The appearance of dandruff in adolescents is a very common problem, which creates a social stigma for the affected individual. Current convention suggests that the overcolonization of a yeast organism is responsible in part for the condition. But host factors are also clearly in play, as everyone has this colonization, but not everyone has dandruff.

The interplay between the colonization and the host response forms the symptomatic treatment approach to seborrheic dermatitis. Topical antifungal agents such as ketoconazole can depress the level of colonization. The addition of a mild topical corticosteroid within the antifungal agent can suppress the itch. In my experience, you need to tackle both parts of this equation for the best response.

That being said, there are circumstances where the above approach doesn’t help. So, rather than try to decolonize the surface, one can try to starve the organism. Since the yeast gets its nutrition from the oil coming from the sebaceous glands, one can change the composition of the sebum through the use of low-dose isotretinoin. While this use is off-label, it can be effective in cases where the topical antifungals have been unhelpful.

If none of these treatments are effective, then one must consider the possibility that the diagnosis is incorrect. A close inspection or referral to a dermatologist may be needed to rule out other conditions such as tinea capitis or psoriasis.

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