How to treat dandruff in a person with a dry and itchy scalp that turns red on scratching?

Hello,

Welcome to icliniq.com.

I went through your query and understood your concern.

According to the history provided by you and from the images shared, it looks like seborrheic dermatitis of the scalp (attachment removed to protect the patient's identity). It can also be commonly seen on facial skin and hair-bearing areas. Seborrheic dermatitis occurs due to multiple reasons,

1. Genetic susceptibility, wherein there is a genetic transmission of similar conditions from parents or ancestors genetically, may also decide our skin type. Depending on the skin type, whether it is extremely oily or extremely dry, it might result in seborrheic dermatitis in the form of flakes.

2. The other causes include hormonal fluctuations, which lead to changes in sebum secretion and sebum production within the skin. Thereby resulting in the formation of flakes and itching as well.

3. It can also result due to climate changes in the case of extremely cold and hot climates, where the flakes would increase their intensity.

4. In addition, stress also plays a role, wherein the outer layer of the skin may show changes in the form of hyperkeratinization, resulting in flake formation.

5. Also, it can result due to dietary factors where the increased intake of oily and fried food, sweets, milk, dairy products, and red meat. Also, inadequate hydration plays a role.

6. Changes in the outer layer of the skin, also called keratin, occur in response to using multiple hair care products in the form of creams, gels, or any other agents that may trigger flakes' formation.

7. Fungal infections of the scalp which may be transmitted from an infected person in case of sharing of objects and the frequent wearing of caps or helmets, may also result in the formation of seborrheic dermatitis.

8. Intake of medications for any underlying medical condition may also trigger seborrheic dermatitis by the changes they cause on the outside of the skin.

Seborrheic dermatitis may occur on and off depending upon the external and internal triggering factors. The external triggers may be relatively controlled. However, the internal triggers may be difficult to control since it is often due to genetic and hormonal fluctuations. Therefore, the condition can be managed each time it occurs and does not have a permanent cure, as skin flaking is one of the main reasons.

So, I suggest you to follow the instructions mentioned below,

1. Use Salidex shampoo (Salicylic Acid + Ketoconazole). Use it externally on the affected area. This medication can be taken in a 2 ml quantity and mixed with three times the amount of water. It can then be applied onto the scalp and massaged for about 1 minute with moderate pressure in order to release the flakes. The mixture should be left on the scalp for five minutes and then washed off. The shampoo has to be used twice a week, three days apart, and can continue to use for months together or till the flakes reduce.

2. Use Ketoconazole 2 % cream. It can be applied on the affected area in the morning and the afternoon. They can be continued for 12 weeks or till the lesions disappear.

3. Use Clobet-S (Clobetasol Propionate 0.05 % and Salicylic Acid 2 %) lotion or cream. It should be applied on the affected area at night only. Since the medication is relatively strong, use the smallest quantity possible in a very thin layer and apply on the affected area for a period of three weeks. After this, a break of three weeks can be taken, and the medication can be continued for three more weeks, and so on. This medication can cause irritation, burning sensation, redness, etc. when used for the first time. Therefore it is advised to use it with caution and in the smallest quantity possible.

4. Take the tablet Fluconazole (antifungal) 400 mg. Take it as a single dose after food, that is, take one tablet in total. This is an antifungal medication that helps in reducing discomfort and itching. Also, it helps reduce the flakes associated with seborrheic dermatitis.

5. Take capsule Omega-3 (nutritional supplement). Take it once daily at night after dinner for one month. They help in reducing flakes and keep the skin and hair hydrated. And helps prevent the recurrence of the issue.

6. Kindly avoid oily and fried food, sweets, red meat, milk, and dairy products. And ensure to consume more fruits, vegetables, fibers, and at least 13 glasses of water a day in a 250 ml glass size, which is required for hydration and to prevent skin flaking.

7. Take the tablet Cetirizine (antihistamine) 10 mg. Take it one hour before bed after dinner. This medication is only considered in case of excess itching as they help reduce the itching sensations and reduce any redness associated with itching. Since this medication is a sedative, it is advised not to drive or go out after consuming it. They can be continued for one week.

8. Use CeraVe SA (Glycerin, Niacinamide, Ceramide, Salicylic Acid, and Hydrolyzed Hyaluronic Acid) facial cleanser. It can be used in case of dry flakes on the face as it consists of Salicylic Acid, which helps remove the flakes on the facial skin. In the case of seborrheic dermatitis on the beard and mustache, apart from the scalp area, the above medications can also be used on any hair-bearing affected area.

Kindly consult a specialist, talk with them and take the medications with their consent.

Consistency with medication is the key. In case of recurrence in the future, the same medication can be used. It is also to be noted that skin and hair hydration is paramount. Therefore, keep yourself hydrated by drinking water and using moisturizers, which will help reduce the lesion's dryness and flaky nature.

I hope the details provided above were informative and provided clarity.

Kindly follow up if you have any doubts.

Take care.

Hi,

Welcome back to icliniq.com.

Fluconazole tablets are available as an OTC (over-the-counter), and they help reduce the itching and the flakes. However, in case of unavailability, it can be ignored as the other medications advised would help reduce them.

And unfortunately, there is no complete cure for the lesions as they usually appear based on triggering factors which may be external or internal, to which our skin reacts. As our skin reacts to these factors, a complete cure may not be possible. However, they can be managed each time they recur.

I hope this helps.

Take care.

Hi,

Welcome back to icliniq.com.

However, as I have mentioned, topical medications will help reduce the lesion. The shampoo that I mentioned, Salidex or Neutrogena T/Sal (Salicylic Acid and Ketoconazole) therapeutic shampoo, can be used initially until the lesions subside and can be used if there are recurrences.

In case of the absence of lesions, I suggest you to use Aveeno oat milk blend (Colloidal Oatmeal Extract, Cocamidopropyl Betaine, Glycol Distearate, and Hydrolyzed Milk Protein) moisturizing daily shampoo to keep the scalp hydrated. Use it once or twice per week only. Using this shampoo daily may be harmful to the scalp and hair and tends to strip off natural oils leading to dryness. For the rest of the days, I suggest you to wash your hair with plain water.

I hope this helps.

Take care.

Hi,

Welcome back to icliniq.com.

Yes, absolutely. They will help manage the current lesions.

I hope you found this helpful.

Thank you.

Hi,

Welcome back to icliniq.com.

You are most welcome.

Kindly follow up if you have more doubts.

Take care.