Dandruff and Seborrheic Dermatitis: A Head Scratcher 402 skin condition is also being restored.56 There is a direct correlation between clinical flaking and the severity of the stratum corneum abnormalities, suggestive of the cause and effect relationship between the sub-surface (morphology) and superficial symptoms (flaking). General Therapy Concerns Multiple topical agents are effective therapies for the treatment of dandruff. These agents include pyrithione zinc,2,59-62 selenium sulfide,2,8,63-64 salicylic acid,60 sulfur,60 coal tar,60,65 hydrocortisone,60 and ketoconazole.2,8,59,62 in the United States. In addition, piroctone olamine, ciclopirox olamine and climbazole are commonly used to treat D/SD in other countries. A common mechanism of most effective actives is their antifungal activity against Malassezia. In vitro fungistatic and fungicidal tests of ketoconazole,8,56,66-69 pyrithione zinc,8,56,66-67,70 and selenium disulfide8,56,66-67,70 have demonstrated low inhibitory concentrations of growth (MICs) against Malassezia furfur.56 Coal tar71 was also demonstrated to possess activity against fifty-four Malassezia strains isolated from patients with dandruff, seborrheic dermatitis and pityriasis versicolor, but with a much lower potency. Other anti-mycotic agents, such as itraconazole, terbinafine, bifonazole, climbazole, fluconazole, clotrimazole, dithranol, and liquor carbonis, also have Figure 8. Treatment strategies for D/SD