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Mack Rachal, MD, PhD:

Generally you want to shampoo three to five times a week, and you want to use a series of anti-dandruff shampoos that have distinct agents.

Anna Pare, MD:

Usually a patient would reach for over-the-counter products to begin with.

Jamie MacKelfresh, MD:

Salicylic acid is a common ingredient you may find in an over-the-counter dandruff shampoo. It really works by decreasing the amount of flaking and scale buildup on the scalp.

Anna Pare, MD:

One of the components of the over-the-counter shampoos is Pyrithione zinc, and that's a common component used to decrease inflammation, which will result in reduced itching on the scalp.

Jamie MacKelfresh, MD:

It helps by being antibacterial and antifungal. We know there are some common skin yeast that live on the scalp, and in some patients they overreact to those. Selenium sulfide works by both decreasing the amount of flaking that you have and also may help decrease some of those yeast that live on the scalp.

Anna Pare, MD:

Coal Tar is an interesting element that's used in many different scaling conditions and in different percentages affects the turnover of skin cells as well. So the build-up that you see and the flaking that you see is significantly reduced by coal tar. It used to be not a very elegant element of the product, but now through pharmaceutical marvel it's a very effective treatment. Using two different sources of control -- one that would reduce the cell turnover and one that would reduce the yeast element -- would be very reasonable.

Mack Rachal, MD:

Seventy percent can be controlled with over-the-counter remedies and you don't have to write a prescription. If it's not responding to over-the-counter medicines, that's the time you want to seek attention.

Lanier Mull, R Ph:

The first line of therapy are the antifungals and you have ketoconazole and ciclopirox.

Mack Rachal, MD:

The ketoconazole can be at 2% and that requires a prescription. The 1% preparation is over-the-counter.

Lanier Mull, R Ph:

Sometimes the problem needs a little bit more of a powerful component, and the doctor wants to give a steroid. There are a lot of steroids. Clobetasol is probably the most popular one. The reason you have these different forms is it just gives people more of a choice in treatment.

Mack Rachal, MD:

I would say to keep it simple. We call it KIS. The easiest, simplest regimen that's going to keep the dandruff under control is the best regimen. It's a chronic process. It comes and goes. You cannot cure it.