There is a reason that you will see a long aisle-full of shampoos for dandruff at the grocery store. It is very common, chronic, not curable, and annoying! Dandruff (seborrheic dermatitis) is mostly just a nuisance but for some people the itch and the flaking can become a major problem. If you think you are experiencing something more than minor dandruff, a visit to the dermatologist can be really important in getting it under control. Seborrheic dermatitis can also occur on the face in the eyebrow hair, beard area, and creases of your nose. It is usually red with a greasy and flaky scale. A proper diagnosis is your first step because seborrheic dermatitis can look very similar to other conditions of the scalp such as fungal infections (tinea capitis) or psoriasis that would need different treatment and management.
Seborrheic dermatitis is caused by several factors that include your genetics, age, environment, stress levels and naturally occurring populations of skin yeast (Malassezia sounds like a tropical island but it is actually the name of the yeast on our skin). In babies, we call it "cradle cap" if on the scalp, however it can occur all over an infant's body and luckily it usually resolves after 3-6 months. In adults, it is considered a chronic and long-standing condition that will come and go, wax and wane, throughout our life. Therefore, a management strategy that includes treatment for flares AND for maintenance in the long-term is crucial to keep your scalp and face clear.
One pearl for patients dealing with seborrheic dermatitis on the scalp I will share with you. Anti-dandruff
shampoos (Head and Shoulders, Selsun Blue, etc) work best when lathered directly onto the scalp and left on for AT LEAST 5-10 minutes.
If you rinse it off 10-30 seconds after applying it, you can't expect it to do much. Rotating the shampoos every few weeks is also
crucial so you don't get resistant to a particular one. For example, use Head and Shoulders (with pyrithione zinc) at least 3 times
per week for about 2 weeks. Then switch to Nizoral (ketoconazole 1%) at the same frequency. If you are getting really thick plaques
up there, do a rotation of T-Sal (salicylic acid to break down the plaques). Rotate and Repeat. This little trick solves the problem
so many times I might have just saved you a copay! If this method doesn't work, or you have extensive facial involvement, you probably
need prescription-strength products so come on in and see me.