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What is dandruff?
Dandruff is a term that generally applies to a constellation of flaking and itching of the scalp along with
dryness and greasiness. The irony for many of my patients is the presence of both oiliness and dryness simultaneously.
These symptoms are most commonly associated with a medical diagnosis of Seborrheic Dermatitis. There can also be some overlap, in some cases, with Psoriasis lending to the term Sebopsoriasis. Seborrhea is not completely understood but thought to be the result inflammation triggered by the presence of of Malassezia yeast (previously referred to as Pityrosporum).
How to deal with seasonal dandruff/psoriasis.
Dandruff can have a significant seasonal tendency for many people. I advise my patients that the most important step they can take is to anticipate it. We know that dandruff will generally flare in Fall and Spring. Knowing this, plan to start preventative approaches 4 weeks in advance. Dandruff shampoos cannot always actively treat dandruff once it flares but are actually very good at preventing it. Start thinking dandruff shampoos as early as August and February to be one step ahead.
Dandruff can be managed with a number of topical options found over the counter.
Remember that there are two main components to dandruff :
There are some ingredients that address one the other or both.
Below are the most common ingredients to consider. Remember that dandruff is truly an inflammatory process that leads to itching and flaking. If it does not respond to these over the counter ingredients it is worth seeing your dermatologist to confirm the diagnosis as dandruff (seborrhea) and not psoriasis.
Coconut oil is gaining a lot of attention in skin care products. It is a proven emollient that can effectively hydrate the skin. It also has antimicrobrial and anti inflammatory properties. These can beneficial for dry flaky scalps to help hydrate and improve scaling or flaking to the scalp.
I don’t think a day goes by where a patient doesn’t tell me that they used apple cider vinegar to treat something! ACV has anti yeast properties and has been used to even treat diaper rash. Seborrheic dermatitis is thought to be related to yeast that overgrows on our skin. It can often be added to scalp exfoliators to help address the underlying yeast that triggers inflammation resulting in scaling.
Tea tree oil
Tea tree oil has become one of the most common ingredients to find in skin care products. It is known for its antimicrobial and antiseptic properties in its activity against bacteria, viruses, fungus, mites, etc. When added to scalp exfoliators it is likely addressing some of the underlying triggers for scalp inflammation that result in scaling and itching. The only caution is that it does have about a 1-2% chance of causing a contact dermatitis in those that use it. If using a product that has tea tree oil and your itching and flaking is getting worse, it’s important to take a look at your products and make sure they are not making it worse!
Salicylic acid breaks apart superficial skin cells to help remove dead skin cells from the surface. It is used in acne medications but can also be found in higher concentrations in wart treatments. It can be effective without being too irritating. In scalp products it can help remove excess dry skin and scale. Under topical therapies we have topical steroids as the most effective with or without a vitamin D analogue topical called calcipotriene and with or without a peanut oil extract to help loosen scale. Benefit here is mostly for isolated lesions to help control the flaking and itching. If there’s lots of flaking we can also add in a salicylic acid containing topical to help resolve the flaking. For those that struggle to apply these or feel like they just are not effective enough, we can supplement with intralesional injections of steroids locally in the skin to speed up resolution. I do remind people that there tends to be a strong stress correlation to flares and it’s important to know this to help control symptoms too!)
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Selenium sulfide containing shampoos are beneficial as selenium sulfide has been shown to be both antimicrobial and an effective treatment for hyperkeratosis or thickening of the skin. By addressing the buildup and the yeast and bacteria that contribute to scalp acne, this is a safe and effective approach to this common problem.
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Shampoos containing zinc pyrithione are effective as this ingredient has had proven antimicrobial qualities. Studies have shown that it inhibits the growth of yeast.
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Coal tar is an agent that can help with itching and calm the skin as well.
Given the role of
Malassezia yeast and associated inflammation, the use of an anti-yeast product such as Ketoconazole can be beneficial. The 1% concentration is over the counter whereas the 2% is considered prescription. This is not to be confused with the oral version of Ketoconazole which is generally not intended for the purpose of treating seborrhea.