Two Biggest Mistakes When Treating Dandruff

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A main cause of dandruff (seborrheic dermatitis) is thought to be an inflammatory immune reaction to an otherwise resident yeast that becomes overly represented on the skin.  The inflammation results in redness, itching, and flaking that we recognize as dandruff.

Mistake number 1

A common misconception is that the flaking skin of seborrheic dermatitis is a result of dryness rather than a result of inflammation. This leads patients to sometimes compensate by reducing the frequency of hair washing or by rubbing oils and conditioners into the scalp.   Unfortunately, this has the opposite of the intended effect by allowing conditions for yeast to flourish and therefore promoting the inflammation. Antifungal shampoos are useful to regulate the yeast population and therefore reduce in part the trigger for the skin inflammation. 

Mistake number 2

In an effort to reduce the appearance of the flaking scalp many people will vigorously scrub and scratch the scalp to remove the scaling and flaking skin on a regular basis..  This may improve the appearance of the scale on the short term but serves to perpetuate the process in the long term by greatly contributing to the inflammation which is ultimately the cause.  In addition, chronic rubbing or scratching will lead to thickening of the skin (lichenification) which can further delay resolution.

The best management for a mild seborrheic dermatitis (dandruff) is to incorporate an anti-dandruff shampoo into your normal routine a few days a week.  If you are not getting satisfactory improvement see a dermatologist for the additional of a topical steroid and to rule out other causes of your scalp condition.

Brent Goedjen