Dandruff is a very common problem
we frequently tackle here on The Doctors.
Take a look.
We received an email from Jocelyn, it reads,
"Dear Docs, I have a terrible problem with dandruff!
It's so out of control:
in the morning, it's all over my pillow when I wake up,
and all day long I feel like my clothes are covered.
I'm itchy all the time.
My colleagues at work always ask me
when the last time I washed my hair was!
What's the best way to treat extreme dandruff?"
Good question.
It is a good question.
And so when we talk about dandruff,
the formal medical name for that is actually
something called seborrheic dermatitis,
which is an overgrowth of a normal yeast
that lives on our skin so it's meant to be there.
It's called pityrosporum, or malassezia.
So when you have an overgrowth of this yeast,
it often really causes these red, scaly, flaky patches
because your body then mounts an immune response to it.
And this is a pretty severe case when you see
tremendous scale like this.
My only concern about this is sometimes when you
already have a lot of inflammation on your scalp,
it actually disrupts the normal immune response
and you can sometimes even get
a secondary bacterial infection.
So for Jocelyn, what I would probably recommend
is she does see someone, and make sure
they do a culture swab and just ensure it's
only the normal yeast that's meant to be there.
Because I actually saw a case like this where,
it was actually a child and she had this
horrible, horrible what they kept calling
cradle-cap, and treating it like seborrheic dermatitis,
and we did a swab and it was actually
staph aureus bacteria that had colonized
in a secondary way.
So for really severe cases like this,
I do think it's worth evaluating.
Now Jocelyn did give us more information,
turns out she's tried a whole bunch of
different things for this.
Everything from oils, to Listerine, to tea tree oil,
to over the counter dandruff shampoos,
and sometimes I do think with seborrheic dermatitis,
this happens a lot, where people keep throwing
oils at it because they think it's dry and flaky
and that's going to help.
But interestingly the yeast that causes this
feeds on oil so you're really just feeding it
and fueling the fire if you do that.
So one of the better options would be
over the counter I think zinc or selenium
are the best over the counter ingredients
to look for in shampoos.
But in her case I know she's tried
one prescription strength shampoo that has
something called ketoconazole,
it didn't work very well for her.
I would try a different one called ciclopirox
which is a prescription strength one
that any doctor can actually take a look
and, if appropriate, prescribe.
I think also looking at her photos,
she does have twists which are synthetic hair
mixed in with her natural hair.
That's what was giving it that look, okay.
Exactly.
And so I think a lot of times with people with
synthetic hair mixed in,
it can also trigger some inflammation.
So there may be more than one thing going on here,
but certainly Jocelyn, what we would recommend,
is do see someone,
make sure it's only seborrheic dermatitis.
And if it is, maybe up the ante to a different
prescription strength product for it.
Well I hope she gets some help.
Yeah and then maybe give the synthetics a rest
How long after you start a shampoo
will you be able to tell if it's effective?
Or you should move on to the next possible treatment?
Oh it's pretty quick, actually.
Yeah you would notice within weeks.
Jocelyn, we wish you the best of luck
with treating this.