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Ask DermDoc Your Own Question
DermDoc, Doctor
Category: Dermatology
Satisfied Customers: 16516
Experience:  M.D with over 30 years of experience in practice.
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My daughter for years has had a terrible flaky scalp,

Customer Question

My daughter for years has had a terrible flaky scalp, doesn't itch but its covered in thick white scales, particularly bad at the back of her head and behind her ears. I can shake her hair and be able to draw a picture on the floor where the dandruff falls. She's now 13 and her blazer is constantly covered in it no matter what I do and she's so down about it. I've tried salicylic acid, tgel, serums etc nothing helps. Please help
JA: How long have you been dealing with the ear issue? Have you had any colds or flus recently?
Customer: Years, no
JA: Is there anything else the Doctor should know before I connect you? Rest assured that they'll be able to help you.
Customer: No
Submitted: 5 days ago.
Category: Dermatology
Expert:  DermDoc replied 5 days ago.

Hello and thanks for trusting me to help you. I am a board-certified consultant with over 30 years of experience.

And I would serve you with care and patience.

First I need to ask a few questions so that I can gather more information related to your health concerns; I am preparing & typing the questions now, and I will follow up with you.

Expert:  DermDoc replied 5 days ago.

I am sorry to hear about your problem.
We can continue our conversation now through text in this reply forum.
Please provide more information regarding your question so I can help you in detail.


Hair fall?

Does this problem only affect her scalp or also her face in areas like the eyebrows and near the sides of the nose?

Did you give any medications?

Any medical history?

Waiting for your response.

Customer: replied 5 days ago.
Hi there thank you. No itching, no hair fall, not her face, I dont give her meds, medical history clear. Thanks
Expert:  DermDoc replied 5 days ago.

Respected customer

Thank you for providing the details. I can understand your concern and worry.

In the meantime, you can give more info regarding this issue.

Please allow me just a few minutes.
I’ll reply to you back soon after reviewing it.

Thanks for your cooperation and patience.

Expert:  DermDoc replied 5 days ago.

Sorry for the late reply and inconvenience.

Thanks for all this additional information.

I understand your concern.

And it’s my first privilege to pay attention and provide you with explanations and suggestions to relieve your discomfort/ worry.

Well as you describe, it sounds like Seborrheic Dermatitis. Seborrheic Dermatitis (SD) is a type of eczema where the body loses tolerance for a yeast called Malassezia (which is present normally on all our skin) and starts attacking it leading to scaling. The scalp, head & neck area, and the upper trunk, ears are the sites prone to the condition.

The first-line treatment for SD is a mid potent prescription steroid-like Mometasone along with Lamisil cream/lotion applied in a tapered manner over 2-4 weeks along with a skin moisturizer and an anti-yeast soap or shampoo.

Once this is tapered Pimecrolimus cream or Tacrolimus ointment/lotion can be started for patients who get frequent recurrences and these can be continued for 6-8 weeks to prevent the chances of an immediate flare.

These are prescription meds and would need to be discussed with your doctor in person.

Now, I would recommend some self-care measures and you can follow them to get some relief.

Try Nizoral-AD shampoo: apply and leave for 5 minutes on the scalp and 30 seconds on the eyebrows and face areas with dandruff. Do this every alternate day. Use regularly for 4-6 weeks then start decreasing the frequency of application gradually till you reach once/twice a week and maintain.

If one type of shampoo does not improve symptoms after four to six weeks, a different shampoo may be tried.

Head and Shoulders Classic Clean Dandruff Shampoo.

Free & Clear Sensitive Skin Shampoo.

Giovanni Invigorating Tea Tree Shampoo.

Dove Dermacare Scalp Anti-Dandruff Shampoo.

Neutrogena T/Sal Shampoo Scalp Build-Up Control.

Kamedis Anti-Dandruff Therapy Shampoo.

Omega 3 capsules and Biotin tablets are helpful supplements in the condition.

Avoid any hair oil or greasy substance application on the scalp/hair.

Cut down on fried and processed food in her diet.

Sorry to say about Seborrheic Dermatitis is that there is, unfortunately, no cure. Come winter or other trigger factors like season change, things like mental or emotional stress, and the condition can flare up.

Some people have the problem all year round without any apparent trigger factors.

General stress-reduction measures also go a long way in preventing frequent flares.

For severely affected patients oral suppressive antifungal treatment is required - Cap Itraconazole 100 mg twice a day for 7 days followed but 100 mg twice a day on the first two days of every month for a year.

This requires a prescription.

Flaking can also be caused by a condition like scalp psoriasis. In that case, your doctor will recommend other treatments.

See a dermatologist in person.

Hope I have been able to clarify the situation for you and helped in resolving your query.

Let me know if you have any further queries so we can discuss it thoroughly in every aspect.

It’s my pleasure to continue this conversation until you satisfy.

Waiting for your response.


Customer: replied 5 days ago.
Can you prescribe these things?
Expert:  DermDoc replied 5 days ago.

Thanks for replying back.

I understand your concern.

Most of the measures/ items are available over the counter.

If you can't get them then you need to get a prescription from your doctor in person.

Unfortunately, Just Answer does not provide Antibiotic Prescriptions.

I am happy to answer follow-up questions - please do get in touch with extra information or further queries and I will do my best to help you.