If, after using dandruff shampoo for several weeks, you are still having flaking and itching, see a dermatologist for an evaluation. Prescription dandruff shampoo, delivered. While medicated dandruff shampoos are the most effective treatments for your dandruff, there are other home remedies that you can try however, these have not been as well studied as the shampoos.
Some things you can do to decrease your risk of having those annoying white flakes include:. Last updated March 1, Written by Chimene Richa, MD. Disclaimer If you have any medical questions or concerns, please talk to your healthcare provider. Vitals Dandruff is a skin condition that causes a dry scalp, itching, and flaking. Approximately 50 million Americans have dandruff. The best dandruff shampoos are therapeutic shampoos that contain one or more of the following ingredients: salicylic acid, sulfur, zinc pyrithione pyrithione zinc , coal tar, selenium sulfide, and ketoconazole.
Other, less well-studied remedies include managing stress, essential oils like tea tree oil , and sunlight. Learn more. Related articles. Dandruff vs. Dandruff—what you need to know about a common condition 5 minute read. Advertising revenue supports our not-for-profit mission. This content does not have an English version. This content does not have an Arabic version. Diagnosis A doctor can often diagnose dandruff simply by looking at your hair and scalp.
Treatment The itching and flaking of dandruff can almost always be controlled. Request an Appointment at Mayo Clinic. Share on: Facebook Twitter. Show references Borda LJ, et al. Seborrheic dermatitis and dandruff: A comprehensive review.
Journal of Clinical and Investigative Dermatology. Dandruff: How to treat. American Academy of Dermatology. Accessed July 12, Tea tree oil. Natural Medicines Database. Accessed June 7, Sasseville D. Seborrheic dermatitis in adolescents and adults. Kermott CA, et al. Time; American Osteopathic College of Dermatology. Kang S, et al. Cosmeceuticals and skin care in dermatology. Montvale, N. Cost to the patient may be greater.
Many cases of seborrheic dermatitis are effectively treated by shampooing daily or every other day with antidandruff shampoos containing 2. Alternatively, ketoconazole shampoo may be used. A moisturizing shampoo may be used afterward to prevent dessication of the hair. After the disease is under control, the frequency of shampooing with medicated shampoos may be decreased to twice weekly or as needed. Topical terbinafine solution, 1 percent, has also been shown to be effective in the treatment of scalp seborrhea.
If the scalp is covered with diffuse, dense scale, the scale may first be removed by applying warm mineral oil or olive oil to the scalp and washing several hours later with a detergent such as a dishwashing liquid or a tar shampoo. Extensive scale with associated inflammation may be treated by moistening the scalp and then applying fluocinolone acetonide, 0. This treatment may be done nightly until the inflammation clears and then decreased to one to three times weekly as needed.
Topical corticosteroid solutions, lotions or ointments may be used once or twice daily for one to three weeks in place of the overnight application of fluocinolone acetonide and may be stopped when itching and erythema disappear. Corticosteroid application may be repeated daily for one to three weeks until itching and erythema disappear, and then used as needed. Maintenance with an antidandruff shampoo may then be adequate. Patients should be advised to use potent topical steroids sparingly because excessive use may lead to atrophy of the skin and telangiectasis.
Involvement may be extensive, but this disorder frequently clears spontaneously by six to 12 months of age and does not recur until the onset of puberty.
A scaly scalp in a prepubertal child is usually caused by tinea capitis, not seborrheic dermatitis. Therapy for infantile seborrheic dermatitis includes frequent shampooing with an antidandruff shampoo. If scale is extensive in the scalp, the scale may be softened with oil, gently brushed free with a baby hairbrush and then washed clear. Daily shampooing may not be reasonable for some populations, such as black persons or persons who are institutionalized. In general, weekly shampooing is recommended for black persons.
As a substitute for daily washing, fluocinolone acetonide, 0. Other options include application of a moderate- to mid-potency topical corticosteroid in an ointment base. As with other modes of therapy, these agents are used every day or twice daily until the condition improves. Thereafter, topical corticosteroids are used as needed to keep the condition under control.
After initial control is attained, fluocinolone acetonide, 0. Involved areas of the face may be washed frequently with shampoos that are effective against seborrhea as detailed above. Alternatively, ketoconazole cream, 2 percent, may be applied once or twice daily to affected areas.
Often, 1 percent hydrocortisone cream will be added once or twice daily to affected areas and will aid with resolution of erythema and itching. Sodium sulfacetamide, 10 percent lotion, is also an effective topical agent for seborrheic dermatitis.
Seborrhea of the trunk may be treated with frequent application of zinc or coal tar containing shampoos or by washing with zinc soaps. Benzoyl peroxide washes are also helpful in controlling seborrhea of the trunk. Patients should be cautioned to rinse thoroughly after application of these agents as they will bleach clothing and bed linens. These agents may be drying, and the patient may benefit from application of a moisturizer after treatment.
An occasional patient with severe seborrhea that is unresponsive to the usual topical therapy may be a candidate for isotretinoin therapy. Isotretinoin also has anti-inflammatory properties.
Treatment with daily doses of isotretinoin as low as 0. Thereafter, a dose as low as 5 to 10 mg per day may be effective as maintenance therapy over several years. However, isotretinoin has potentially serious side effects and few patients with seborrhea are appropriate candidates for therapy. The most devastating side effect is teratogenicity, but other serious side effects include hyperlipidemia, neutropenia, anemia and hepatitis. Mucocutaneous adverse effects include cheilitis, xerosis, conjunctivitis, urethritis and hair loss.
Long-term use has been associated with the development of diffuse idiopathic skeletal hyperostosis DISH. This agent must be used cautiously and only by physicians who are well versed in all of its adverse effects. A more practical approach to the refractory patient may be to first try different combinations of the usual agents: a dandruff shampoo, an antifungal agent and a topical steroid. Therapeutic choices for pulse therapy may include a nonfluorinated class III steroid such as mometasone furoate Elocon or an extra-potent class I or class II topical steroid such as clobetasol propionate Temovate or fluocinonide Lidex.
The class III topical steroid should be tried first, but if the condition remains unresponsive, the clinician may then choose to use a class I agent. These more potent agents may be applied once or twice per day, even on the face, but must be stopped after two weeks because of the increased frequency of side effects.
If the patient responds before the two-week limit, the agent should be stopped immediately. Most corticosteroids are available as solutions, lotions, creams and ointments. Which vehicle to use is often determined by the patient and the treatment site. Lotions and creams are frequently used on all areas of the face and body, whereas solutions and ointments are more commonly used on the scalp.
In general, application of a scalp solution is preferred by white and Asian patients but may be too drying for black patients. Ointments may be a better option. The vehicle affects the potency of a topical steroid. In most circumstances, the same steroid in an ointment is more potent than the steroid in a cream, which, in turn, is more potent than the same chemical in a lotion. Patients should be referred to a dermatologist if the diagnosis is in doubt or if they are not responding to treatment.
Seborrhea may be difficult to distinguish from atopic dermatitis, psoriasis, rosacea or superficial fungal infections. Chronic treatment with topical corticosteroids may lead to permanent skin changes, such as atrophy and telangiectasia. The explosive onset of seborrheic dermatitis in a young patient should give rise to consideration of underlying human immunodeficiency virus infection. One should consider referral to a dermatologist for patients with severe seborrhea in whom treatment with oral isotretinoin is contemplated, particularly if long-term therapy will likely be required.
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