Dandruff is a very common problem we frequently tackle here on The Doctors. Take a look. We received an email from Jocelyn, it reads, “Dear Docs, I have a terrible problem with dandruff! It’s so out of control: in the morning, it’s all over my pillow when I wake up, and all day long I feel like my clothes are covered. I’m itchy all the time. My colleagues at work always ask me when the last time I washed my hair was! What’s the best way to treat extreme dandruff?” Good question. It is a good question. And so when we talk about dandruff, the formal medical name for that is actually something called seborrheic dermatitis, which is an overgrowth of a normal yeast that lives on our skin so it’s meant to be there. It’s called pityrosporum, or malassezia. So when you have an overgrowth of this yeast, it often really causes these red, scaly, flaky patches because your body then mounts an immune response to it. And this is a pretty severe case when you see tremendous scale like this. My only concern about this is sometimes when you already have a lot of inflammation on your scalp, it actually disrupts the normal immune response and you can sometimes even get a secondary bacterial infection. So for Jocelyn, what I would probably recommend is she does see someone, and make sure they do a culture swab and just ensure it’s only the normal yeast that’s meant to be there. Because I actually saw a case like this where, it was actually a child and she had this horrible, horrible what they kept calling cradle-cap, and treating it like seborrheic dermatitis, and we did a swab and it was actually staph aureus bacteria that had colonized in a secondary way. So for really severe cases like this, I do think it’s worth evaluating. Now Jocelyn did give us more information, turns out she’s tried a whole bunch of different things for this. Everything from oils, to Listerine, to tea tree oil, to over the counter dandruff shampoos, and sometimes I do think with seborrheic dermatitis, this happens a lot, where people keep throwing oils at it because they think it’s dry and flaky and that’s going to help. But interestingly the yeast that causes this feeds on oil so you’re really just feeding it and fueling the fire if you do that. So one of the better options would be over the counter I think zinc or selenium are the best over the counter ingredients to look for in shampoos. But in her case I know she’s tried one prescription strength shampoo that has something called ketoconazole, it didn’t work very well for her. I would try a different one called ciclopirox which is a prescription strength one that any doctor can actually take a look and, if appropriate, prescribe. I think also looking at her photos, she does have twists which are synthetic hair mixed in with her natural hair. That’s what was giving it that look, okay. Exactly. And so I think a lot of times with people with synthetic hair mixed in, it can also trigger some inflammation. So there may be more than one thing going on here, but certainly Jocelyn, what we would recommend, is do see someone, make sure it’s only seborrheic dermatitis. And if it is, maybe up the ante to a different prescription strength product for it. Well I hope she gets some help. Yeah and then maybe give the synthetics a rest How long after you start a shampoo will you be able to tell if it’s effective? Or you should move on to the next possible treatment? Oh it’s pretty quick, actually. Yeah you would notice within weeks. Jocelyn, we wish you the best of luck with treating this.