Dandruff and Seborrheic Dermatitis

W. Steven Pray, PhD, RPh, Professor of Nonprescription Products and Devices, School of Pharmacy, Southwestern Oklahoma State University, Weatherford, OK

US Pharmacist. 2001;26(4) 

In This Article

Patient Information

The Scaling of Dandruff and Seborrheic Dermatitis

The scalp, like the hands, neck and face, is often completely exposed to the elements, including snow, rain and blistering sun. In addition, it is also exposed to all types of shampoos, conditioners, dyes, sprays, hair straighteners, hair growers, and other cosmetic hair products. All of these exposures combined can take a toll on the scalp, which may respond with several types of skin conditions.


One of the most common skin conditions occurring on the scalp is dandruff. Scientists are not absolutely sure that dandruff has a single cause. The upper layer of the skin covering our bodies is a layer of dead cells that continually sheds into the environment. These shed cells are not usually visible. However, this is not the case with dandruff. As the upper layer of scalp sheds its scales, the scales are visible as whitish or grayish clumps of material falling from the scalp. Scales are even more noticeable when the patient is wearing dark clothing.

Seborrheic Dermatitis

Seborrheic dermatitis (SD) is a skin condition that causes flaking and redness. It is found most often on the hairline, face, forehead, eyebrows, eyelashes, eyelids, external ear canal, and in the nasal folds. The scales are yellow and oily, rather than dry and white like dandruff.

Treatment Options

Dandruff is not harmful, and it does not lead to more serious conditions. Further, there are several types of products that may be effective in its treatment. SD is somewhat harder to treat than dandruff, but many of the products used to treat dandruff may be used to treat SD as well. Ingredients that are effective in treating both conditions include salicylic acid (Scalpicin, T/Sal), selenium sulfide (Head & Shoulders Intensive Treatment, Selsun Blue), and zinc pyrithione (Head & Shoulders). While coal tar and its various forms (Denorex, Oxipor VHC, Pentrax, Tegrin, MG217 Medicated Tar Shampoo) are effective for dandruff and SD, there are several reasons they may not be the best choice. Products containing coal tar have a characteristic odor reminiscent of road tar, which people may find unpleasant. Users of coal tar dandruff shampoos also must be cautious in exposing the skin to sunlight after use, since coal tar can increase the tendency to sunburn for up to 24 hours after use. Unlike milder treatments, it should not be used for prolonged periods without consulting a physician.

Sulfur (Suave Dandruff Control Shampoo) and salicylic acid combined with sulfur (MG217 Medicated Tar-Free Shampoo) are effective in treating dandruff only. There is also a new dandruff treatment: Nizoral A-D shampoo. Based on the finding that some people with dandruff have a fungus living on the scalp that causes the scaling, Nizoral A-D contains an antifungal ingredient known as ketoconazole. It can control the flaking, scaling, and itching associated with dandruff. It should not be used on children under the age of 12 years.

Hydrocortisone cream (Cortaid, Scalpicin) may be used to treat SD only. If seborrheic dermatitis covers a large part of the body, it is advisable to seek the advice of a physician before applying this or any other nonprescription product.


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