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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REZA UL KARIM, ET AL
as much as half the global population affected
by dandruff at some point of time in life3.
Factors Causing Dandruff
Age: The incidence and severity decrease after
the age of 204. A survey conducted by the
Council Survey Analysis (CSA) Health poll
institute covering 1,703 French people aged 15–
65 years indicated that the prevalence of
dandruff decreased with age5.
Gender: Dandruff is more prevalent among
males than females. In a study done by Misery et
al., the prevalence among male participants was
20.7% compared to 12.8% in females6.
Racial factor: A recent study conducted on
1,408 people of three ethnicities (Caucasians,
African Americans and Chinese) showed that
most of the African Americans had dandruff,
while prevalence was the lowest among the
Chinese7.
Medical history: The risk of having dandruff is
high in certain medical conditions (for example,
skin conditions such as eczema, psoriasis and
SD, and systemic diseases like diabetes8, 9).
Environmental factors: People living in humid
areas suffer more from dandruff than those in
dry areas. A study conducted in the northern
and southern parts of India indicated low
prevalence in the northern area, which is dry,
compared to the southern area, which is highly
humid10. Excessive exposure to sunlight as well
as contact with dirt and dust can have an impact
on the occurrence of dandruff11, 12.
Lifestyle: Lack of hygiene or excessive hygiene
could aggravate dandruff (for example, repeated
combing, over-shampooing or over-utilization
of hair products, etc.13). People not doing
physical exercises are more prone to having
dandruff than those doing exercises regularly14.
Individuals with high stress levels have a greater
chance of getting dandruff than those who are
more relaxed by nature.
Rationale
1. Limited availability of information related
to the epidemiology of this problem in
the UAE
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GMJ. ASM 2016;5(S2):S79–S86
2. Identifying the psychological impact of
dandruff
3. Providing information that can be used in
planning educational sessions according
to the need of the target population
4. Increasing awareness about dandruff
Objectives
Primary objective: To determine the prevalence
of self-reported dandruff cases among adults in
Gulf Medical University, Ajman, UAE
Secondary objective: To determine the link
between self-reported dandruff and:
a) Socio-demographic factors
b) Personal hygiene
c) Environmental factors
MATERIALS & METHODS
Research Design
This population-based study followed a cross-
sectional design.
Study Population
The sample included undergraduate students,
staff and faculty members from Gulf Medical
University, Ajman, UAE. Convenience
sampling was used to gather data. Male and
female participants aged 18–65 years, and were
of varied nationalities. The student group
included first, second and third year
undergraduates of BBMS, BHS, BPT, DMD,
MBBS and Pharm D programs. People who did
not consent to being a part of our study and
were not accessible at the time of the survey
were excluded.
Study Instrument & Validation Procedure
Data was collected using a self-administered
questionnaire, which was prepared after an
extensive review of literature.
The questionnaire had six parts:
 Socio-demographic details of
participants: Age, gender, nationality,
residence in emirate, occupation, course
and year of study (if student)
 Medical history and details of self-
reported dandruff
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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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
self-reported dandruff and hair hygiene. The
frequency of wash was 56.3% among
participants who washed their hair less than
twice a week and had dandruff. This result was
not significant with a p value of 0.22. The type
of water used was also not a major factor, with
a p value of 0.18. Of the individuals using tap
water, 45.7% had dandruff; of those using
mineral water, 56.8% had dandruff, while
among those using other types of water, 35.1%
had dandruff. The p value was 0.00 for usage of
anti-dandruff shampoo and the practice of
combing hair. Nearly 55% of those using anti-
dandruff shampoo had dandruff, while 56.1%
of those who combed their hair seven times or
more a week had dandruff. About 48.6% of
those who said ‘yes’ to using hair products had
dandruff, although the p value was 0.13 and
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
to sunlight and growth of dandruff. Those with
dandruff and no exposure to sunlight totaled 51
(39.2% of the total number of respondents with
no exposure to sunlight). Individuals
complaining of dandruff and having 0–30
minute exposure to sunlight per week
numbered 129 (45.1% of the total in this
category). People who had dandruff and were
exposed to sunlight for more than 30 minutes
per week totaled 148. The p value was 0.16.

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REZA UL KARIM, ET AL
People who studied or worked indoors and
complained of dandruff totaled 295 (45.5% of
the total number of respondents
working/studying indoors). People who worked
outdoors and had dandruff numbered 33
(48.5% of the total number of respondents who
studied or worked outdoors). This could be due
to the size of the sample for the survey. The p
value was 0.63, which was insignificant.
People who lived near the coast and
complained of dandruff totaled 96 (40.9% of all
respondents from coastal areas). This was far
less than those who lived inland and faced the
same problem (232 or 48.1% of all respondents
in this category). The p value was still
insignificant at 0.07.
The link between exposure to air-
conditioned environment and dandruff can be
gauged from the following statistics. People
with dandruff who were using the air
conditioner (AC) totaled 307 (48% of all
respondents using AC), considerably higher
than those who did not use the AC. The p value
was <0.001, the first significant value under
environmental factors.
