Dandruff

WHEN TO SEE YOUR DOCTOR

* You also have itchy red patches on your scalp.

What Your Symptom Is Telling You

The first flakes fluttering from the sky usually confirm that winter has arrived. Flakes falling from your head—dandruff—are usually a tip-off that an annoying yet common yeast called Pityrosporon ovale has set up a snow-making machine on your scalp.

There's no need to catch the next sleigh out of town, however. Pityrosporon lives on everyone. In about 20 percent of the population, the yeast inflames the skin of the scalp, which makes it shed and flake faster than normal—a condition doctors call seborrheic dermatitis. This condition turns the light dusting on your shoulder—which happens imperceptibly to everyone, everyday—into a whitish blizzard.

It may just be a cold day in you know where before doctors know what transforms this mild-mannered yeast into a dermatological demon. One theory suggests that the immune system, which normally guards your skin, stages a slowdown, allowing the freeloading yeast free reign.

"It might be that the immune response of the skin—the checks and balances, so to speak—for some reason suddenly allows the proliferation of bacteria and fungi on our skin, which may aggravate the dandruff," says Maria Hordinsky, M.D., associate professor of dermatology at the University of Minnesota in Minneapolis. Heredity may also play a role.

Skin conditions like psoriasis, characterized by bright red patches on elbows and knees, can also start with what seems to be a bad case of dandruff, says Jerome Shupack, M.D., professor of clinical dermatology at New York University Medical Center in New York City. These more severe types of dandruff should receive medical attention.

Symptom Relief

Once you've had dandruff, its return is as inevitable as fresh powder on your driveway after a day at the shovel.

There's simply no cure. But you can manage your scalp's flaking and itching by killing the yeast that causes it. "That's your whole goal," says Albert Kligman, M.D., Ph.D., professor of dermatology at the University of Pennsylvania in Philadelphia, who was once dubbed the King of Dandruff for his work in the field. "When you suppress that yeast, dandruff disappears."

If dandruff has your dander up, try these remedies.

Work yourself into a lather. If you're suffering from only a few errant flakes, just washing your hair more often (at least once a day) with a standard shampoo may be enough to do the trick, says Dr. Shupack.

Choose your weapon. If the flakes persist, it's time to move to a more aggressive treatment. Over-the-counter shampoos containing selenium sulfide are the best at battling dandruff, says Dr. Kligman. "It's great stuff—knocks the heck out of it in two to three weeks," he says. Next on Dr. Kligman's list: shampoos made with pyrithione zinc, coal tar and salicylic acid, in that order. "Coal tar and salicylic acid aren't as good because they're messy, they smell lousy and they just aren't as effective," he says.

Take turns with your treatment. "I've found that if you have people rotate their shampoos, they get an even better response," says Dr. Hordinsky. "When you shampoo on a daily basis with a particular shampoo, all of a sudden you perceive a plateau—the shampoo doesn't do any good any more." For best results, says Dr. Hordinsky, buy a couple different dandruff shampoos and use them in rotation.

Shampooing twice is nice. That line on the dandruff shampoo bottle urging you to lather your hair twice isn't just a line to get you to buy more shampoo, says Dr. Shupack. "Dandruff shampoo has two elements to it, the soap or detergent action to degrease the hair, and the medicinal quality delivered the second time around," he says. "You'd probably have a little better penetration of the medicine when you have a degreased scalp."

Subdue stress. "Certainly the three conditions that are the most common causes of dandruff are all known to be influenced by stress or aggravated by stress," says Dr. Shupack. "If you could reduce that, it would probably help."

Put some sunlight on the subject. If your hair is thinning and you have dandruff, some exposure to sun may help temper the yeast, says Dr. Shupack.

All's well with oil—when it's not too hot. "Applying oil to the scalp will often help loosen and dissolve dandruff. But oil, when it's too hot, can damage the hair shaft and cause breakage of the hair," says Dr. Shupack. Rather than buying a hot-oil treatment, simply put a few drops of olive oil on your scalp after shampooing at night, cover your head with a shower cap and shampoo again in the morning. "That's an excellent home remedy." he says.

Hunt down some hydrocortisone lotion. Available without a prescription, 1 percent hydrocortisone lotion helps relieve the inflammation that contributes to dandruff, says Dr. Shupack. The only drawback: Hydrocortisone can mask a serious fungal infection until treatment is stopped—allowing it to reappear with a vengeance, he says. Apply several drops after shampooing and work it into the scalp. A stronger hydrocortisone cream is also available by prescription; see your doctor.

Make your dandruff miserable—with Nizoral. This highly touted antifungal shampoo is available by prescription only, but it works well on stubborn cases, says Dr. Shupack. Ask your doctor.

See also Scalp Itching