Seborrhoea and Dandruff Treatment in Ukraine

Dandruff and seborrhoeic dermatitis are different degrees of the same process. Dandruff is its mildest form: fine flaking of the scalp without noticeable redness, sometimes with itching, not spreading beyond the hair-bearing area. Seborrhoeic dermatitis is the same process with inflammation: pink or reddish patches with yellowish greasy scales, which often also appear on the eyebrows, the sides of the nose, behind the ears and on the chest.

Three factors are involved. The first is yeast-like fungi of the genus Malassezia, which live on the skin of practically everyone and feed on the fatty acids in sebum. The second is the sebum itself: the fungi break down its triglycerides and leave free fatty acids behind. The third, and decisive, factor is the skin's individual reaction to these products: in most people it is neutral, but in some it triggers inflammation and accelerated shedding of the skin. That is why seborrhoea is not contagious: the issue is not the presence of the fungi but the response to them.

There are dry and oily forms. In dry seborrhoea the scales are fine and white and easily fall onto the shoulders, the skin feels tight and the hair is dull and brittle. In the oily form the scales are larger and yellowish, stick together into crusts and stay on the skin, the hair gets greasy quickly and itching is more often a problem. The form guides the choice of product: ketoconazole and selenium sulphide suit the oily form, while the dry form calls for gentler regimens, because aggressive degreasing increases flaking.

Seborrhoea comes in waves, and flare-ups have their own triggers: prolonged stress and lack of sleep, the cold season with dry indoor air, hormonal fluctuations in puberty, during pregnancy and in menopause, and certain medicines. Severe, treatment-resistant seborrhoeic dermatitis can accompany neurological conditions such as Parkinson's disease, the after-effects of stroke or facial nerve palsy, as well as weakened immunity. If the course is unusually severe, the doctor looks for such an underlying condition rather than simply changing the shampoo.

MediUkraine is a service that finds and coordinates treatment; it is not a clinic. We select the medical centre and a dermatologist, agree the appointment date and support you throughout, including if you travel from abroad. The doctor makes the diagnosis and prescribes the regimen after an in-person examination.

Treatment has two stages, and it helps to understand this before you buy anything at the pharmacy. The attack stage is intensive use of the product two to three times a week for two to four weeks, until the flaking, redness and itching have gone. The maintenance stage is the same, but less often, once a week or twice a month, and it lasts for months. Most failures happen because people stop everything as soon as the scales disappear, and three to four weeks later the symptoms return.

Ketoconazole in a 2% shampoo has the strongest evidence base for seborrhoeic dermatitis of the scalp. It suppresses the growth of Malassezia and reduces inflammation: in the attack regimen it is used twice a week, then once every one to two weeks to maintain remission. The 1% form is usually available without a prescription, the 2% form on a doctor's prescription.

Ciclopirox (1–1.5%) has a broader antifungal spectrum and in studies is comparable to ketoconazole in effectiveness, so it is used as an alternative if there is irritation or the usual regimen works less well. Zinc pyrithione (1–2%) is weaker, but gentle and suitable for long-term use, including in the dry form. Selenium sulphide (2–2.5%) degreases well and suits oily seborrhoea, but it can change the shade of dyed or bleached hair and leave a smell. Tar shampoos reduce flaking and itching, but they stain light hair, have a characteristic smell and increase the skin's sensitivity to the sun.

How you wash matters as much as which bottle you choose. Apply the product to the scalp, not along the length of the hair, spread it with your fingertips and leave it on for 3–5 minutes, the time the active ingredient needs; rinsing it off straight away like an ordinary shampoo turns treatment into a cosmetic routine. Between medicated washes you can use an ordinary mild shampoo, even daily: frequent washing does not increase flaking, because it is the sebum and scales left on the skin that feed the process. If a product stops working, the doctor alternates active ingredients rather than increasing the frequency.

Topical corticosteroids, as lotions, foams or solutions, are prescribed as a short course when redness and itching are too severe to wait for the antifungal to work. This is usually up to two weeks, with a gradual reduction in frequency. Steroids must not be used to maintain remission: long-term use thins the skin, dilates blood vessels and causes a flare-up as soon as they are stopped.

On the face (the eyebrows, the sides of the nose, the nasolabial folds and behind the ears), calcineurin inhibitors such as tacrolimus or pimecrolimus are more often used instead of steroids. They relieve inflammation without the risk of skin atrophy, so they are suitable for repeated courses in areas of thin skin. A burning sensation may occur in the first days and fades after a few applications; avoid strong sun during treatment.

Systemic antifungals such as itraconazole or fluconazole are used only when indicated, not routinely. They are considered for widespread involvement, a severe flare-up or a lack of response to topical therapy when the diagnosis has been confirmed. The course is short and is followed by topical products; before prescribing, the doctor reviews all the medicines you take: itraconazole interacts with many drugs, including statins and certain antiarrhythmics, and is not used in pregnancy.

The process rarely stays confined to the scalp, so the regimen covers all affected areas. For the face and body, creams with ketoconazole or ciclopirox are used; for skin folds, short courses of anti-inflammatory products; for the chest and back, the same shampoo used as a body wash and left on for a few minutes. Skin care is part of the plan too: gentle cleansing without alcohol or harsh detergents, no scrubs on inflamed skin, and a cautious approach to sun exposure, which helps some patients and triggers flare-ups in others.

The key point, stated plainly: seborrhoeic dermatitis is a chronic relapsing disease. Treatment controls it well, and the skin stays calm for weeks and months, but the predisposition does not go away. Flare-ups come back, most often in autumn and winter, or during stress or illness. The sensible goal is to keep the condition under control with minimal treatment, not to search for a regimen that ends flaking for ever.

A note on the link with hair loss. On its own, seborrhoea rarely leads to permanent baldness: it does not destroy the follicles, and flaking and thinning often simply coincide in time. However, itching, scratching and chronic inflammation increase the amount of hair that falls out and make the hair shafts more brittle; once the inflammation is relieved, the loss usually decreases within a few weeks. The reverse also matters: while the scalp is inflamed, other methods work less well. Minoxidil solution irritates it further, injection treatments are postponed while the skin is inflamed, and the effect of hair loss therapy is hard to judge when the scalp is flaking. So when both problems are present, the doctor first calms the inflammation and only then deals with the cause of the thinning.

Itching and redness subside first, usually within a few days of starting a correctly chosen regimen. Flaking recedes more slowly: a noticeable reduction in scales is seen after 2–4 weeks of regular use of the product.

The attack stage is assessed properly after four weeks. If the skin is calm, the doctor moves you to the maintenance regimen and explains which signs mean you should return to more frequent use. Do not stop everything at once: this is when relapse most often occurs.

If there is no change after four weeks, that is a reason to review the diagnosis, not to double the dose. Scalp psoriasis, fungal infection, and atopic and contact dermatitis can masquerade as seborrhoea; in that case a scraping is taken, sometimes a biopsy, and the regimen is changed completely.

A flare-up after remission is an expected part of the course, not a failure of treatment. Flare-ups most often come in the cold season, at a time of stress or during illness. The approach is simple: return to the attack regimen for two to three weeks, then switch back to maintenance; do not wait for the flaking to become severe.

Hair responds more slowly than skin. Increased shedding caused by itching and inflammation usually decreases within one to two months of the skin calming down, and changes in hair density are assessed no sooner than 3–6 months, by comparing trichoscopy images of the same areas.

For patients from abroad, follow-up can conveniently be done remotely: you keep the report, the images and the written regimen, and if needed MediUkraine arranges a video consultation with the same doctor. The decision to switch to maintenance does not always require an in-person visit.