Understanding Dandruff & Seborrheic Dermatitis in India
Dandruff affects 40-50% of adults globally, with higher prevalence in India due to humid climates, oily scalps, and frequent hair oiling practices. While often dismissed as cosmetic, persistent dandruff signals seborrheic dermatitis—a chronic inflammatory condition driven by Malassezia yeast overgrowth and individual immune sensitivity.
Key differences:
- Simple dandruff: Dry, white flakes; mild itching; scalp-only
- Seborrheic dermatitis: Greasy, yellowish scales; red, inflamed scalp; extends to eyebrows, nasolabial folds, chest
- Scalp psoriasis: Thick, silvery plaques with well-defined borders (often confused with seborrheic dermatitis)
At Ajuda Hospitals Dermatology, we provide IADVL-aligned protocols for scalp health:
- Trichoscopy-guided diagnosis to differentiate dandruff, seborrheic dermatitis, psoriasis, and fungal infections
- Medicated antifungal shampoos targeting Malassezia yeast
- Topical steroids and calcineurin inhibitors for inflammation control
- Maintenance regimens to prevent chronic recurrence
Our multilingual team (Telugu, Hindi, Urdu, English) delivers personalized scalp care rooted in evidence.
When to Consult Our Dandruff & Scalp Care Specialists
⚠️ Seek Expert Care If You Experience:
- ✓ Persistent flakes despite regular shampooing or OTC dandruff shampoos
- ✓ Itchy, red, or greasy scalp with yellowish scales
- ✓ Flaking on eyebrows, ears, chest, or nasolabial folds (seborrheic dermatitis)
- ✓ Hair loss associated with scalp inflammation or burning sensation
Schedule a consultation if dandruff affects your confidence, professional appearance, or if over-the-counter treatments haven't provided lasting relief.
Our Diagnostic Approach
Clinical Examination & Pattern Recognition
Visual inspection and trichoscopy differentiate:
- Dandruff (Pityriasis Capitis): Dry, fine white flakes; minimal inflammation; scalp-only
- Seborrheic Dermatitis: Greasy, yellowish-white scales; red, inflamed patches on scalp, eyebrows, nasolabial folds, chest
- Scalp Psoriasis: Thick, silvery scales; well-demarcated red plaques; often extends beyond hairline
- Tinea Capitis (Scalp Ringworm): Patchy hair loss; black dots (broken hairs); more common in children
Trichoscopy findings:
- Seborrheic dermatitis: Perifollicular scaling, diffuse erythema, fine arborizing vessels
- Psoriasis: Twisted red loops, silvery-white scales, pinpoint bleeding (Auspitz sign)
- Tinea capitis: Comma hairs, black dots, broken hair shafts
KOH Mount (If Fungal Suspected)
Skin scrapings from scalp examined under microscopy:
- Positive hyphae: Tinea capitis (requires oral antifungal, not just shampoo)
- Negative: Confirms seborrheic dermatitis or psoriasis
Trigger & Risk Factor Assessment
- Malassezia yeast: Normal scalp flora; overgrows in oily scalps
- Stress, sleep deprivation: Flares correlate with cortisol surges
- Seasonal changes: Winter dryness and monsoon humidity worsen symptoms
- Hair oils: Prolonged oiling (coconut, castor) feeds yeast growth
- Underlying conditions: Parkinson's disease, HIV, immunosuppression increase severity
Scalp Biopsy (Rare; Severe or Atypical Cases)
Punch biopsy differentiates:
- Seborrheic dermatitis vs scalp psoriasis (histology shows different epidermal patterns)
- Exclude lupus, lichen planopilaris (scarring alopecias)
Treatment Pathways
Our dandruff and seborrheic dermatitis management follows stepped protocols:
Stage 1: Medicated Antifungal Shampoos (First-Line)
Ketoconazole 2% shampoo:
- Mechanism: Antifungal; kills Malassezia yeast
- Protocol: Apply to wet scalp, lather, leave 5-10 minutes, rinse thoroughly. Use 2-3x weekly for 4-6 weeks, then weekly maintenance.
- Effectiveness: Reduces flakes by 70-80%; controls yeast overgrowth
- Alternatives: Ciclopirox 1%, zinc pyrithione 1-2%, selenium sulfide 2.5%
Tips for best results:
- Massage into scalp (not just hair); leave on for contact time
- Rinse thoroughly to avoid residue buildup
- Alternate with gentle, sulfate-free shampoo on non-treatment days
Stage 2: Scale Removal (Coal Tar, Salicylic Acid)
Coal tar 1-2% shampoo or salicylic acid 3% shampoo:
- Mechanism: Keratolytic; dissolves thick, greasy scales (seborrheic dermatitis, scalp psoriasis)
- Use before antifungal shampoo: Descaling improves penetration of ketoconazole
- Caution: Coal tar can darken light hair; may have medicinal odor
Effectiveness: Mechanical removal of scale enhances antifungal efficacy by 30-40%.
