Icon WebMD Expert Blogs

This blog has been retired.


The opinions expressed in WebMD User-generated content areas like communities, review, ratings, or blogs are solely those of the User, who may or may not have... Expand

The opinions expressed in WebMD User-generated content areas like communities, reviews, ratings, or blogs are solely those of the User, who may or may not have medical or scientific training. These opinions do not represent the opinions of WebMD. User-generated content areas are not reviewed by a WebMD physician or any member of the WebMD editorial staff for accuracy, balance, objectivity, or any other reason except for compliance with our Terms and Conditions. Some of these opinions may contain information about treatments or uses of drug products that have not been approved by the U.S. Food and Drug Administration. WebMD does not endorse any specific product, service or treatment.

Do not consider WebMD User-generated content as medical advice. Never delay or disregard seeking professional medical advice from your doctor or other qualified healthcare provider because of something you have read on WebMD. You should always speak with your doctor before you start, stop, or change any prescribed part of your care plan or treatment. WebMD understands that reading individual, real-life experiences can be a helpful resource, but it is never a substitute for professional medical advice, diagnosis, or treatment from a qualified health care provider. If you think you may have a medical emergency, call your doctor or dial 911 immediately.


Wednesday, February 1, 2012


By Debra Jaliman, MD

Dandruff is a minor skin condition, but very annoying to those who have it, and it can sometimes be surprisingly hard to treat.

Exactly what causes dandruff is something of a gray area. It may be the result of a yeast overgrowth on the scalp or seborrheic dermatitis (which also shows up as greasy scales on eyebrows and the sides of the nose). Sometimes flakes are caused by sensitivities to hair products or dyes. If the itch is severe, it can be treated with steroid creams for a week or two to bring it under control. If the scales are very thick or there is a crust on the scalp, it may well be psoriasis, which requires specific prescription drugs.

Over-the-counter shampoos work well in mild cases. The active ingredients are usually zinc pyrithione, selenium sulfide, salicylic acid, ketaconazole or tar. It’s really a matter of trial and error to find which works best for you. I usually recommend starting with zinc pyrithione or salicylic acid shampoos. If they don’t work – or if they stop working after a time – try a shampoo with 1% ketaconozole. The 2% ketaconazole shampoo is more effective, but usually requires a prescription. Even better is prescription ketaconazole foam, which is quite expensive, but gives excellent results; a generic ketaconazole foam, which will probably be considerably less expensive, has just been approved by the Food and Drug Administration. I am less enthusiastic about tar shampoo. Tar is carcinogenic and should not be used for long periods; besides, patients complain that tar shampoos have a funny smell and change the color of grey or blonde hair.

The trick to every dandruff shampoo is leaving it on long enough. Most people don’t realize that in order to work, medicated shampoos have to be left on for at least five full minutes. I always tell my patients to keep a kitchen timer in the bathroom. The other factor is consistency – to treat dandruff successfully, I recommend washing hair every day or every other day. Shampooing just once or twice a week is not going to do much. Dandruff shampoos do tend to be leave hair feeling dry, so make sure to use conditioner.

If your dandruff doesn’t clear up with over-the counter-shampoos, my best advice is to go to a dermatologist to establish what is going on in your scalp. Dandruff can also be caused by vitamin deficiencies (usually vitamin B-6, D or A) or insufficient essential fatty acids in your diet. For reasons not fully understood, dandruff is also associated with Parkinson’s disease, heart attacks, strokes and autoimmune diseases.

Bottom line: Dandruff can be treated, but treatment must be consistent to work.

Posted by: Debra Jaliman, MD at 3:37 pm

Subscribe & Stay Informed

Skin & Beauty

Start receiving the Skin & Beauty newsletter and get the latest diet, exercise and health tips to keep your skin glowing and beautiful!


WebMD Health News