
Citation: Karim RU, Azam J, Bhyat M, Samman A, Pillay K, Al Sharbatti S. Prevalence and factors
associated with self-reported dandruff among adults in Gulf Medical University, Ajman, UAE. Gulf
Medical Journal. 2016;5(S2):S79–S86.

INTRODUCTION condition, referred clinically as pityriasis capitis1.


Dandruff is a flaky and sometimes pruritic scalp It is multifactorial and could be caused by
underlying medical conditions, age, sex, state of
Correspondence: Prof. Shatha Al Sharbatti, the hair (greasy or dry), and diet (malnutrition)2.
HOD, Community Medicine, Gulf Medical Dandruff can range from mild (yellow scales
University, Ajman, UAE. Email: similar to dry skin) to severe [as in seborrheic
shatha_alsharbatti@gmu.ac.ae dermatitis (SD)]. It is a common complaint with

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as much as half the global population affected 2. Identifying the psychological impact of
by dandruff at some point of time in life3. dandruff
Factors Causing Dandruff 3. Providing information that can be used in
Age: The incidence and severity decrease after planning educational sessions according
the age of 204. A survey conducted by the to the need of the target population
Council Survey Analysis (CSA) Health poll 4. Increasing awareness about dandruff
institute covering 1,703 French people aged 15– Objectives
65 years indicated that the prevalence of
Primary objective: To determine the prevalence
dandruff decreased with age5.
of self-reported dandruff cases among adults in
Gender: Dandruff is more prevalent among Gulf Medical University, Ajman, UAE
males than females. In a study done by Misery et
Secondary objective: To determine the link
al., the prevalence among male participants was
between self-reported dandruff and:
20.7% compared to 12.8% in females6.
a) Socio-demographic factors
Racial factor: A recent study conducted on
b) Personal hygiene
1,408 people of three ethnicities (Caucasians,
African Americans and Chinese) showed that c) Environmental factors
most of the African Americans had dandruff,
MATERIALS & METHODS
while prevalence was the lowest among the
Chinese7. Research Design
Medical history: The risk of having dandruff is This population-based study followed a cross-
high in certain medical conditions (for example, sectional design.
skin conditions such as eczema, psoriasis and Study Population
SD, and systemic diseases like diabetes8, 9). The sample included undergraduate students,
Environmental factors: People living in humid staff and faculty members from Gulf Medical
areas suffer more from dandruff than those in University, Ajman, UAE. Convenience
dry areas. A study conducted in the northern sampling was used to gather data. Male and
and southern parts of India indicated low female participants aged 18–65 years, and were
prevalence in the northern area, which is dry, of varied nationalities. The student group
compared to the southern area, which is highly included first, second and third year
humid10. Excessive exposure to sunlight as well undergraduates of BBMS, BHS, BPT, DMD,
as contact with dirt and dust can have an impact MBBS and Pharm D programs. People who did
on the occurrence of dandruff11, 12. not consent to being a part of our study and
Lifestyle: Lack of hygiene or excessive hygiene were not accessible at the time of the survey
could aggravate dandruff (for example, repeated were excluded.
combing, over-shampooing or over-utilization Study Instrument & Validation Procedure
of hair products, etc.13). People not doing Data was collected using a self-administered
physical exercises are more prone to having questionnaire, which was prepared after an
dandruff than those doing exercises regularly14. extensive review of literature.
Individuals with high stress levels have a greater The questionnaire had six parts:
chance of getting dandruff than those who are
 Socio-demographic details of
more relaxed by nature.
participants: Age, gender, nationality,
Rationale
residence in emirate, occupation, course
1. Limited availability of information related and year of study (if student)
to the epidemiology of this problem in
 Medical history and details of self-
the UAE
reported dandruff

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PREVALENCE AND FACTORS ASSOCIATED WITH SELF-
REPORTED DANDRUFF IN UNIVERSITY STUDENTS GMJ. ASM 2016;5(S2):S79–S86

