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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest Treatment For Dandruff Covering Like White Crust On The Scalp

Hello,
I feel desperate and am frustrated with my scalp.for 5 months now I've been dealing with really bad dandruff.a white crust covers the crown of my scalp and goes back in some areas to the middle of my head.I've done tea tree oil,acv,coal tar shampoos,salicylic acid shampoos,selenium sulfide,pyrithizione shampoos,and jojoba oil.my routine has been to mix these products up but It feels like an uphill battle that I'm not winning.it worries me to see how fast my scalp regenerates the crust to come back.If i skip a day whichni do often it's like I never treated my scalp.but I have to do this crazy upkeep as I need to be presentable at work and the misconception is how unhygienic you are as a person when it's snowing all of over you. What else can I do? Am I doing something wrong?am I treating this right? Thank you for your time!
Sincerely,

Desperate &frustrated
Tue, 27 May 2014
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Dermatologist 's  Response
Hello and welcome to healthcaremagic

I would keep a possibility of seborrheic dermatitis of the scalp. Dandruff or seborrheic dermatitis is an important cause of scalp itching. Clinically there may be ill-defined erythema and yellowish/greasy adherent scales which when forcibly scraped/scratched exposes raw skin which oozes scantily and subsequently re-accumulates crusts/scales.

Seborrheic dermatitis patients have an overgrowth of yeast, malassezia furfur which may be pathogenetically related/contributes to the inflammation of seborrheic dermatitis

If I was the treating doctor I would have asked to use an antidandruff lotion/shampoo. My choice is 2% ketoconazole shampoo, thrice weekly for 2-4 weeks followed by once or twice weekly for maintenance. It is available OTC as Nizral 2% solution. Ketoconazole is antifungal,antiinflammatory. It inhibits the yeast Malessezia furfur which is present in abundance in seborrheic dermatitis and thus benefits seborheic dermatitis

A moderately potent topical steroid e.g fluticasone or mometasone lotion can be applied to the scalp skin for faster relief, from itching,scaling and inflammattion of seborrheic dermatitis.

Oil application should be avoided in your case. Oil won't benefit dandruff, would rather increase it

The topical steroid lotion can be stopped once the dandruff is well controlled and thereafter the improvement can be sustained with just an anti-dandruff lotion/shampoo.

regards
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Suggest Treatment For Dandruff Covering Like White Crust On The Scalp

Hello and welcome to healthcaremagic I would keep a possibility of seborrheic dermatitis of the scalp. Dandruff or seborrheic dermatitis is an important cause of scalp itching. Clinically there may be ill-defined erythema and yellowish/greasy adherent scales which when forcibly scraped/scratched exposes raw skin which oozes scantily and subsequently re-accumulates crusts/scales. Seborrheic dermatitis patients have an overgrowth of yeast, malassezia furfur which may be pathogenetically related/contributes to the inflammation of seborrheic dermatitis If I was the treating doctor I would have asked to use an antidandruff lotion/shampoo. My choice is 2% ketoconazole shampoo, thrice weekly for 2-4 weeks followed by once or twice weekly for maintenance. It is available OTC as Nizral 2% solution. Ketoconazole is antifungal,antiinflammatory. It inhibits the yeast Malessezia furfur which is present in abundance in seborrheic dermatitis and thus benefits seborheic dermatitis A moderately potent topical steroid e.g fluticasone or mometasone lotion can be applied to the scalp skin for faster relief, from itching,scaling and inflammattion of seborrheic dermatitis. Oil application should be avoided in your case. Oil won t benefit dandruff, would rather increase it The topical steroid lotion can be stopped once the dandruff is well controlled and thereafter the improvement can be sustained with just an anti-dandruff lotion/shampoo. regards