Seborrheic dermatitis (dandruff)

Washing the scalp and affected skin regularly with a mild cleanser and rinsing well, so oil and flakes do not build up.

Often considered as the base of care for mild flaking and as a way to keep flares quieter between treatments.

Less suitable to overdo: very hot water or harsh scrubbing can irritate skin and make redness or stinging worse.

Stinging, new redness, or dryness after washing may mean the product or routine is too harsh for that skin.

Often judged over a few weeks, since flaking changes slowly.

• How often would you suggest I wash my scalp and face?
• Which gentle cleansers are less likely to irritate my skin?

Adapting wash and styling routines to hair that is naturally drier and more fragile, so the scalp stays clean without stripping or breaking the hair. Coily and curly hair is often washed less often than straight hair, which can let scale build up if there is seborrheic dermatitis.

Often considered when the hair is washed weekly or less, when braids, twists, wigs, or weaves are worn, or when medicated shampoos feel too drying.

Less suitable to apply the same advice to everyone. Heavy oils and pomades on the scalp may feed flaking in some people, and tight styles that pull on the scalp can add irritation or hair loss.

Tenderness, bumps, or thinning hair along tight styles, and scale that builds up under protective styles.

Routine changes are usually judged over a few weeks.

• How often should I wash if my hair is coily or curly?
• Can I apply a medicated shampoo to the scalp only and condition the lengths?
• How can I care for my scalp under braids or wigs?

Cradle cap is the infant form of seborrheic dermatitis. It often fades without treatment within weeks to months, and gentle washing is the usual starting point.

Often considered when thick or greasy yellow scale is on a baby's scalp and the baby is otherwise well and comfortable.

Less suitable to pick or scrub scales, or to use adult medicated products, without a pediatric clinician's advice.

Redness spreading to the face, neck, or body folds, oozing, signs of infection, or a baby who seems uncomfortable.

Often settles on its own over weeks to months.

• Does this look like cradle cap or something else?
• What gentle care is right for my baby?
• When should I call back?

Shampoos with ingredients that reduce Malassezia yeast, such as ketoconazole, selenium sulfide, zinc pyrithione, or ciclopirox. Some are sold without a prescription and some need one.

Often considered as a first step for dandruff and scalp seborrheic dermatitis, and sometimes used on the face or chest as a wash.

Less suitable when there is a past allergy to an ingredient. Selenium products may discolor some hair, and some people find certain shampoos very drying, especially with coily or color-treated hair.

Scalp irritation, dryness, a change in hair texture or color, or an itchy rash after use. Check with a clinician about use during pregnancy or in young children.

Many clinicians look for a change over about 2 to 4 weeks.

• Which type of antifungal shampoo fits my scalp and hair type?
• How should I fit it into my wash routine without drying my hair out?
• Can I use it on my face or chest?

Ketoconazole shampoo is the best-known option in this group. It can be used as a shampoo on the scalp, and as a lathered wash on the face, ears, chest, and other affected areas, left on briefly before rinsing (follow the product label). Other ingredients people see include ciclopirox, selenium sulfide, and zinc pyrithione. Ketoconazole shampoo is available over the counter in a lower strength and by prescription in a higher strength.

Often considered as a first step for dandruff and seborrheic dermatitis of the scalp, and for patches on the face, ears, or chest where a wash is easier than a cream.

Less suitable when there is a past allergy to an ingredient. Selenium products may discolor some hair. These products can dry hair, so coily, curly, or color-treated hair may need extra care: spacing out use and moisturizing the hair afterward matters. Ask a clinician about use during pregnancy or in young children.

Dryness or irritation of the skin or hair, stinging, a change in hair texture or color, or an itchy rash after use. Keep it out of the eyes. Some people need to rotate between products over time. Stop and ask a clinician if the skin gets worse.

Many clinicians look for a change over about 2 to 4 weeks.

• Is ketoconazole shampoo a good fit for my scalp and hair type, or would another ingredient suit me better?
• How should I use it on my face, ears, or chest, and how do I protect my hair from drying out?
• Should I rotate products if one stops working, and when should I come back if I am not better?

Shampoos with salicylic acid, which loosens thick scale, or coal tar, which slows skin cell turnover. They are often available over the counter.

Often considered when scale is thick or stuck to the scalp, or when other shampoos have not been enough.

Less suitable when the scalp is raw or very irritated. Tar has a strong smell, can stain light hair or fabric, and may make skin more sun-sensitive. Pregnancy and young age call for a clinician's input.

Dryness, stinging, scalp irritation, or hair feeling brittle. Salicylic acid can be drying.

Often judged over 2 to 4 weeks.

• Would a scale-softening product help me, or could it dry my scalp too much?
• Is a tar shampoo reasonable for my hair color and routine?

Anti-inflammatory medicines applied to the skin, available in solutions, foams, lotions, and creams of different strengths, to calm redness and itch during a flare.

Often considered for flares with clear redness and itching that have not settled with shampoos alone.

Less suitable for long, unsupervised use, especially on the face, eyelids, and skin folds, where skin is thin. Caution with active skin infection. A clinician chooses the strength with age and body area in mind.

Skin thinning, stretch marks, visible small vessels, acne-like bumps, or lightening of skin, which can be more noticeable on brown and Black skin. Flares sometimes return after stopping. Eye-area use needs special care.

Clinicians often look for improvement within days to a couple of weeks; the plan is usually reviewed early.

• Which strength and form fit my scalp, face, or chest?
• What should I watch for on my face and around my eyes?
• What is the plan if the rash returns after I stop?

Antifungal medicines such as ketoconazole or ciclopirox made as creams, gels, or foams for the face, ears, and chest, where shampoos are less practical.

Often considered for seborrheic dermatitis of the face and body, or as a way to limit steroid use.

Less suitable with a known allergy to the product or its base. Some bases, such as alcohol-containing gels, can sting on inflamed skin.

Burning, itching, or redness at the spot where it is applied.

Often judged over 2 to 4 weeks.

• Is an antifungal cream a good fit for my face?
• Could this be used on its own or alongside a shampoo?

Prescription options that calm inflammation without being steroids, such as calcineurin inhibitors (tacrolimus, pimecrolimus) and a roflumilast foam, which has FDA approval for seborrheic dermatitis.

Often considered for the face and skin folds, for long-term control, or when a clinician wants to avoid repeated steroid use.

Less suitable with allergy to an ingredient or active skin infection. Calcineurin inhibitors are often used for seborrheic dermatitis in a way that is not on the label, and they carry boxed warnings that your clinician can explain. Cost and insurance coverage vary.

Burning or stinging when first applied, and warmth or itching. Ask about any other effects specific to the product.

Often judged over several weeks.

• Would a non-steroid option make sense for my face?
• What are the benefits and limits of each option for me?
• Is insurance likely to cover it?

In widespread or stubborn cases, some clinicians discuss a short course of an oral antifungal medicine. These uses are often not on the product label.

Often considered when topical care has not been enough, or the rash covers large areas.

Less suitable with liver disease, pregnancy or breastfeeding, or when taking medicines that interact. Blood tests may be needed.

Stomach upset, liver effects, and drug interactions. Report new yellowing of skin or eyes, dark urine, or unusual tiredness to a clinician.

Judged by a clinician over several weeks.

• Is an oral option reasonable for me?
• What monitoring would I need?
• How would it affect my other medicines?