Seborrhea of the scalp and dandruff: causes, medicated shampoos and care in Tashkent

Other names: Себорея, перхоть, себорейный дерматит кожи головы, жирная себорея, сухая себорея, малассезия

Dandruff and seborrheic dermatitis of the scalp are not two different diseases, but different expressions of one process: dandruff is its mild form without obvious inflammation, and seborrheic dermatitis is the same story, but with redness, itching and spread beyond the scalp. The reason for this process is not dirt or dryness, as is commonly thought, but the skin’s reaction to the yeast-like fungus Malassezia, which lives in all people and feeds on the components of sebum. This leads to the main practical misconception that has been preventing people from coping with the problem for years: the belief that the scalp is “dry” and needs to be washed and lubricated with oils less often. In fact, oils feed the fungus, infrequent washing accumulates grease and scales, and the condition only worsens. Proper care is exactly the opposite.

🧾 МКБ-10: L21 🏥 Where it is treated: 4 It's not about dry skinMalassezia fungus is to blameShampoo needs to last

👨‍⚕️ Which doctor

Dermatologist, trichologist

🔬 Diagnostics

Examination, dermatoscopy, Wood's lamp, scraping if in doubt

💊 Treatment

Therapeutic shampoos, external agents, maintenance regime

📈 Prognosis

Well controlled but prone to return

⚠️ At risk

Stress, cold season, hormonal fluctuations, decreased immunity

⏱ When to see a doctor

Planned

🚨 See a doctor urgently

With these signs do not wait for a scheduled appointment — the condition requires emergency care.

Гнойнички, мокнутие, болезненные корки и неприятный запах от кожи головы
У ребёнка — округлый очаг шелушения с обломанными у корня волосами
Быстрое очаговое выпадение волос с образованием проплешин
Плотные бляшки с серебристыми чешуйками, выходящие за линию роста волос, и изменения ногтей
Увеличенные болезненные лимфоузлы на шее и затылке
Внезапно тяжёлая, распространённая себорея, не отвечающая на обычное лечение

Dandruff and seborrheic dermatitis: what's the difference?

Normally, epidermal cells renew themselves in about a month and peel off imperceptibly, one at a time. With the seborrheic process, the renewal is sharply accelerated, the cells do not have time to fully mature and are separated by layers glued together with sebum. This is how visible scales appear. If there is little inflammation, a person sees only white flakes on the shoulders - this is dandruff. If redness, itching, and yellowish greasy crusts are added, we are talking about seborrheic dermatitis, and it often extends beyond the scalp.

The division into “dry” and “oily” seborrhea, familiar from everyday conversations and advertising, is quite arbitrary. We are not talking about two different diseases, but about how much the scales are saturated with sebum: in the so-called dry form they are small, white and easily fall off onto the shoulders, in the oily form they are large, yellowish and sticky, holding on to the skin. The mechanism in both cases is the same, and the treatment is not fundamentally different. It is important to understand this, because it is from the division into “dry” and “oily” that the main harmful advice arose - to moisturize what actually needs to be cleansed.

Dandruff - small dry or greasy flakes, little or no itching, skin not red
Seborrheic dermatitis of the scalp - pink and red spots with flaking, noticeable itching, sometimes yellow crusts
Favorite places besides the head: eyebrows and bridge of the nose, wings of the nose and nasolabial folds, behind the ears and in the ear canal, beard and mustache, center of the chest, between the shoulder blades
The course is chronic, undulating: exacerbations alternate with periods of calm
Exacerbations are typical in autumn and winter, and in the summer in the sun the condition often improves

Себорейный дерматит в наружном слуховом проходе — частая и почти всегда пропускаемая локализация. Человек годами лечит «серные пробки» и зуд в ушах, капает капли, а причина при этом дерматологическая. Если зуд в ушах сочетается с перхотью и шелушением бровей, стоит показаться дерматологу.

What does fungus have to do with it?

Malassezia is a yeast-like fungus that lives in the mouths of the sebaceous glands of almost every adult and normally does not cause any inconvenience. It cannot synthesize the fatty acids it needs and therefore breaks down sebum, taking some components for itself and leaving others on the skin - free fatty acids that have an irritating effect. In people with hypersensitive skin, this triggers inflammation and accelerated renewal of the epidermis.