 Personal hygiene and preventive  The questionnaire was collected the same
measures day.
 Dietary factors Data Management and Analysis
 Environmental factors 1. The information gathered was entered in
Microsoft Excel as numerical data.
 Psychosocial factors
2. The data was then transferred to SPSS,
For validation:
Version 22.
 Two dermatologists from GMC Hospital, 3. Descriptive statistics were presented in
Ajman, validated the questionnaire. the form of tables and graphs.
 A pilot study was conducted on five 4. Inferential statistics were presented using
participants to assess the level of the Chi-square and Fisher’s exact tests.
difficulty in communication,
compatibility with language, RESULTS
comprehensibility of content and the The cross-sectional study covered 717
time needed to fill the questionnaire. participants: 475 students and 242 staff and
 The final questionnaire was modified and faculty members (response rate: 76%).
finalized based on the results of the pilot About 59.4% of the participants aged 20
study. years or above. Majority of the participants
Ethical Issues were females (62.1%). The nationalities were
categorized according to regions classified by
1. Approval was obtained from Gulf
the World Health Organization (WHO). Most
Medical University’s Ethics and Research
were from Southeast Asia (40.9%), followed
Committee.
closely by those from Eastern Mediterranean
2. Informed consent was taken from the
(39.7%). Among respondents from the UAE,
participants.
most were residents of Ajman (55.9%).
3. Objectives of the research were shared
Figure 1 shows the distribution of
with the participants.
participants based on suffering from dandruff.
4. Privacy was ensured by distributing the Of the 717 respondents, 328 (46%) had
questionnaire in a lecture hall booked dandruff, whereas 389 (54%) did not.
exclusively for the purpose and at a Figure 1. Distribution of participants based on
scheduled time. suffering from dandruff
5. Confidentiality and anonymity norms
were complied with.
Methodology
 Approval from the deans of various
Yes
colleges in the university was taken prior 328 (46%)
No
to distributing the questionnaire. 389 (54%)

 The self-administered questionnaire was


handed only to those who had given their
consent.
 The research team was available in the
classroom or at the study setup to clarify
Table 1 depicts the link between self-
doubts.
reported dandruff and two age groups: less than
 Researchers distributed the 20 and 20 or above. The number of people
questionnaires. suffering from dandruff in the two groups was

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REZA UL KARIM, ET AL GMJ. ASM 2016;5(S2):S79–S86

101 and 227, respectively, indicating the high Mediterranean (98), Africa (30) and other
association between dandruff and age. The p regions (24). The p value was 0.00, implying it is
value was <0.001, which is significant. a significant reading for our research and
The results indicated prevalence varied characteristics.
based on gender. Our research showed that the The correlation between those complaining
prevalence of dandruff was higher among males of dandruff and the emirate they resided in was
(52.6%) than females, though the margin is not another significant aspect of our research. As
large. In the female group, 185 complained of the study was conducted in Ajman, most people
dandruff vis-à-vis 143 in the male group. The p in the sample group were from the emirate.
value was 0.004, which is significant. Unsurprisingly, therefore, it had the highest
Results indicated a drastic variation in terms number of people complaining of dandruff
of correlation between nationality (classified by (194), followed by Dubai (60), Sharjah (53),
different global regions) and dandruff. Abu Dhabi (12), Ras Al Khaimah (5) and Umm
Southeast Asia led with 176 from the region Al Quwain (4). The p value was 0.20.
reporting dandruff, followed by Eastern
Table 1. Association between self-reported dandruff and socio-demographic characteristics
Self-reported dandruff
Socio-demographic characteristics Yes No p value
No. % No. %
Age group (Total) <20 years 101 34.7 190 65.3
0.00
(n = 717) ≥20 years 227 53.3 199 46.7
Gender Male 143 52.6 129 47.4
0.00
(n = 717) Female 185 41.6 260 58.4
African Region 30 37.5 50 62.5
Region (According Eastern Mediterranean
98 34.4 287 65.6
to WHO region)1 Region 0.00
(n = 717) Southeast Asia Region 176 60.1 117 39.9
Other 24 40.7 35 59.3
Abu Dhabi 12 40 18 60
Dubai 60 48 65 52
Emirates (Currently Sharjah 53 37.1 90 62.9
living) 0.20
(n = 717) Ajman 194 48.4 207 51.6
Ras Al Khaimah 5 41.7 7 58.3
Umm Al Quwain 4 66.7 2 33.3
1 Other regions include the Americas, Europe, and Western Pacific

