International Academy of Cosmetic Dermatology
The scale or scurf on the scalp that makes a blue blazer look like freshly fallen snow is better called dandruff. It represents epidermal cells that are being shed. When there is accompanying oiliness, the word seborrhea can be used. Dandruff may also be associated with seborrheic dermatitis, the redness and scaling that can occur on the scalp, between the eyebrows, around the nose, behind the ears, under the arms, on the chest, around the umbilicus, and in the groin.
Dandruff, like seborrheic dermatitis, can wax and wane. The Malassezia sp. yeast, also associated with tinea versicolor, probably causes this condition, too. When the scaling is more intense, even crusted or plaque-like, psoriasis should be considered.
Treatment consists of using a therapeutic shampoo every three to five days. The active ingredient in the shampoo can be selenium sulfide, coal tar, ketoconazole, salicylic acid, or zinc pyrithione. For the itching that sometimes occurs, the use of a topical corticosteroid can be helpful. What should not be used is a pomade or Vaseline-type preparation, as this will only aggravate the condition.
Contrary to popular belief, dandruff does not cause hair loss. Brushing and combing also do not affect dandruff, just as vitamins and herbal remedies will not stop the production of scurf.
Dandruff seems to disappear, eventually; however, that does not mean it should not be treated. It can be controlled but not necessarily eliminated.
Lawrence Charles Parish, MD, MD (Hon)
Philadelphia, PA, USA