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ASK THE DOCTOR: Itching for an answer to dandruff
By DR. JIM MITTERANDO
The Patriot Ledger

Q. What do you recommend to treat dandruff?

A. Everyone sheds dead skin cells from their face and scalp. When such flaking becomes excessive and appears on your hair or clothing, we call the condition dandruff.

Dandruff also can cause scaling or redness on the sides of the nose or eyebrows.
Like other skin problems, dandruff varies with the seasons - improving in summer and worsening in winter because of drier air and less ultraviolet exposure from the sun.

The fungus pityrosporum lives on everyone's skin, but in people prone to dandruff, it causes irritation, itching and increased shedding of dead skin cells. This shedding may occur every five days rsther than once a month in people without dandruff.

Shampooing frequently to wash away flakes before they build up is the first step to treating dandruff. But it is difficult to shampoo enough to keep up with this extra shedding and simply shampooing may not stop the irritation or itching.

Dandruff occurs in teenagers and adults but not in children. Parents sometimes treat their newborn's cradle cap - scaling of the scalp similar to dandruff - with dandruff shampoos if it does not respond to frequent shampooing.

Infants, though, usually outgrow cradle cap after several months. In adults, however, dandruff is chronic and cannot be cured, though it can be controlled with certain medicated shampoos and creams.

Surprisingly dandruff shampoos typically treat the excess shedding and scalp fungus rather than the dry, scaly skin. I recommend using a conditioner after rinsing the dandruff shampoo, because I find that dandruff treatments can further dry hair and the scalp.

I also recommend first trying a shampoo that contains selenium sulfide, such as Selsun Blue or Exsel. If this does not work after several weeks, then try the dandruff shampoos that contain pyritione zinc (such as Head & Shoulders or DHS Zinc) or salicyclic acid (such as X-Seb or Sebex).

"Medicated" dandruff shampoos often contain menthol, which causes tingling, giving the illusion that it is doing something helpful. But menthol really does not treat dandruff, except to briefly stop the itching.

For people who do not respond to two of these shampoos, I recommend using Nizoral A-D, the antifungal medicated shampoo that used to need a prescription but now is sold over-the-counter.

Shampooing tips:

  • Use dandruff shampoo two to three times per week.
  • Rub the dandruff shampoo into your hair thoroughly and give it time to work - at least five minutes.
  • You may need to rotate dandruff shampoos because they can lose their effectiveness over time.
  • For mild cases of dandruff, alternate dandruff shampoo with your regular shampoo.
If shampoo alone does not help, consult your doctor to make sure the problem is simply dandruff and not an-other skin problem, such as psoriasis.

For persistent or severe dandruff, your doctor may prescribe a steroid lotion to decrease the redness, itching or scaling. For people who have scaling on their face or eyebrows, I often prescribe Nizoral cream or a mild steroid cream, such as hydrocortisone.

I must emphasize that steroid creams and lotions are merely short-term solutions. Prolonged use of steroid creams can cause thinning of the skin. Dandruff shampoos are meant for long-term use to help control the underlying problem.

I rarely recommend coal tar dandruff shampoos (Denorex or Neutrogena T-Gel) because they smell badly and may discolor blond or gray hair. I use coal tar shampoos only when severe dandruff does not respond to other treatments.

Dr. Jim Mitterando is a family doctor at Health Care South/Cohasset Family Practice and a staff member at South Shore Hospital in Weymouth.

Readers should send questions to: Ask the Doctor, The Patriot Ledger, P.O. Box 699159, Quincy, MA 02269-9159, or by E-mail to his attention at features@ledger.com.

Questions of general interest will be answered in this column. The information in this column is not intended to diagnose individual conditions, and individual replies are not possible. Readers should see their own doctors about specific problems.

Copyright 2001 The Patriot Ledger
Transmitted May 15, 2001