Table 2 depicts the correlation between among those using other types of water, 35.1%
self-reported dandruff and hair hygiene. The had dandruff. The p value was 0.00 for usage of
frequency of wash was 56.3% among anti-dandruff shampoo and the practice of
participants who washed their hair less than combing hair. Nearly 55% of those using anti-
twice a week and had dandruff. This result was dandruff shampoo had dandruff, while 56.1%
not significant with a p value of 0.22. The type of those who combed their hair seven times or
of water used was also not a major factor, with more a week had dandruff. About 48.6% of
a p value of 0.18. Of the individuals using tap those who said ‘yes’ to using hair products had
water, 45.7% had dandruff; of those using dandruff, although the p value was 0.13 and
mineral water, 56.8% had dandruff, while therefore not significant. The type of hair

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PREVALENCE AND FACTORS ASSOCIATED WITH SELF-
REPORTED DANDRUFF IN UNIVERSITY STUDENTS GMJ. ASM 2016;5(S2):S79–S86

products was significant, on the other hand, respectively, of the total number of respondents
with a p value of 0.00. Individuals who had in those categories. However, the proportion
dandruff and used hair gel, cream and other was the highest for those who used oil and had
products constituted 46.8%, 40.9% and 64.7%, dandruff (68.2% of all participants using oil).
Table 2. Association between self-reported dandruff and hair care practice (n = 717)
Self-reported dandruff
Hair care practice Yes No p value
No. % No. %
<2 times/week 18 56.3 14 43.8
Frequency of wash 0.22
≥2 times/week 310 45.3 375 54.7
Frequency of <4 days/week 221 55.7 176 44.3
0.00
shampoo ≥4 days/week 107 33.4 213 66.6
Tap water 294 45.7 349 54.3
Type of water1
Mineral water 21 56.8 16 43.2 0.18
Other 13 35.1 24 64.9
Using anti-dandruff Yes 187 55 153 45
0.00
shampoo No 141 37.4 236 62.6
<7 times/week 186 40.1 278 59.9
Combing hair 0.00
≥7 times/week 142 56.1 111 43.9
Yes 173 48.6 183 51.4
Using hair products 0.13
No 155 42.9 206 57.1
Hair gel 58 46.8 66 53.2
Type of hair Cream 63 40.9 91 59.1
0.00
products2 Oil 30 68.2 14 31.8
Other 22 64.7 12 35.3
1 Other includes filtered tap water, ionic tap water, and purified water
2 Other includes heat protector, clay, hair growth products, fenugreek, egg, hair color, hair tonic, wax, spray, hair serum, conditioner, and dry
shampoo

Table 3. Correlation of self-reported dandruff and exposure to environmental factors (n = 717)


Self-reported dandruff
Environmental factors Yes No p value
No. % No. %
None 51 39.2 79 60.8
Exposure to
0–30 min/week 129 45.1 157 54.9 0.16
sunlight
30+ min/week 148 49.2 153 50.8
Job/studies Indoor 295 45.5 354 54.5
indoors or 0.63
outdoors Outdoor 33 48.5 35 51.5
Live in coast or Coast 96 40.9 139 59.1
0.07
inland Inland 232 48.1 250 51.9
Use Air Yes 307 48 332 52
conditioner when 0.00
indoor No 21 26.9 57 73.1
Cover head when Yes 123 43.8 158 56.2
0.39
outside No 205 47 231 53

Table 3 indicates the link between exposure minute exposure to sunlight per week
to sunlight and growth of dandruff. Those with numbered 129 (45.1% of the total in this
dandruff and no exposure to sunlight totaled 51 category). People who had dandruff and were
(39.2% of the total number of respondents with exposed to sunlight for more than 30 minutes
no exposure to sunlight). Individuals per week totaled 148. The p value was 0.16.
complaining of dandruff and having 0–30

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REZA UL KARIM, ET AL GMJ. ASM 2016;5(S2):S79–S86

