Dandruff or Fungal Infection?
2 to 5 % population suffers from Seborrheic dermatitis (SD), a skin condition marked by redness and scaling affecting areas with a large number of sebaceous glands such as the scalp, face and body folds. Scalp SD is commonly known as Dandruff. The condition is More common in males than females and there is often a hereditary diathesis. Most patients in my Southlake Dermatology practice seek medical help after trying over the counter dandruff shampoos and products.
Malassezia furfur (a common yeast) is thought to play a role in pathogenesis of SD which accounts for the clinical improvement with topical antifungal agents and with Selenium sulfide.
I like to discuss patient expectations from the treatment during the first visit. It helps to know the course and the triggers for flare ups. Avoiding triggers provides better long term management of the disorder and knowing the course of illness leads to less frustration over period of time.
Triggers for Flare ups
Emotional stress is a putative factor, cold dry winter air tends to induce flare ups. There is some evidence that certain nutritional deficiencies play a role in incidence and severity, such as Zinc and Niacin deficiency.
Treatment and management
In my clinical practice, for severe cases I start treatment with a topical corticosteroid for 3 to 4 weeks. Long term use of topical steroid preparations can lead to skin atrophy (skin thinning), formation of new blood vessels and redness. I combine topical steroid preparations with over the counter selenium sulfide shampoo and prescription or over the counter antifungal preparations as needed.
The goal of treatment is adequate control of symptoms with the knowledge that most patients experience recurrences and remissions.
Lifestyle changes with adequate stress management, supplementation of Niacin with Zinc and copper when indicated helps achieve proper management.
Immunosuppressed patients, such as HIV/AIDS, transplant patients, have a higher incidence of SD and tend to have more severe symptoms. For severe intractable SD possibility of immunosuppression should be considered.
If you have seborrheic Dermatitis and difficulty managing your symptoms with over the counter products please call our Southlake dermatology office at 888-210-9693 for an appointment. We see patients fron all over DFW metroplex including Southlake, Colleyeville, Keller, Grapevine, Hurst, North Richland Hills, Lewisville and other surrounding cities.
