One of the most common complaints that appear in my dermatology clinic on a daily basis is complaints of an itchy, flaky scalp. Although there can be many causes for these complaints, far and above, the most common culprit is seborrheic dermatitis (also known as dandruff). Unfortunately, some patient’s have it and don’t bring it up, whether for fear of embarrassment or thinking it is not something that can be medically treated. Well let me tell you we can help!
What exactly is seborrheic dermatitis and can I get rid of it?
First things first, I will open with the biggest bummer- this is a CHRONIC condition. Now don’t loose all hope, seborrheic dermatitis can be controlled but it will never be “cured”. This condition affects approximately 5% of the global population.
We don’t entirely know why seborrheic dermatitis occurs in some people and not in others, but we believe it is a combination of overgrowth of a yeast called Malassezia, sebaceous gland overactivity and immune dysregulation. We all have the yeast Malassezia on our skin as part of our normal skin flora. However, for some people it grows in excess and our immune system triggers an inflammatory response to it, resulting in redness, flaking, greasy scale and sometimes scratching.
Although the scalp is the most common area affected, I also commonly see behind and inside the ears, eyebrows, the creases of the nose, beard area and V neck of the chest involved in clinic.
What can I try at home to manage it?
Seborrheic dermatitis is not a result of poor hygiene, but you may notice it getting worse the longer you go between hair washings. Therefore, increasing the frequency of hair washing can help decrease the yeast load, particularly after vigorous exercise or warm, humid summer months.
Utilizing over the counter dandruff shampoos that are made to target this condition can be very helpful. It’s important that you are rubbing these into the scalp and letting them sit for 5-10 minutes before washing them out so the active ingredients have a chance to work. Additionally, rotating shampoos with different active ingredients also have a benefit.
My favorite over the counter dandruff products
Hello Jupiter Shampoo, Conditioner & Serum *Use code 'DERMLIVING' for discount
- Active ingredient is Pyrithione Zinc.
- I love this brand because it smells fantastic and doesn’t leave your hair feeling dry after use, which can be a common complaint with traditional dandruff shampoos
- Active ingredient is Pyrithione Zinc.
- A great tried and true option available at any local pharmacy, CVS, Target, etc.
- Active ingredient is Ketoconazole 1%.
- The most common prescription for seborrheic dermatitis is Ketoconazole 2%, so it’s worth trying the over the counter version first if your symptoms are mild.
- Active ingredient is Salicylic Acid.
- This can be a great options if you also develop scalp acne, as it can help control both. I also like this option if you have an oily scalp or large flakes.
- Active ingredient is Selenium Sulfide.
- Another great over the counter option with a different active ingredient to add to your lineup.
Failed DIY? Time to see dermatology.
Although many over the counter products work for some people, a subset of the population can have more severe symptoms or it can be impacting their psychosocial activities out of embarrassment. In either of these cases or when it is not responding to treatment, it’s best to seek out a dermatology trained provider for additional evaluation and treatment. We have lots of tools in our toolbox to help get adequate control of this to help you live your best flake free life ;)
