Q: My 14-year-old son suffers from severe dandruff. He has it in his head, eyebrows, chest, and ears. What can be done to control it?

Most of us have suffered from mild dandruff. It is confined to the scalp and results in flaking and sometimes mild itching. Seborrheic dermatitis (SD) is a more severe form of dandruff that can cause scaly greasy plaques involving the scalp, eyebrows, eyelids, nose, ears, upper back, chest, under the breasts and navel. It is quite common for SD to have flares alternating with periods of remission, with or without specific treatment.

SD is not contagious. While there are a number of treatment modalities that can control SD, however, there is no known cure.

SD is also referred to as:

• Dandruff
• Seborrheic eczema
• Seborrheic psoriasis
• Cradle cap (when found on scalp of babies)

Causes

A specific cause of SD has not been pinpointed. However, there appears to be a strong association with the overgrowth of a fungus (Malassezia) that is found in the oily secretions of SD sufferers. Additionally, the malfunctioning of the immune system seems to play a part in the flare-ups.

Predisposing factors to the development and flares of SD:

• Psychological- Stress, depression, and anxiety
• Major illnesses – Parkinson’s, heart attacks, pancreatitis, some cancers, epilepsy
• Immunocompromised – HIV, autoimmune, secondary to medications
• Excessively oily skin
• Suboptimal hygiene
• Family history of SD
• Having other skin disorders – acne, rosacea, psoriasis
• Excessive alcohol consumption
• An increase in blood androgen (male hormone) levels
• Under the age of 3 months and between the ages of 30 to 60
• Dry and cold weather
• Down syndrome

Symptoms of SD

• Itchy white/ creamy flakes of the affected areas
• Crusty; matted; scaly lesion on the scalp in babies (cradle cap)
• Scaly edges of eyelids
• Thick plaques in the eyebrows, mustache, both sides of the nose, upper lip, inside the ears, behind the ears, armpits, groin and under breasts

Home remedies

• Anti-dandruff shampoos containing zinc, sulfur, ketoconazole, cold tar, or salicylic acid can be used daily until symptoms subside. Thereafter, it can be used 2-3 times a week. If a given shampoo loses its effectiveness after a while, another should be tried.
• Mineral oil can be applied to the scalp for an hour before shampooing.
• Avoid hair products that contain dyes and alcohol.
• Shaving the mustache or beard should be considered in severe forms of SD.
• Keeping the hair on the scalp short often helps.
• For cradle cap, the application of mineral oil for 1-2 hours followed by the use of baby shampoo is helpful.

Treatment options for SD

The most frequently recommended treatments for SD are medicated shampoos, lotions, and creams.

• Steroid lotions and creams: While these are effective, they should not be used for prolonged periods; long-term use can cause thinning of the skin.
• Topical antifungal shampoos, gels and creams: These can be used by themselves or alternated with other treatment modalities.
• Oral antifungal medications: These are reserved for severe forms of SD that are not satisfactorily responding to topical treatment measures.

Author: Dr. C. Malcolm Grant – Family Physician, c/o Family Care Clinic, Arnos Vale, www.familycaresvg.com, clinic@familycaresvg.com, 1(784)570-9300 (Office), 1(784)455-0376 (WhatsApp)

Disclaimer: The information provided in the above article is for educational purposes only and does not substitute for professional medical advice. Please consult a medical professional or healthcare provider if you are seeking medical advice, diagnoses, or treatment. Dr. C. Malcolm Grant, Family Care Clinic or The Searchlight Newspaper or their associates, respectively, are not liable for risks or issues associated with using or acting upon the information provided above.