Seborrheic dermatitis (SD) is a chronic inflammatory condition characterized by redness and flaking in areas with a high concentration of sebaceous glands, such as the face and scalp. Dandruff is a milder, non-inflammatory form of SD and is a common scalp disorder that can cause social embarrassment. The development of SD/dandruff is linked to the composition of sebaceous gland secretions, the proliferation of Malassezia yeasts, and the immune response of the host.

The primary goal of treating dandruff/SD is to improve symptoms by reducing itching and restoring normal skin function, rather than aiming for a complete cure. Treatment options involve using topical products that contain antifungal agents, keratolytic agents, and anti-inflammatory agents. Patients should be educated about the importance of maintaining good hygiene practices, including regular hair washing (at least three times a week) to remove excess oil. Sunlight exposure can be beneficial but must be accompanied by proper sun protection. It is important to avoid using products that can irritate active lesions, such as keratolytic preparations or physically removing scales. The use of hair oils should be avoided, but emollients have shown to be beneficial.

Numerous topical therapeutic agents have been clinically tested for the treatment of dandruff/SD. These agents can be categorized based on their mechanisms of action, including antifungal, anti-inflammatory, and keratolytic properties. Antifungal medications are commonly considered as the first-line treatment for dandruff/SD. They are applied topically to inhibit the growth and reduce the colonization of Malassezia yeast, the main causative agent of dandruff/SD. One of the most frequently prescribed antifungal agents is ketoconazole, available in various forms such as shampoo (1% and 2%), cream (2%), oil-in-water emulsion (2%), and foaming gel (2%). All these preparations have shown effectiveness in treating dandruff/SD.

When choosing an appropriate treatment, healthcare providers should consider factors such as safety, effectiveness, ease of use, patient age, and treatment cost to achieve the best clinical outcome.

Thomas LM, Khasraghi AH. Topical treatment of seborrhoeic dermatitis and dandruff: An Overview. Ann Trop Med & Public Health. 2020;23(S18): SP231823. DOI: http://doi.org/10.36295/ASRO.2020.231823