The disease develops not from the fact that the fungus has “started up”, but from the individual reaction of the skin to its metabolic products
Therefore, seborrhea is not contagious: dandruff cannot be transmitted through a comb, towel or hat
The activity of the sebaceous glands depends on hormones, hence the peak of the problem in adolescence and in adult men
Antifungal agents work precisely because they reduce the number of Malassezia, and not because they “dry out”
It is neither possible nor necessary to completely remove fungus from the skin - the goal of treatment is to keep it under control

Себорейный дерматит нередко становится заметно тяжелее при diseases Паркинсона, после инсульта, при некоторых неврологических состояниях и при выраженном снижении иммунитета. Поэтому внезапно возникшая, распространённая и упорная себорея у взрослого человека — повод не только подобрать шампунь, но и обсудить с врачом общее состояние здоровья.

The Myth of Dry Scalp

Almost every person with dandruff has at least once heard the advice: “Your scalp is dry, mine less often and lubricate it with oil.” This advice almost always makes the situation worse. Firstly, with seborrhea, the sebaceous glands usually work normally or excessively, and the feeling of dryness is created by scales and inflammation, and not by a lack of oil. Secondly, vegetable oils and fatty masks are literally a breeding ground for Malassezia, which lives off lipids. Thirdly, infrequent washing allows sebum and scales to accumulate, increasing both itching and inflammation.

If you have seborrhea, you can and should wash your hair often - at least daily, if it is comfortable; Frequent washing does not increase oiliness
Oil wraps, burdock and coconut oil are usually harmful for seborrheic dermatitis
A feeling of tightness often indicates irritation and too aggressive shampoo, rather than dryness.
Hard water itself does not cause dandruff, although it can increase discomfort.
Dandruff is not associated with uncleanliness: it occurs in people who wash their hair daily
Scratching and tearing off scales with nails increases inflammation and provokes the addition of bacteria

Настоящая сухость кожи головы тоже существует, но выглядит иначе: очень мелкие светлые чешуйки, стянутость, отсутствие покраснения и жирного блеска, часто на фоне сухой кожи всего тела и зимнего отопления. Отличить её от себореи может дерматолог при осмотре — и подход к уходу в этих двух случаях действительно разный.

What causes exacerbations

Psycho-emotional stress and lack of sleep are one of the most noticeable triggers; exacerbation often occurs one to two weeks after a stressful period
Cold season, dry heating air, wearing thick hats
Hormonal fluctuations, adolescence
Excess simple carbohydrates and alcohol in the diet - the connection is not direct, but many patients note it
Aggressive shampoos, varnishes, foams, frequent coloring
Rare washing and attempts to treat your hair with oils
Concomitant diseases and taking medications that reduce immune defense

Understanding your own triggers is important because seborrheic dermatitis is a chronic condition. The realistic goal of treatment is not to “get rid of it forever,” but to put the disease into long-term remission and know how to quickly extinguish an exacerbation when it does begin.

When it's not dandruff at all

Peeling of the scalp is caused not only by seborrhea, and it is not always possible to distinguish the conditions by eye. A mistake here is costly: for example, a fungal infection received from an animal, when treated with ordinary dandruff shampoo, will quietly progress and lead to persistent baldness in the area.

Psoriasis of the scalp - dense plaques with silvery scales, often extending beyond the hairline to the forehead and neck; There are often changes in the nails and rashes on the elbows and knees
Microsporia and trichophytosis are a contagious fungus, most often in children and from cats and dogs: a rounded lesion with peeling and hair broken off near the skin. Requires Wood's lamp examination, scraping, and systemic treatment
Atopic dermatitis - severe itching, dryness, damage to the folds, usually begins in childhood
Contact dermatitis - a reaction to hair dye, shampoo, mask; appears after changing the product
Pediculosis - nits are firmly glued to the hair and do not shake off, unlike dandruff flakes
Folliculitis and abscess lesions are painful pustules that require different treatment

Отдельный вопрос — выпадение волос. Сам по себе себорейный дерматит редко приводит к стойкому облысению, но зуд, расчёсы и хроническое воспаление могут усиливать временное диффузное выпадение. Часто у пациента параллельно идёт андрогенетическая алопеция, и её нужно лечить отдельно: устранение перхоти само по себе не остановит поредение волос.

Medicinal shampoos: composition and how to use correctly

A medicated shampoo is not a cosmetic, but an external medicinal product, and it only works when used correctly. There are several key active ingredients, and they act in different ways: some suppress the fungus, others reduce inflammation, and others dissolve dense scales.

