Dandruff caused by dry skin can be treated with a moisturizing shampoo. Dandruff caused by oily skin is a much more serious condition. It is callled seborrheic dermatitis and it is very difficult to get under control.
There are three skin conditions that, for all practical purposes, are one in the same: seborrheic dermatitis, eczema of the scalp, and malassezia. According to the National Intitutes for Health (NIH):
- “Seborrheic eczema” is another name for seborrheic dermatitis.
- Over growth of Malassezia, a normal scalp fungus, is one of the causes of seborrheic dermatitis.
What is Seborrheic Dermatitis?
- Seborrheic dermatitis occurs when the scalp produces too much sebum, a waxy substance that is referred to as “oily skin.” The cause is not known, and the condition seems to run in families.
- The sebum accumulates in clumps of yellowish, flaky scales that become dandruff. You can feel them if you run your fingers through your hair or comb it with a fine comb.
- The clumps of sebum also become red, inflamed and horribly itchy; it is hard to resist scratching them. Scratching results in bleeding, scabbing and more flaking.
- These red and itchy clumps may also form on the skin around the scalp line, at the temples, on the eyebrows, the bridge of the nose and the sides of the nostrils.
- Like acne, seborrheic dermatitis usually begins at puberty. However, it does not go away with age. I have had seborrheic dermatitis since age 13 and now I am middle-aged.
Social Stigma of Seborrheic Dermatitis
- Visible dandruff is unacceptable in our society and so this condition must be controlled.
- The red patches or scabs on the face are very unsightly and visible dandruff gives the appearance of poor hygiene.
- Hairdressers are sometimes afraid when they see lesions on the scalp, fearing that it is a contagious or an AIDs-related condition.
Treatment for Seborrheic Dermatitis – Medicated Shampoo
Daily shampooing with medicated shampoo, specifically targeted to alleviate seborrheic dermatitis, can control seborrhea. Popular dandruff shampoos will only help control dandruff caused by dryness of the skin.
The active ingredients in shampoos that alleviate seborrheic dermatitis are: coal tar, zinc, resorcin, ketoconazole, selenium and salicylic acid. Read the label to make sure that the product contains one of these ingredients.
- When I was young, coal tar shampoo was the only available treatment for the condition. It was very unpleasant, although coal tar based products may have improved since then.
- Years later, a dermatologist recommended a shampoo containing salicylic acid, which, in my case, was more effective.
How to Shampoo if You Have Seborrheic Dermatitis
- Prior to shampooing, scrape the scalp gently but firmly with a very fine comb to loosen clumps of sebum or flakes left by scabs.
- Make sure that your hair is wet enough to form a lather that enables medicated shampoo to reach the scalp.
- Rub the lather into your scalp with your fingertips – top, back and sides – and on the backs of your ears.
- Hold a face cloth over your eyes and lather your eyebrows, temples and scalp line.
- Let the medication work for at least two minutes. It may sting a little if you have open lesions from scratching.
- Rinse hair. Do not apply conditioner and rinse a second time, or the medication will wash away. Most medicated shampoos include conditioner in the formula.
- Comb hair very gently using a large, blunt comb.
- Shampoo daily in the morning or evening.
Do Not Use Hot Water to Shampoo
Do not use hot water on your scalp or blow dry with hot air. After twenty years, I learned this from a hairdresser. My symptoms improved dramatically. Heat irritates tissue that is inflamed or injured. It makes inflammation worse and prevents healing.
- Remember: Hair is dead tissue. Do whatever you like with it. Your scalp is living skin; you would not put scalding hot water on an open wound on your body. Treat your scalp with gentleness, especially if you have seborrhea.
If you miss having a hot shower, wash your hair in the sink and shower from the shoulders down; or shampoo in a warm shower and turn the water to hot when you are finished shampooing.
Tips for Long Hair
If you have long hair, some of the lather may not reach the back of the scalp. Apply a second application of shampoo and lather the back of your scalp just above the nape of the neck.
Long hair requires conditioning:
- Wash your hair with the medicated shampoo and rinse as above.
- Grab your hair into a high ponytail and apply conditioner on the ponytail only.
- When you rinse the conditioner, be sure not to rinse away the medication on your scalp. With your hand or arm, lift your hair away from the scalp to rinse.
If you need to blow-dry long hair using the hot setting, hold or comb your hair away from your head and scalp.
Seborrheic Dermatitis Requires Constant Vigilance
Even if you shampoo daily, at any time you may feel a stinging itch in your eyebrow, at the hairline, behind your ears or anywhere on your scalp.
- Deal with the itch immediately. There is a product that is a clear lotion of 3% salicylic acid in a squeeze bottle with a narrow tip that reaches the scalp. It is specifically designed for seborrheic dermatitis and relieves itching, redness and flaking.
- When you apply the lotion you will feel a burning sensation. This means you got the right spot. Carry a squeeze bottle with you at all times. The lotion is expensive, but usually lasts several weeks and is well worth the cost. It used to be prescription medication - be thankful that you can buy it over the counter!
- Always have a mirror to “check yourself,” especially if you have dark hair. You never know when dandruff is visible on your eyebrows or hair.
External Factors Affect Seborrheic Dermatitis
External factors may cause seborrheic dermatitis to flare up so that it is difficult to manage. Some examples are:
- Emotional upset
- Stress
- Fatigue
- Seasonal changes
- During flare-ups, apply lotion daily to eyebrows, scalp line, temples and behind the ears to prevent more outbreaks.
- Let the medicated shampoo work longer when you shampoo.
It has taken me a lifetime to learn to manage seborrheic dermatitis. So start right away - take charge of this condition early and learn how to look and feel great. Follow the advice of your dermatologist. With the help of these instructions and tips, you should be able to successfully control this difficult and recurrent condition.
Disclaimer: The information contained in this article is for educational purposes only and should not be used for diagnosis or to guide treatment without the opinion of a health professional. Any reader who is concerned about his or her health should contact a doctor for advice.
