Managing Dandruff

How to Treat Those Flakes

By D. R. Thomas, MD, FRCPC

What is dandruff?

Pityriasis capitis is an excess of white scales or skin flakes on the scalp that itches. It is caused by a yeast that is normally present on the skin that combines with the secretions of the oil glands. When the yeast produces fatty acid, it causes irritation. Dandruff is common but can be embarrassing due to shedding on upper body clothing and the tendency to scratch. Read another article on dandruff on www.skincareguide.ca/articles/general_skin_care/dandruff.html

Treatment for dandruff

Usually dandruff can be treated by antiyeast shampoos available without a prescription at your pharmacy. These shampoos contain different medicinal ingredients that contain salicylic acid, coal tar, or antifungal properties. Many dandruff shampoos are now more pleasant to use. Recent developments in zinc pyrithione shampoos have made them especially effective. Apply daily until the condition is controlled, and then one to three times a week as needed.

Effective dandruff shampoos include:

• Head & Shoulders (antifungal)
• Selsun (antifungal)
• Nizoral (antifungal)
• Sebcur (salicylic acid)
• T-Gel (coal tar)

Severe dandruff

• between the eyebrows
• on the sides of the nose
• in and around the ears
• on the center of the chest
• on the upperback
• on opposing skin surfaces such as under armpits or breasts

The risk factors for seborrheic dermatits are:

• neurological conditions such as Parkinsonism or after strokes
• HIV-AIDS (with AIDS the condition can be more extensive and inflamed)
• antipsychotic drugs

Seborrheic dermatitis can be confused with other skin conditions such as:

• scalp psoriasis (Read more on www.psoriasisguide.ca/basics/types/scalp_psoriasis.htm)
• tinea capitis (http://www.fungalguide.ca/types/fungal_hair_infections.html )
• facial rosacea
• atopic dermatitis
• intertrigo
• erythrasma

Treatment for seborrheic dermatitis

Antiyeast shampoos can treat seborrheic dermatitis by application in the shower to the scalp, rubbing the lather onto the face and chest for 30-60 seconds and then washing off. If the condition does not improve by trying several over-the-counter treatments, consult your doctor. Creams or pills may be prescribed.

Recommended treatments are:

• ketoconazole cream or pills
• hydrocortisone cream
• lithium succinate ointment with 15% propylene glycol in water
• zinc pyrithione shampoo

If seborrheic dermatitis persists, the following may be prescribed:

• betamethasone valerate solutions (Betnovate)
• flucinonide gels
• clobetasone shampoo (Clobex)
• pimecrolimus cream (Elidel)
• tacrolimus ointment (Protopic)

If your dandruff is severe or uncontrollable with other the counter shampoos, it is best to see your doctor to get an accurate diagnosis.

About the author:

Richard Thomas, MD, FRCPC is Assistant Professor of Clinical Dermatology, Department of Dermatology, University of British Columbia, Vancouver, Canada.

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