Dandruff is a common skin condition that often affects the scalp. It is also known as seborrheic dermatitis and is a benign but often lifelong skin condition.

Dandruff is found most commonly on the scalp, however it can actually affect any oily area of the skin including the face or even the chest and back. It is most commonly recognized as white flaking on darker clothing, but what you might not see is the redness and irritation that is on the scalp beneath the hair.

For many patients, the flaking can be managed with over-the-counter shampoos and topical medications, but sometimes the itching and inflammation become too intense and require a visit to your dermatologist.

Unfortunately, dermatologists are still unclear on the exact cause of seborrheic dermatitis, but it does seem to be related to a fungus that can be found on the skin. There has also been some evidence to show a link to inflammatory diseases such as psoriasis. Seborrheic dermatitis can affect both sexes, all races and all ages. In infants it is known as cradle cap.

The diagnosis is commonly made clinically without any lab or testing needed, but tinea capitis is often ruled out. A biopsy can also be done to confirm the diagnosis if the clinical presentation is not clear. Treatment is more effective if started early.

A quick trip to the pharmacy and you can find over-the-counter antifungal shampoos that also contain ingredients to help debride scales and weak steroid solutions. Daily treatment involves more frequent shampooing with salicylic acid, zinc or tar to help decrease and break up plaques that can form.

Many patients find that alternating shampoos with zinc, selenium or tar is more effective for treating dandruff long term.

Antifungals are used to help reduce the fungal load on the skin. If over-the-counter treatments are not effective, then patients can use prescription strength antifungals such as ketoconazole 2 percent. This medication helps reduce the fungal load on the scalp and does not have the possible side effects that steroids can have.

Prescription topical steroids are used when antifungals or keratolytic shampoos are not effective and moderate inflammation is present.

Steroids are very helpful when itching and redness is a major complaint, but it is important to know that steroids can sometimes cause seborrhea to flare sooner after stopping treatment and should be used for short-term treatment in combination with other non-steroidal treatments.

Seborrheic dermatitis is a benign disease but can cause long-term stress and irritation to patients. It is important to know when to see your dermatologist if your skin is not improving.

Caitlin Cleland, PA-C is accepting new patients at the Bluffton office of May River Dermatology.