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A Dermatologist's Tips for Dry, Flaky Skin On the Scalp;
It's the Season for Seborrheic Dermatitis

by Dr. Cynthia Bailey

In my dermatology practice I see quite a few patients whose seborrheic dermatitis really acts up in the winter. Patients commonly misinterpreted the redness and scale of seborrhea as dry skin. They layer on moisturizers, which of course don’t improve the condition because seborrhea is a rash, not dry skin. Seborrheic dermatitis is a frustrating, confusing and at times embarrassing rash that’s often seen.  Most people don’t know they have it until they see a doctor. 

Seborrheic dermatitis is more common as we age. In fact, seborrheic dermatitis is so common that almost everyone will have it at some point in their life. It presents differently in different age groups.  It manifests itself as:

•    Cradle cap in babies
•    Red, greasy, scaly skin in the nose cease or between the eyebrows in teens
•    ‘Dry’ and itchy scalp starting in the teen years  and going on throughout life
•    ‘Dry’, red, scaly skin in the T-zone of the face at any time in life
•    Red, crusty skin on and behind the ears 
•    Flaking of the eyebrows
•    Crusty scale and itching of the eyelashes (blepharitis), especially in the morning when you wake from sleep
•    Greasy, red scaly skin on the chest and upper back

Seborrheic dermatitis may or may not be accompanied by tender, itchy pimples on the scalp, around the hair line and on the neck, chest and upper back.

If you are prone to seborrheic dermatitis then you’ll always have a tendency for reoccurrences.  The causes of seborrheic dermatitis is unknown as is the cure. Treatment is aimed at controlling the problem and extending the time between flair ups.  The positive news is that with medicated products, good skin and scalp care, it's possible to have clear, healthy skin by controlling your seborrhea. 

I counsel patients on over the counter treatment options for seborrheic dermatitis based on the areas of their skin affected.  The most common problem areas are scalp, facial skin and ears. In this article, I'll deal with the scalp exclusively

The Scalp: Over The Counter Treatment Recommendations for Scalp Seborrheic Dermatitis (aka Dandruff)
Normally your scalp shouldn’t itch. The most common cause of an itchy scalp is seborrheic dermatitis, also called dandruff.  Dandruff may or may not be accompanied by scaly skin and a red rash.

Treatment for seborrhea of the scalp is aimed at delivering medicated ingredients to the involved scalp skin by using medicated shampoos. These products leave a layer of medicine on the skin after you rinse off the lather.  It’s important to know how to properly use medicated shampoos in order to get the best results.  There are tricks to getting the best results from your dandruff products.

Dandruff Shampoo Instructions

  1. Try to shampoo as often as possible. Initially, you may want to shampoo every day until your scalp is controlled. Remember, shampooing delivers medicine to the scalp skin and it also helps to remove the oils and scale that contribute to seborrheic dermatitis.
  2. Lather and rinse your hair twice with each washing. Each lathering needs to reach down to the skin of your scalp. Evenly cover the skin with suds and rub or scruff them into the scalp using your finger tips or a scalp scrubber that are inexpensive and available at drug stores. Use a non-medicated shampoo for your first lather to clean dirt, oil and hair care products from your scalp and hair.
  3. Use your medicated shampoo for your second lather and allow the shampoo to stay on your scalp for about 5 minutes before rinsing.

Follow up with conditioners or the other hair care products that you like to use. Rotate the medicated dandruff shampoo active ingredients. Use a different type of medicated ingredient each time that you shampoo. The scalp gets used to one ingredient and you need to keep rotating through at least 3 different ones. This phenomenon is called tachyphylaxis and it’s why medicines sometimes stop working. Continue using your medicated shampoos until your scalp is controlled with the addition of at least a month. If you stop too soon, the dandruff will return rapidly.

Many medicated shampoos are harsh to your actual hair shafts. If you have fine or fragile hair, take care to only apply the shampoo to your scalp skin. There’s no need to lather up the full length of your hair shafts because you cleaned them with your first, non-medicated shampoo product.

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