1. Dandruff (Seborrhea) Slideshow Pictures
2. What Your Scalp and Hair Say About Your Health
3. Top 10 Foods for Healthy Hair Slideshow Pictures

Medical Author:

Nili N. Alai, MD, FAAD

Nili N. Alai, MD, FAAD

Dr. Alai is an actively practicing medical and surgical dermatologist in south Orange County, California. She has been a professor of dermatology and family medicine at the University of California, Irvine since 2000. She is U.S. board-certified in dermatology, a 10-year-certified fellow of the American Academy of Dermatology, and Fellow of the American Society of Mohs Surgery.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Once a health care practitioner has confirmed an individual has dandruff (seborrheic dermatitis), the main treatment includes antifungal shampoos, antibacterial cleansers, and anti-inflammatory creams and lotions. More importantly, often the most effective dermatologic treatments are combination treatments using several different medicated ingredients used at the same time.

Prescription-strength shampoos and steroid cream medications are the usual treatments. More frequent shampooing and cleansing is usually recommended.

For severe cases not responding to a combination of ultra high-potency steroid creams, foams, sprays, or lotions, alternate treatments may be tried. A dermatologist may be very helpful for resistant cases that have not cleared with standard prescriptions.

Rare severe cases may require short-term treatment with oral steroids such as prednisone (Deltasone, Orasone, Prednicen-M, Liquid Pred) and/or oral antifungal pills. Oral pills are not the mainstay of dandruff treatment and should not be routinely used.

Sample escalating (step-up) treatment of adult dandruff by a dermatologist:

Skin care routine for mild dandruff:

• Wash scalp with ketoconazole (Nizoral) or ciclopirox (Loprox) shampoo daily or every other day



• May use hair conditioner on hair as needed (avoid applying to scalp)



• Need more frequent daily shampooing when symptoms are more severe

Skin care routine for moderate dandruff:

• Wash scalp with ketoconazole (Nizoral) or ciclopirox (Loprox) shampoo daily



• May use hair conditioner on hair as needed (avoid applying to scalp)



• Need more frequent daily shampooing when symptoms are more severe



• Rub in fluocinonide or clobetasol (Olux) solution one to two times a day into scalp for itchy skin

Skin care routine for severe dandruff:

• First, wash scalp with a tar shampoo such as Neutrogena T/Gel or DHS Tar



• Rinse scalp



• Second, wash scalp with salicylic acid shampoo such as DHS Sal or Neutrogena T/Sal



• Rinse scalp



• Third, wash scalp with ketoconazole (Nizoral) or ciclopirox (Loprox) shampoo daily and leave in for two to five minutes



• Rinse scalp



• May use hair conditioner on hair as needed (avoid applying to scalp)



• Rub in clobetasol (Olux) foam or solution one to two times into scalp for itchy, inflamed skin areas



• Use weekly or biweekly special nourishing bedtime treatment with Dermasmoothe under shower cap. Rinse off in the morning.



• As dandruff improves, step back to every other day treatments or rescale to the moderate or mild dandruff recipe above