Dandruff

by Valerie Gladstone — February 1, 2008

If dandruff is the only thing standing between you and a closet full of basic black, you're not alone. Many people have this chronic scalp disorder, which is marked by itching and excessive flaking of the scalp. Although dandruff isn't contagious and is rarely serious, it can be embarrassing and surprisingly persistent.

The good news is that dandruff can usually be controlled. Mild cases of dandruff may need nothing more than daily shampooing with a gentle cleanser. And stubborn flakes often respond to medicated shampoos. What's more, researchers have identified a yeast-like fungus that may cause or aggravate dandruff -- a discovery that may lead to better treatments.

Dandruff is a chronic condition that can almost always be controlled, but dandruff treatment may take a little patience and persistence. In general, mild scaling can often be helped by daily cleansing with a gentle shampoo to reduce oiliness and cell buildup. When regular shampoos fail, over-the-counter (OTC) dandruff shampoos may succeed. But dandruff shampoos aren't all alike, and you may need to experiment until you find one that works best for you. Dandruff shampoos are classified according to their active ingredient:

• Zinc pyrithione shampoos (Selsun Salon, Head & Shoulders) contain the antibacterial and antifungal agent zinc pyrithione, which has been shown to reduce the fungus that causes dandruff and seborrheic dermatitis.
• Tar-based shampoos (Neutrogena T/Gel) contain coal tar, a byproduct of the coal manufacturing process, which helps conditions such as dandruff, seborrheic dermatitis, and psoriasis by slowing cell turnover.
• Shampoos containing salicylic acid (Ionil T), "scalp scrubs," help eliminate scale, but they may leave your scalp dry, leading to more flaking. Using a conditioner after shampooing can help counter dryness.
• Selenium sulfide shampoos (Selsun Blue) help prevent cell turnover and may also reduce the number of malassezia. Because they can discolor blonde, gray, or chemically colored hair, be sure to use them only as directed and to rinse well after shampooing.
• Ketoconazole shampoos (Nizoral) are the newest addition to the dandruff fighter market. Ketoconazole is a broad-spectrum antifungal agent that may work when other shampoos fail. It's available OTC as well as by prescription.

Try using one of these shampoos daily until your dandruff is controlled, then cut back to two or three times a week. If one type of shampoo works for a time and then seems to lose its effectiveness, try alternating between two types of dandruff shampoos. Be sure to leave the shampoo on for at least five minutes -- this allows the ingredients time to work. If you've shampooed faithfully for several weeks and there's still a dusting of dandruff on your shoulders, talk to your doctor or dermatologist. You may need a prescription-strength shampoo or more aggressive treatment with a steroid lotion.

Complementary and Alternative Medicine
Daily shampooing with tea tree oil is another option. Tea tree oil, which is extracted from the leaves of the Australian tea tree, has been used for centuries as an antiseptic, antibiotic, and antifungal agent. It's now included in a number of shampoos found in natural foods stores. The oil is generally well tolerated but may cause allergic reactions in some people.