People who studied or worked indoors and Our study showed that the prevalence of
complained of dandruff totaled 295 (45.5% of dandruff was more in males (52.6% affected by
the total number of respondents it) vis-à-vis females (41.6%). The results are in
working/studying indoors). People who worked sync with those of a study by Misery et al.,
outdoors and had dandruff numbered 33 where more males reported having dandruff
(48.5% of the total number of respondents who than females6.
studied or worked outdoors). This could be due According to our study, 56.3% of
to the size of the sample for the survey. The p participants who washed their hair less than
value was 0.63, which was insignificant. twice/week had dandruff, while 45.3% of
People who lived near the coast and respondents who washed their hair more than
complained of dandruff totaled 96 (40.9% of all twice/week had dandruff. The inference is in
respondents from coastal areas). This was far agreement with that of a study done by
less than those who lived inland and faced the Ravichandran et al., which states that increase in
same problem (232 or 48.1% of all respondents sebum levels aids pityrosporum ovale infection,
in this category). The p value was still which commonly results in dandruff15.
insignificant at 0.07. The data showed that 55.7% of participants
The link between exposure to air- who used shampoo less than four days/week
conditioned environment and dandruff can be had dandruff, while 33.4% of participants who
gauged from the following statistics. People shampooed more than four days/week had
with dandruff who were using the air dandruff. The results are in line with those of a
conditioner (AC) totaled 307 (48% of all study by Draelos et al., which shows that some
respondents using AC), considerably higher shampoos may contain an anti-dandruff
than those who did not use the AC. The p value chemical pyrithione zinc (1%)16.
was <0.001, the first significant value under Our results showed that 40.1% of subjects
environmental factors. who combed their hair less than seven
The number of individuals who had times/week had dandruff, while 56.1% of those
dandruff and covered their head outdoors was who combed their hair more than seven
123 (43.8% of all respondents who covered times/week had dandruff. This is in agreement
their head when outside). This was less than with a study done by Pierard-Franchimont et al.
those who did not cover their head outdoors that states hard brushing or over brushing may
and had dandruff (205 or 47% of all contribute to minimal chronic irritation to the
respondents who did not cover their head when scalp17.
outside). The p value for this was 0.39, which is The current study showed that 48.6% of
insignificant as well. subjects who used hair products had dandruff,
while 42.9% of subjects who did not use hair
DISCUSSION
products had dandruff. Our results are in line
Dandruff is multifactorial; it can be caused by with those of a study by Manuel et al. that states
fungal infection, underlying medical conditions, that hair styling products may irritate the scalp
age, sex, state of the hair (greasy or dry), and and could be a predisposing factor for
diet (malnutrition)2. dandruff18.
According to our survey, 53.3% of In our study, 56.8% of participants who
respondents who were more than 20 years old used mineral water to wash their hair had
were more prone to dandruff than those less dandruff, while only 45.7% of participants who
than 20 years (at 34.7%). Our results contradict used tap water had dandruff. This is in
with those of a study by Misery et al., which agreement with a study done by Malibu et al.,
showed that the prevalence of dandruff which states that mineral water has a higher
decreases with age6.

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PREVALENCE AND FACTORS ASSOCIATED WITH SELF-
REPORTED DANDRUFF IN UNIVERSITY STUDENTS GMJ. ASM 2016;5(S2):S79–S86

content of calcium that increases the risk of scalp hot and sweaty, thereby over-stimulating
dandruff19. the sebaceous glands21.
Our study showed that an increase in the
CONCLUSION
duration of exposure to sunlight resulted in an
increase in dandruff. This is in agreement with In our study, the proportion of participants
the studies of other authors who have shown suffering from dandruff was about 46% of the
that dandruff can be triggered by prolonged sample group. About 53.3% suffering from
exposure to sunlight, which can cause dandruff were over 20 years of age. In terms of
desquamation of the scalp12. On the other hand, prevalence, males were in majority (52.6%)
some authors have found that sunrays can kill compared to females (41.6%). The prevalence
the organism Malassezia, which has been shown of dandruff was the highest among participants
to play an important role in the pathogenesis of from Southeast Asia (60.1%). Most participants
dandruff15. who complained of dandruff also washed their
hair less than two times/week (p > 0.05), used
Our study showed that the
shampoo less than four days/week (p < 0.001),
percentage/proportion of people suffering
combed hair more than seven times/week (p <
from dandruff was lower among participants
0.001), used hair products (p > 0.05), had more
who did jobs or studies indoor compared to
than 30-minute exposure to sunlight per week
those who worked or studied outdoor. The
(p > 0.05), and did not cover their head when
reason is that working/studying outdoors leads
outside (p > 0.05).
to exposure to sunlight. Furthermore, the study
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