Dandruff

Question 1

What is dandruff?

Answer 1

Chronic, non-inflammatory scalp condition
Excessive scaling of the scalp, characterized by accelerated epidermal cell turnover (13-15 days)
It’s less severe during the summer

Question 2

At what age does dandruff present?

Answer 2

Uncommon in children
Generally appears during puberty (10-20 years old)
Less prominent after 75 years of age

Question 3

What are the risks/aggravating factors of dandruff?

Answer 3

Environmental (dry climate (winter months), extremes in weather)
Increased stress
Obesity
Inadequate hair washing
Possibly caused by the fungus Malassezia furfur

Question 4

What are the signs and symptoms of dandruff?

Answer 4

Dry, white or silver-grey flakes
Scaling from accumulation of flakes
Detached by combing of the hair (key differential between dandruff and lice)
Some itching
Usually symmetrical 
May be in patches but most often not

Question 5

What are the treatment goals of dandruff?

Answer 5

Reduce or eliminate flaking and associated symptoms
Minimize cosmetic embarrassment of visible flakes
Prevent recurrences

Question 6

What are non-pharmacologic treatment options?

Answer 6

Remove triggers/aggravating factor (avoid irritating soaps, gels, greasy creams, hair products, avoid excessive hot water, avoid or decrease exposure to cold, dry air, use a cool air humidifier, warm compresses to the area)
Wash hair with a general, non-medicated shampoo every other day or daily
Control stress

Question 7

What are pharmacological treatment options?

Answer 7

Initial treatment with an agent that reduces Malassezia is recommended (zinc pyrithione, selenium sulfide, or ketoconazole shampoo)
Second line treatments reduce scaling by decreasing epidermal turnover (keratolytic agents like salicylic acid, anti proliferative agents such as coal tar)

Question 8

What is important in terms of patient education?

Answer 8

Contact time is vitally important for effectiveness of medicated shampoos
Medicated shampoos need to be used only 2 to 4 times weekly until controlled (approximately 2 to 3 weeks) then reduce to once a week or every other week to maintain control of dandruff

Question 9

What are examples of OTC products available?

Answer 9

Zinc pyrithione (Head and Shoulders, Pantene anti-dandruff)
Selenium sulfide (Selsun, Selsun Blue, Head and Shoulders Clinical Strength)
Ketoconazole (Nizoral shampoo)
Salicylic acid (Sebcur, Selsun Blue Deep Cleaning)
Coal tar (Neutrogena T-gel, Denorex, PolyTar, Sebcur/T)

Question 10

Compare the efficacy of the OTC products

Answer 10

Ketoconazole and Hydrocortisone are better than selenium sulfide, which is better than zinc pyrithione, which is better than coal tar

Question 11

What are prescription products available?

Answer 11

Antifungal (Ciclopirox): Stieprox - used 2-3 times a week, used for prophylaxis or treatment

Question 12

What are the monitoring parameters?

Answer 12

Scaling (monitor daily for improvement within 7 to 10 days)
Redness (monitor daily for improvement within 8 to 12 weeks)
Thickness of plaque (Monitor daily for improvement within 6 to 8 weeks)
Itching (Monitor for improvement within 1 to 2 weeks)