Ketoconazole and other antifungal agents - act directly on Malassezia, the basis of treatment
Ciclopirox - antifungal action in combination with anti-inflammatory
Zinc pyrithione is an antifungal and antibacterial component, well tolerated
Selenium disulfide - reduces peeling and fungal growth
Salicylic acid - dissolves and exfoliates thick crusts, helps other components penetrate the skin
Coal tar - reduces flaking, useful when combined with psoriasis
External anti-inflammatory drugs - prescribed by the doctor in a short course for severe inflammation

Наносите шампунь на кожу головы, а не на длину волос: лечится кожа, а не волосы.
Распределите средство подушечками пальцев по всей поверхности, включая затылок и область за ушами, которую обычно пропускают.
Выдержите не менее трёх-пяти минут. Это тот самый шаг, который пропускают чаще всего, и именно из-за него средство «не работает».
Тщательно смойте; при необходимости вымойте длину обычным мягким шампунем.
В период обострения применяйте лечебный шампунь 2-3 раза в неделю, обычно 3-4 недели.
После стихания симптомов не бросайте: переходите на поддерживающий режим — примерно раз в неделю или раз в две недели, длительно.
При привыкании и снижении эффекта имеет смысл чередовать средства с разными действующими веществами по схеме, подобранной врачом.

Conventional anti-dandruff cosmetic shampoos from the mass market contain the same substances, but often in significantly lower concentrations, and therefore are suitable for maintaining the result, and not for treating an exacerbation. Washing your hair with them instead of a remedy is about the same as treating pneumonia with cough drops: pleasant, but essentially useless. A reasonable scheme looks like this: first, a course of medication until the symptoms subside, then a long-term maintenance regimen, and between uses, any mild shampoo to taste. And one more detail that is almost never talked about: with seborrheic dermatitis, all affected areas need to be treated, not just the head. If you ignore the eyebrows, wings of the nose and the area behind the ears, the feeling of incomplete results will remain.

Себорейный дерматит возвращается у большинства людей в течение нескольких недель или месяцев после полной отмены ухода — и это не признак неудачного лечения, а естественное течение хронического состояния. Именно поэтому поддерживающий режим важнее, чем интенсивность лечения в момент обострения.

Frequently asked questions: Seborrhea of the scalp and dandruff

Is dandruff a fungus or dry skin?+

Neither one nor the other in its pure form. This is a skin reaction to metabolic products of the Malassezia fungus, which normally lives in all people and feeds on sebum. The feeling of dryness is caused by scales and inflammation, while the sebaceous glands often work normally or even excessively. Therefore, moisturizing with oils does not help, but antifungal shampoos do.

Is it possible to wash your hair every day if you have dandruff?+

Yes, and during an exacerbation it is rather useful. Frequent washing removes excess oil and flakes, reducing irritation, and does not make hair greasy. It is only important not to use aggressive products and not to rub the skin with your nails.

Does burdock or coconut oil help?+

With seborrheic dermatitis it is usually not, and often harmful. Malassezia uses lipids as a nutrient medium, so fatty masks create favorable conditions for it. Oils make sense for true dry scalp, which a dermatologist can distinguish, but this is a different condition.

Why doesn't medicated shampoo help?+

The most common reason is that it is washed off almost immediately. The active substance must be in contact with the skin for at least three to five minutes, and it should be applied to the skin, and not to the length of the hair. Other reasons are too short a course, lack of a maintenance regime and incorrect diagnosis: psoriasis, microsporia or contact dermatitis may be hidden under dandruff.

Is dandruff contagious?+

No. Seborrheic dermatitis is not transmitted through combs, towels, hats or contacts. The Malassezia fungus is already present on the skin of all people, and the disease develops due to the individual reaction of the skin. Another condition that is contagious is microsporia, which is obtained from animals, and it looks different.

Does dandruff cause hair loss?+

Seborrheic dermatitis itself rarely leads to permanent hair loss, but chronic inflammation and scratching can exacerbate temporary, diffuse hair loss. If the hair is noticeably thinning in a certain pattern, most often there is androgenetic alopecia in parallel, and it is treated separately. Trichoscopy helps to figure it out.

The information on this page is for reference only and does not replace a doctor consultation. Only a qualified specialist can make a diagnosis and prescribe treatment after an in-person examination.

Where it is treated seborrhea of the scalp в Ташкенте

Самая частая причина фразы «лечебный шампунь мне не помог» — не состав средства, а то, что его смывают через двадцать секунд: действующему веществу просто не хватает времени подействовать на кожу. Приём дерматолога и трихолога, дерматоскопия и подбор ухода в Ташкенте: