Hoffmann R
Dermaticum, Practice for Dermatology, Freiburg i. B., Germany

While the actual cause of dandruff is not definite, the proposed etiology focuses on microinflammation with increased cellular activity and pathologic cornification, and on microbial involvement, though sebaceous gland secretions appear to also play a role. It is however well established that yeast-like organisms (Malassezia spp.) are involved. Shampooing is the most frequent form of hair and scalp treatment. The diversity of qualities expected from shampoos surpass the primary function of cleansing. Current shampoo formulations are not only adapted to the variations associated with hair quality and hair care habit, but also to specific problems related to the superficial condition of the scalp. Recommendations for the treatment of the scaling scalp include (1) exclusion or treatment of underlying specific dermatological diseases, such as eczema (seborrhoic eczema, atopic dermatitis, contact dermatitis), psoriasis, and lesser common diseases (tinea capitis, chronic cutaneous lupus erythematosus, pemphigus foliaceus, histiocytosis), (2) adaptation of shampooing frequency to the condition of the scalp (dry or greasy), (3) choice of non-irritating shampoos, and (4) generous rinse with water. Current antidandruff ingredients of shampoos with proven efficacy are virtually all antimicrobial agents: selenium disulfide, zinc pyrithione, octopirox, and ketoconazole. Constant research to find new formulas is at the root of the progress of shampoo technology. For example, micronization of the anti-dandruff agent zinc pyrithione has enhanced its efficacy with shorter contact time. Hand in hand, test methods are developed to evaluate the efficacy, so physicians and patients are offered reliable products that perform as claimed. Management of specific dermatologic diseases underlying scaling of scalp will be discussed further in detail.