The number of individuals who had
dandruff and covered their head outdoors was
123 (43.8% of all respondents who covered
their head when outside). This was less than
those who did not cover their head outdoors
and had dandruff (205 or 47% of all
respondents who did not cover their head when
outside). The p value for this was 0.39, which is
insignificant as well.
DISCUSSION
Dandruff is multifactorial; it can be caused by
fungal infection, underlying medical conditions,
age, sex, state of the hair (greasy or dry), and
diet (malnutrition)2.
According to our survey, 53.3% of
respondents who were more than 20 years old
were more prone to dandruff than those less
than 20 years (at 34.7%). Our results contradict
with those of a study by Misery et al., which
showed that the prevalence of dandruff
decreases with age6.
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GMJ. ASM 2016;5(S2):S79–S86
Our study showed that the prevalence of
dandruff was more in males (52.6% affected by
it) vis-à-vis females (41.6%). The results are in
sync with those of a study by Misery et al.,
where more males reported having dandruff
than females6.
According to our study, 56.3% of
participants who washed their hair less than
twice/week had dandruff, while 45.3% of
respondents who washed their hair more than
twice/week had dandruff. The inference is in
agreement with that of a study done by
Ravichandran et al., which states that increase in
sebum levels aids pityrosporum ovale infection,
which commonly results in dandruff15.
The data showed that 55.7% of participants
who used shampoo less than four days/week
had dandruff, while 33.4% of participants who
shampooed more than four days/week had
dandruff. The results are in line with those of a
study by Draelos et al., which shows that some
shampoos may contain an anti-dandruff
chemical pyrithione zinc (1%)16.
Our results showed that 40.1% of subjects
who combed their hair less than seven
times/week had dandruff, while 56.1% of those
who combed their hair more than seven
times/week had dandruff. This is in agreement
with a study done by Pierard-Franchimont et al.
that states hard brushing or over brushing may
contribute to minimal chronic irritation to the
scalp17.
The current study showed that 48.6% of
subjects who used hair products had dandruff,
while 42.9% of subjects who did not use hair
products had dandruff. Our results are in line
with those of a study by Manuel et al. that states
that hair styling products may irritate the scalp
and could be a predisposing factor for
dandruff18.
In our study, 56.8% of participants who
used mineral water to wash their hair had
dandruff, while only 45.7% of participants who
used tap water had dandruff. This is in
agreement with a study done by Malibu et al.,
which states that mineral water has a higher
PREVALENCE AND FACTORS ASSOCIATED WITH SELF-
REPORTED DANDRUFF IN UNIVERSITY STUDENTS
content of calcium that increases the risk of
dandruff19.
Our study showed that an increase in the
duration of exposure to sunlight resulted in an
increase in dandruff. This is in agreement with
the studies of other authors who have shown
that dandruff can be triggered by prolonged
exposure to sunlight, which can cause
desquamation of the scalp12. On the other hand,
some authors have found that sunrays can kill
the organism Malassezia, which has been shown
to play an important role in the pathogenesis of
dandruff15.
Our study showed that the
percentage/proportion of people suffering
from dandruff was lower among participants
who did jobs or studies indoor compared to
those who worked or studied outdoor. The
reason is that working/studying outdoors leads
to exposure to sunlight. Furthermore, the study
showed that the prevalence of dandruff was
more among those working for longer hours
under the sun compared to those working for
lesser hours in sunlight.
Our study showed that living on the coast
has a lower correlation with the prevalence of
dandruff as compared to living inland. This is in
contrast with the results of another study
conducted in India that covered two specific
areas: Northern India, where humidity is low;
and Southern India, where humidity is high
throughout the year10, 20. Prevalence of dandruff
was found to be higher in Southern India.
Participants who reported using AC when
indoors had a significantly higher prevalence of
dandruff than those who did not use AC. The
condition may fluctuate depending on seasons,
often worsening in winter17. As AC cools the air
and makes it dry air, creating winter-like
conditions, the chances of dandruff increase.
In this study, we found out that among the
participants who had dandruff, a higher number
did not cover their head when outside
compared to those who covered their head.
This is an unexpected finding compared to a
research done by Rucker et al. (2011), which
mentions that covering the head makes the
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scalp hot and sweaty, thereby over-stimulating
the sebaceous glands21.
CONCLUSION
In our study, the proportion of participants
suffering from dandruff was about 46% of the
sample group. About 53.3% suffering from
dandruff were over 20 years of age. In terms of
prevalence, males were in majority (52.6%)
compared to females (41.6%). The prevalence
of dandruff was the highest among participants
from Southeast Asia (60.1%). Most participants
who complained of dandruff also washed their
hair less than two times/week (p > 0.05), used
shampoo less than four days/week (p < 0.001),
combed hair more than seven times/week (p <
0.001), used hair products (p > 0.05), had more
than 30-minute exposure to sunlight per week
(p > 0.05), and did not cover their head when
outside (p > 0.05).
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