Dandruff - Not Lethal But Loathsome

Last Editorial Review: 6/13/1999

Nobody ever died of dandruff, but that's a small consolation if you spy those awful white flakes sprinkled on your jacket or dress!

What is dandruff? It's a mild skin condition that some people have and others don't.

"We're shedding skin all the time. In most people this shedding isn't visible. In some people it is and we don't know exactly why," said Daniel Berg, MD, Associate Professor of Dermatology at the University of Washington.

In some people, the sebaceous glands overwork which can cause a lot of dandruff flakes. (The sebaceous glands keep the skin properly oiled.)

Another cause of dandruff can be fungus, especially Pitrosporum ovale. Most people have this fungus, but people with dandruff have more.

What can you do about dandruff? Tom Archer, who has a doctorate in Pharmacy from the University of Southern California, has some advice. At the first sign of dandruff, stop shopping at the supermarket for shampoo and purchase a good quality product. "Dry skin is one of two main reasons people have dandruff. Spend a little more money to be sure you're using a high quality product. Try a brand like Paul Mitchell, Aveda, Redken, something like that. Upper end shampoos moisturize better," he says.

If using a better shampoo doesn't stop dandruff after several weeks, move to what Archer calls the second tier of dandruff treatment. This means using an antifungal shampoo.

"We're covered in fungus. Most of the time it causes no problem. It lives in the dead layers of the skin. But if conditions are right you can develop a fungal infection. Your body may try to shed the fungus and this causes flakes," said Archer.

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

The active ingredients approved for dandruff treatment by the U.S. Food and Drug Administration (FDA) include tar, pyrithione zinc, salicylic acid, selenium sulfide, sulfur, and ketoconazole.

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, Archer said.

Before using products for dandruff, Archer recommends seeing a physician. For these problems, you may receive a prescription for a special lotion that is rubbed into the scalp at night and washed out in the morning.

If the first product you use doesn't work, take heart. Sometimes a person has to try several shampoos before finding one that controls the problem. With a little effort, most cases of dandruff can be shed.

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