Dandruff

Question 1

Dandruff

Answer 1

Common relapsing skin condition of the scalp.

Question 2

Symptoms

Answer 2

Greyish-white flakes or scales on the scalp
Dry/itchy scalp
Seasonal - generally, improvement in summer

Question 3

What should you ask?

Answer 3

CAP-SLAM
Appearance
Presence of scales
Colour/texture of scales
Location
Severity
Aggravating factors
Medications

Question 4

Aggrevating factors

Answer 4

Stress
Cold weather
Hair dyes/perms
Not washing shampoo off correctly

Question 5

Differential diagnosis

Answer 5

Seborrheic dermatitis
Tinea capitis (ringworm)
Eczema
Contact dermatitis
Psoriasis
Cradle cap

Question 6

Referral

Answer 6

Treatment failure - no improvement after 1 month.
Severe itchiness/dandruff
Red or swollen scalp
Flaky, itchy patches elsewhere e.g. face

Question 7

Treatment

Answer 7

Nizoral

Question 8

Treatment timescale

Answer 8

Can take around 12 weeks to work.

Question 9

Nizoral

Answer 9

Ketoconazole 2%
Adults and children over 12
Safe in P + BF
Leave on scalp for 3-5 minutes, then wash off.

Question 10

Non-pharmacological advice

Answer 10

Treatment does not cure it - frequent use is sensible i.e. at least once every 2 weeks after remission.
Make sure you apply to scalp NOT just hair
Frequent hair washing