By Dr. Anita Grassi
Dandruff is a common condition characterized by increased flaking of skin on the scalp. It may be itchy and unsightly with visible accumulation of scale on the hair and clothing but is otherwise medically harmless. It may worsen with cold, dry weather and stress. Men are often affected more than women.
Dandruff represents a mild form of seborrheic dermatitis, an inflammatory skin condition that produces both scaling and annular red patches. Most dermatologists will use the term seborrheic dermatitis for the diagnosis. While dandruff is confined to the scalp, more widespread forms of seborrheic dermatitis can affect the eyebrows, beard, and groin, as well as oily areas of skin including the central face, ears, and chest. In infants, the thick matted scaling of seborrheic dermatitis on the scalp is known as cradle cap.
The cause of seborrheic dermatitis in all its forms is not known but the combination of sebum production and yeast colonization seems to play a role. Seborrheic dermatitis is worse in areas of skin with high sebaceous or oil gland activity especially on the scalp, face, and chest. Yeast, specifically Malassezia species, that normally live on skin degrade the sebum to free fatty acids, which in turn promote skin cell shedding and inflammation.
Treatments therefore are directed towards reduction of oil production, cell turnover and yeast. Patients with certain neurological disorders such as Parkinson’s and immunodeficiency diseases including HIV are also at increased risk for seborrheic dermatitis.
Although there is no cure, effective treatments are available to control the flaking and itch.
Consider the following steps:
• Wash hair daily or every other day if possible. Infrequent shampooing can lead to build up of scale and worsening itch.
• Try a medicated shampoo. Anti-dandruff shampoos containing active ingredients such as salicylic acid (e.g., Neutrogena T/Sal), pyrithione zinc (e.g., Vanicream 2% zinc), selenium sulfide (e.g., some Selsun products) or tar (e.g., Neutrogena T/Gel) will help to relieve symptoms. They can be alternated with your regular shampoo. If one ingredient does not work then try another. Be aware that tar-based products can discolor blond or white hair.
• Ketoconazole 1% shampoo is an over-the counter antifungal agent which targets the yeast species that promote dandruff.
• If you still see no improvement, then you may have a more stubborn case of seborrheic dermatitis that requires prescription medications to clear. Stronger antifungal agents or anti-inflammatory topical steroids are available through your doctor. These medications include both shampoos as well as solutions and foams that are left on the scalp overnight.
Remember that seborrheic dermatitis is chronic and recurrent so realistic treatment goals are aimed at management rather than cure. If you are struggling with a flaky scalp, consult your dermatologist about a regimen that works best for you.
DR. ANITA GRASSI
Board Certified Dermatolgist
Dr. Anita Grassi is a board-certified dermatologist who joins Skin Wellness Physicians after a long career in both academic and private practice in the Boston area. She spent 30 years in practice at the Dermatology Laser and Cosmetic Center at xpert for Massachusetts General Hospital in Boston, MA, where she gained experience in cutting-edge laser treatments of skin disorders. She also served on the faculty of Harvard Medical School as an assistant professor and was instrumental in training many residents and fellows in medical dermatology, laser, and cosmetic procedures. Furthermore, she co-founded a private practice in Watertown, MA, bringing the same level of skillful dermatologic care into the community setting.
DR. ANITA GRASSI
239.732.0044
www.SkinWellnessFlorida.com