Dandruff

Background

Dandruff is the shedding of dead skin cells from the scalp (normal), associated with itching scalp and visible skin flakes. In seborrhoeic dermatitis redness and itching frequently occurs around the folds of the nose and eyebrow areas, not just the scalp.

Cause

Although there may be other contributing factors, at its root dandruff is caused by a fungal infection. It may be just one of many manifestations of fungal infections in the body, including itchy ears, sinusitis, and irritable bowel syndrome. If these other symptoms are present, it may be worth considering body wide treatment as opposed to just topical (see Candida).

Treatments

The key to treatment is to use a shampoo that kills the fungal infection. Shampoos for this  include:

• Shampoos that contain selenium (e.g., Selsun Blue)
• Shampoos that contain zinc (e.g., Head and Shoulders)

Medications

By prescription:

• Nizoral (ketoconazole) shampoo. Though oral Nizoral may be pulled off the market because safer alternatives exist, the topical Nizoral is very safe and much more effective than over-the-counter shampoos.
• Diflucan 200 mg a day for six weeks. In severe cases, especially when other symptoms of fungal overgrowth are present, I may give this medication by mouth. See Candida for more information.