Medical Edge Newspaper Column

Dandruff Control Requires Regular Treatment

Jan. 22, 2006
DEAR MAYO CLINIC:
For several months, I had terrible scalp itch. I tried everything in my medicine cabinet, kitchen cabinet and under the sink (from white vinegar to cortisone cream). I found a tube of antifungal cream with tolnaftate in my boyfriend's cabinet, and I put it on my scalp. The next day, my skin was better! Then I read the label. It said, "Do not use on the scalp." Why can't I use this cream on my scalp? -- Longview, Wash.

ANSWER:
Scalp itching can have a variety of causes, but your prompt response to an antifungal cream raises the likely possibility that you have seborrheic dermatitis -- commonly known as dandruff. Many patients believe that to have dandruff they must see obvious white flakes on their hair or clothing. In fact, seborrheic dermatitis may involve significant itching with little scaling.

One current theory holds that seborrheic dermatitis is caused by an immune reaction to a fungus growing on the skin. This theory is based on the fact that many people who have seborrheic dermatitis respond well to topical antifungals. The antifungal cream containing tolnaftate you used will not harm your scalp or hair. The manufacturer discourages you from using it on your scalp, though, because it is not reliable in treating other fungal infections involving the scalp.

Most physicians recommend antidandruff shampoos or liquids, rather than creams or ointments, because of cosmetic effects -- creams or ointments often mat down hair unattractively. In general, all antidandruff shampoos have antibacterial and antifungal ingredients. Given your quick response to the antifungal cream, you may have the best results with an over-the-counter shampoo containing ketoconazole (brand name Nizoral), another antifungal medication. Tolnaftate (brand name Tinactin) is not available as a shampoo.

Because seborrheic dermatitis is usually a chronic problem, you will likely need to treat your scalp regularly to keep it under control. Many patients have success by using an antidandruff shampoo several times per week.

-- James Yiannias, M.D., Dermatology, Mayo Clinic, Scottsdale, Ariz.