More Severe Dandruff Problems?

What do you do if you have dandruff but suspect your problem may be a more severe disorder like seborrheic dermatitis?

"If you have mild scaling, you can usually take care of it with an OTC dandruff shampoo containing salicylic acid," Bark advises. "Use it for several weeks, and if you don't see a clear-cut improvement in the scaling, consult a dermatologist. A dermatologist can diagnose whether you have a fungus infection of the scalp, seborrheic dermatitis, or some other disorder."

A form of seborrheic dermatitis that sometimes alarms new parents is known as "cradle cap." The scaly scalp inflammation is common in newborn babies, although it can occur anytime in infancy. Rubbing warm olive or mineral oil into the baby's scalp and leaving it on overnight can loosen and soften scales, which can be washed off the next day with a mild shampoo. It usually clears up quickly and does not recur.

Psoriasis

Psoriasis is an inflammatory skin disease in which skin cells replicate at a rapid rate. Although the symptoms of psoriasis--silvery scales covering reddened areas of the scalp--seem similar to dandruff, psoriasis is very different. New skin cells are produced about 10 times faster than normal, but the rate at which old cells are shed is unchanged. Live cells then accumulate and form the thick patches covered with flaking skin.

The scales are heaped-up, and the disorder may involve other areas of the body besides the scalp, most commonly the knees, elbows, back, or buttocks. It can also affect legs, arms, and just about any other part of the body. Psoriasis can be chronic or it may have periods of flare-ups and remission periods.

Psoriasis is annoying mainly because of its tendency to return again and again, and because of its unsightly, blotchy appearance. It is more common in whites than in blacks and Asians.

If you think you may have psoriasis, consult a doctor about treatment.

Coal Tar

Coal tar, one ingredient in OTC dandruff products, is a byproduct of treated bituminous coal. In constant exposure to concentrated solutions in industrial settings over long periods (20 to 25 years), coal tar has been associated with skin cancer. But coal-tar products are considered safe for topical use in shampoos
because contact with the scalp is only for a short duration.

For body seborrheic dermatitis and psoriasis, however, products containing coal tar remain on the skin for longer periods. There are no well-defined, long-term studies that demonstrate how long coal-tar products can be used safely. FDA has noted that prolonged use of such products may not be completely risk free due to possible cancer-causing effects.

Coal tar also produces photosensitivity reactions (reactions that occur with exposure to sunlight). Residual amounts of coal tar may remain on the scalp, hair, or surrounding areas after using. So if you're going out in the sun after shampooing with these products, you may want to take extra precautions.

FDA requires OTC dandruff products that contain coal tar to state on their labels, "Do not use for prolonged periods without consulting a doctor. Use caution in exposing skin to sunlight after applying this product. It may increase your tendency to sunburn for up to 24 hours after application."

Coal-tar shampoos also tend to give an orange tinge to light-colored hair.

Dave Bostwick, a reviewer in FDA's division of anti-infective drugs, Office of Drug Evaluation II, says one alternative to using OTC products to control dandruff is  mechanical.

"Washing your hair more often means you remove dandruff flakes that otherwise would remain on the head," he says.

Other than washing your hair more frequently, there is really no way to control dandruff without treatment. So if you find you're flakier than you'd like to be, OTC drug products may solve your problem.

OTC Dandruff Treatments

In 1990, the U.S. Food and Drug Administration (FDA) banned 27 ingredients in dandruff shampoos because they were not proven safe and effective. Today dandruff can be treated with over-the-counter drug products containing the six ingredients FDA has verified as safe and effective: salicylic acid, pyrithione zinc, sulfur, selenium sulfide, coal tar and ketoconazole. FDA allows drug products to be sold without a prescription if they are safe for consumer use without a doctor's supervision and provide adequate detailed information for use on their labels.

Approved OTC ingredients for dandruff treatment are available in shampoos, rinses, or in products that users apply and leave on the scalp. Each works in different ways to control dandruff symptoms like scaling or itching.

Ketoconazole, once only available by prescription, was approved in 1997 by the FDA for sale over-the-counter in the form of Nizoral A-D shampoo. This medication can be used for particularly difficult cases to attack the Malassezia fungus that is the cause of most dandruff.

According to Ida I. Yoder, "a drug is intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease, or intended to affect the structure or function of the body," says Yoder. Shampoos classified as cosmetics cannot make such medical claims. They are marketed for cleansing, beautifying, or promoting attractiveness.

If a product only claims to wash off dandruff flakes, it could be considered a cosmetic, Yoder says. But if it claims to prevent or treat the condition, it's considered a drug.

Some brands of antifungal shampoo to try include, in alphabetical order: Denorex, DHS Targel, ionil-T plus, MG217, Neutrogena T/Gel, Nizoral, Scalpicin, Sebulex, Selsun Blue, Tegrin, and Zircon.