Treating Seborrheic Dermatitis (dandruff)

Seborrheic dermatitis (dandruff) is a skin condition that causes itching, redness and/or scaling of skin of the scalp, ears, face, and less commonly other areas. It can occur in people of all ages, starting with infants, in whom it commonly presents as cradle cap. The name, seborrheic (oily) dermatitis (inflamed skin), captures one of the more interesting conundrums of dandruff.

Although dandruff often presents with scaling, which most people associate with dryness, this disease tends to occur on more oily areas of the skin. Basically there is a family of yeasts, genus Malassezia, that overgrow on oily areas. Their presence in abundance triggers inflammation, which leads to the redness, scaling, and itching.

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What are the treatments for dandruff?

  • Remove oil

    Shampooing the scalp and washing the skin literally removes oil and leads to a less hospitable environment for the yeast. When possible, most people clear easier if they can shampoo their hair / scalp daily.
  • Treat the yeast

    Most dandruff shampoos are anti-fungal in their mechanism of action (for example, pyrithione zinc, selenium sulfide, and ketoconazole). People usually clear and then maintain clearance longer when they use two different shampoos with different active ingredients, and mix it up (prevent antimicrobial resistance and keep the yeast on its toes!).
  • Treat the inflammation

    Once dandruff has progressed to a highly inflammatory state, people usually respond much better when topical steroids are used for a short period of time. After clearance, less frequent use of shampoos and/or antifungal agents are usually enough to keep the disease from coming back.

Individual results may vary.

Medical Dermatology