INDIVIDUAL ARTICLE: Etiology, Treatment Challenges, and the Role of Scalp and Haircare in Managing Dandruff

February 2025 | Volume 24 | Issue 2 | s8 | Copyright © February 2025


Published online January 31, 2025

Maria Hordinsky MD FAADa, Anneke Andriessen PhDb, Doris Day MD FAADc, Amy McMichael MD FAADd, Natasha Mesinkovska MD FAADe, Heather Woolery-Lloyd MD FAADf

aClinical Research Division, Department of Dermatology, University of Minnesota, Minneapolis, MN
bUMC Radboud, Nijmegen, Andriessen Consultants, Malden, The Netherlands
cDirector, Day Dermatology and Aesthetics, New York, NY
dDepartment of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC
eDepartment of Dermatology, University of California Irvine, Irvine, CA
fDirector, Skin of Color Division Dr Phillip Frost Department of Dermatology and Cutaneous Surgery University of Miami Miller School of Medicine, Miami, FL

Abstract
Dandruff and seborrheic dermatitis are associated with a disrupted scalp barrier that contributes to irritation, pruritus, and flaking of the scalp. The flaking and itch associated with dandruff can significantly impact an individual's self-esteem and quality of life. While the exact pathogenesis of dandruff is still not completely understood, scalp barrier health and its microbiome are thought to play significant roles in disease propagation. Five expert dermatologists with extensive experience in hair, dandruff, and seborrheic dermatitis were selected to participate in discussions that would result in five consensus statements focused on scalp barrier health and dandruff. Results of a systematic literature search and expert panel discussion are presented. These consensus statements aim to reflect expert opinions on the current understanding of scalp health in the context of dandruff and seborrheic dermatitis. The panel addressed challenges to promote scalp health, improve patient comfort, and prevent flares during dandruff management and maintenance. The presented consensus statements urge reframing our current understanding of dandruff and seborrheic dermatitis treatment by refocusing attention on global scalp and hair health.

J Drugs Dermatol. 2025;24:2(Suppl 1):s8-14.

INTRODUCTION

Dandruff and seborrheic dermatitis (D/SD) affect about half of the general population worldwide.1 SD in the scalp is commonly known as dandruff and is considered the same condition with varying degrees of severity.1 Dandruff appears more prevalent among males, suggesting a potential androgenic component to pathogenesis.1,2 D/SD commonly affects younger individuals between the ages of 18 and 24, with greater frequency in those over the age of 55 or under the age of 17.1 Furthermore, SD occurs at a higher prevalence in immune-comprised populations, including patients with HIV/AIDs, neurological or psychiatric conditions (eg, Parkinson's disease, depression, brain and spinal cord injuries) lymphoma, and organ transplant recipients.1

Dandruff is characterized by white and yellow flaking on the scalp and hair.1,3 It can be associated with pruritus and irritation that may also be present on the forehead adjacent to the hairline, eyebrows, and retro-auricular areas.1 An itchy scalp can significantly impair patient quality of life and may be detrimental to a person's self-esteem. It has been estimated that Americans spend $300 million annually on over-the-counter (OTC) products to treat dandruff-associated flaking and scalp itching.3
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