Seborrheic Dermatitis (Dandruff)

Seborrheic dermatitis (dandruff) is a chronic inflammatory process due to Malassezia yeast overgrowth that affects 3–5% of the population.

It can occur on the scalp, on the foreheads, around the nose, behind the ears, chin, and chest. It can cause red or light greasy, scaly patches on the affected skin. It can worse by stress, cold, dry weather, decreased immunity and certain neurologic conditions.

Treatments include prescription or over the counter anti-yeast or anti-inflammatory preparation (creams and or shampoos). One recent study demonstrated that Kombucha, a fermented tea contains probiotics may have positive therapeutic implications for the resolution of seborrheic dermatitis.

When using shampoos for seborrheic dermatitis look for active ingredients that are anti-inflammatory and anti-yeast such as coal tar, ketoconazole, selenium sulfide, or zinc pyrithione.

Although anti-yeast/ dandruff shampoos can be very helpful for the scalp condition, they can be very drying to the hair. This is especially problematic for natural and/or color-treated hair as many preparations (particularly prescription shampoos) contain sodium lauryl sulfate.

TIP: If you are going to use these #shampoos, make sure that you pre-poo (apply conditioner and maybe an oil to the length of the hair before applying the shampoo) the hair SHAFT and apply the shampoos only to the SCALP (like you are "greasing your scalp with the shampoo"). Avoid widespread use of these shampoos on the hair shaft as this may result in dry brittle hair. This will help to protect the hair Apply shampoos once two twice a week and allow to sit on the scalp for 5-10 minutes and follow up with a deep condition.

Always consult with a dermatologist to rule out other scalp issues and discuss the best treatment options


Mahmoudi E, Saeidi M, Marashi MA et al. In vitro activity of kombucha tea ethyl acetate fraction against Malassezia species isolated from seborrhoeic dermatitis. Curr. Med. Mycol. 2016;2:30–6.

Maarouf M, Platto JF, Shi VY. The role of nutrition in inflammatory pilosebaceous disorders: Implication of the skin-gut axis. Australas J Dermatol. 2018 Sep 3.

Clinical Trial Alert: Apremilast

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Apremilast is phosphodiesterase 4 (PDE4) inhibitor that reduces pro-inflammatory cytokine production.

The brand name is Otezla® and is FDA approved for moderate to severe plaque psoriasis and psoriatic arthritis.

Due to its mechanisms for immune modulation and suppression and it relatively good safety profile, it has also been tested in various types of inflammatory alopecia.

Published Data

Alopecia Areata (AA)

Alopecia areata is an non scarring autoimmune condition hair loss condition. Although the exact cause of AA has not been identified, various immune system abnormalities have been identified including (1):

  • increased PDE4 in human scalp lesions of AA patients

  • hair regrowth in a humanized AA mouse model after treated with apremilast.

It is typically treated with various topical and oral anti-inflammatory medications. There have been three recently published studies, including one randomized placebo-controlled single-center investigation, on the use of apremilast in AA (2, 3, 4). Two of the three studies (2, 4) demonstrated no clinical benefit in moderate to severe cases of AA.

Clinical Trial

Central Centrifugal Cicatrical Alopecia (CCCA)

Central centrifugal cicatricial alopecia is a lymphocyte-mediated scarring hair loss condition. The exact cause is unknown although several immune pathways have been hypothesized. Since apremilast reduces several inflammatory factors, it is currently being investigated to decrease scalp inflammation in CCCA.

Frontal Fibrosing Alopecia (FFA)

Frontal fibrosing alopecia is a lymphocyte-mediated scarring hair loss condition. The exact cause is unknown although several immune pathways have been hypothesized. Current therapies for the treatment of this FFA have been less than satisfying. Since apremilast reduces several inflammatory pathways, it is currently being investigated to reduce scalp inflammation in FFA.


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Does Biotin Work for Hair Loss?

Biotin is a commonly recommended vitamin for hair loss sufferers. It has been popularized as “wonder vitamin” vital for hair growth and healthy hair. Biotin is a B7 vitamin important in many important human metabolic pathways. Common foods containing biotin include egg yolks, milk, nuts, grains, supplementation, and synthesis by intestinal bacteria.

Recent reports have demonstrated little scientific evidence (1, 2) about the efficacy of biotin for treatment of hair loss, except in limited cases (3, 4). Much of the data supporting the use of biotin in hair loss stems from the use of the vitamin in animal models and humans with deficiencies. Biotin deficiencies results in hair loss, skin inflammation and brittle nails. Replacement of B7 in these people improves symptoms including reversing hair alopecia.. However, it is important to note that the standard American diet contains adequate biotin, thus deficiencies are rare. Moreover, “biotin has not been shown to be beneficial for normal, healthy hair” (2). The FDA also warns individuals taking high levels of biotin may dangerously interfere with important lab values that use biotin technology (5).

Some vitamins and minerals are important in hair cycling. It is best to consult with a physician to assess your specific needs.