Stage 3: Topical Corticosteroids (Inflammation Control)
Betamethasone valerate 0.1% or clobetasol propionate 0.05% scalp lotion/foam:
- Indications: Severe itch, redness, or inflammation unresponsive to antifungal shampoos alone
- Protocol: Apply to dry scalp once daily for 2 weeks, then alternate days or weekends only (pulse therapy)
- Effectiveness: Rapid itch and redness relief within 7-14 days
- Caution: Prolonged daily use can cause scalp thinning, folliculitis; taper to lowest effective frequency
Stage 4: Topical Calcineurin Inhibitors (Steroid-Sparing for Face)
Tacrolimus 0.1% ointment or pimecrolimus 1% cream:
- Indications: Facial seborrheic dermatitis (eyebrows, nasolabial folds, beard area) requiring long-term control
- Advantage: No skin thinning or steroid side effects
- Protocol: Apply thin layer twice daily until clear; then as-needed maintenance
- Mild burning first few days (resolves with continued use)
Stage 5: Oral Antifungals (Severe, Widespread, or Resistant Disease)
Itraconazole 200mg daily for 1-2 weeks or fluconazole 150mg weekly for 4 weeks:
- Indications: Extensive seborrheic dermatitis (scalp + face + chest); failure of topical therapy
- Effectiveness: Systemic yeast suppression; rapid clearance
- Monitoring: Baseline liver function; avoid if liver disease
- Reserve for refractory cases (not first-line due to systemic exposure)
Stage 6: Lifestyle & Hygiene Modifications
Hair care adjustments:
- Reduce oiling frequency: Apply light oils (jojoba, argan) sparingly; avoid overnight heavy oiling (coconut, castor)
- Wash regularly: 2-3x weekly with medicated shampoo (infrequent washing worsens greasiness)
- Avoid harsh shampoos: Sulfate-free, gentle formulations on non-treatment days
Stress management:
- Yoga, meditation, adequate sleep (stress is a major flare trigger)
Diet:
- Anecdotal evidence: Reduce sugar, refined carbs (may feed yeast overgrowth); balanced diet with omega-3, zinc
What to Expect: Your Care Journey
First Visit (30 min)
- Scalp and facial exam with trichoscopy
- Differentiate dandruff vs seborrheic dermatitis vs psoriasis
- KOH mount if fungal infection suspected
- Prescription: Medicated shampoo ± topical steroid/calcineurin inhibitor
- Hair care and lifestyle counseling
2-Week Follow-Up (Telemedicine)
- Assess flake reduction and itch improvement
- Reinforce shampoo technique (leave on 5-10 min for efficacy)
- Adjust steroid frequency or switch formulations if irritation
4-Week Review
- Evaluate clearance; transition to maintenance regimen
- Weekly antifungal shampoo to prevent recurrence
- Address any hair loss concerns (inflammation-related telogen effluvium)
Long-Term Maintenance
- Weekly medicated shampoo to suppress Malassezia yeast
- As-needed steroid (pulse therapy on weekends) during seasonal flares
- Annual check-ups for chronic cases; telemedicine support between visits
Technology & Innovation
Trichoscopy for Precise Scalp Diagnosis
Dermatoscopic scalp examination provides 10-70x magnification to visualize:
- Perifollicular scaling and erythema (seborrheic dermatitis)
- Twisted red loops and silvery scales (psoriasis)
- Comma hairs and black dots (tinea capitis)
Benefits:
- Differentiates look-alike conditions instantly (no biopsy needed in most cases)
- Guides targeted therapy (antifungal vs steroid vs antipsoriatic)
- Monitors treatment response objectively
Telemedicine Scalp Monitoring
- Photo uploads of scalp for remote assessment during treatment
- Prescription adjustments without clinic visits for stable patients
- WhatsApp support for shampoo technique questions or flare management
Preventing Complications
Untreated seborrheic dermatitis causes:
- Chronic inflammation → hair loss: Telogen effluvium from prolonged scalp inflammation
- Secondary infections: Scratching breaks skin → bacterial folliculitis
- Social embarrassment: Visible flakes on clothing affect confidence and professional life
- Scarring (rare): Severe, long-standing inflammation can damage follicles permanently
Our Prevention Strategy:
- Early treatment controls inflammation before hair loss develops
- Maintenance therapy prevents chronic recurrence
- Lifestyle adjustments (reduced oiling, stress management) lower flare frequency
Why Ajuda for Dandruff & Scalp Care?
🔬 Trichoscopy-Guided Diagnosis
Dermatoscopic scalp exam instantly differentiates dandruff, seborrheic dermatitis, psoriasis, and fungal infections—ensuring targeted treatment, not guesswork.
💊 Evidence-Based Protocols
IADVL-aligned stepped therapy combining antifungal shampoos, steroids, and calcineurin inhibitors for rapid clearance and long-term control.
📅 Maintenance Support
Personalized maintenance plans (weekly medicated shampoo, pulse steroids) prevent chronic recurrence and reduce flare frequency by 70-80%.
Take the First Step
Persistent dandruff and seborrheic dermatitis are manageable with proper diagnosis and treatment. Stop the flaking, calm the itch, and restore scalp health with personalized care.
Call 9010550550 or WhatsApp for dandruff and scalp care consultations. Our dermatology specialists are available Monday-Saturday, 9 AM-7 PM, with telemedicine follow-ups for your convenience.
Clear, healthy scalp is achievable—let Ajuda Hospitals guide your journey to lasting relief.