Chapter 12 403 the ability to inhibit P. ovale (presumed to be M. furfur, due to culture conditions).67-68 Salicylic acid, sulfur and liquor carbonis possess exfoliative qualities expected to improve the appearance of scaling, while the antimitotic effect of topical corticosteroids and coal tars might also be involved in reducing the hyperproliferation associated with dandruff scaling. Traditionally, non-scalp seborrheic dermatitis has been treated with either topical or oral steroids.31 However, renewed interest in the role of Malassezia yeasts and the known side effects of topical steroids have made antifungal medications an increasingly popular choice. Tacrolimus has been shown to have potent antifungal activity against Malassezia furfur in vitro.72 Tacrolimus and pimecrolimus may be effective as they possess both anti- inflammatory and antifungal activity. The role of commensal fungi in dandruff causes it to be a refractory condition. As Malassezia are commensal, cessation of antifungal therapy results in a relapse of the condition. When considering any topical therapy for long-term prophylaxis, particularly when impacting cosmetic attributes of hair, it must be cosmetically acceptable enough to maintain compliance. This highlights the assertion that for dandruff treatment the use of cosmetic antidandruff shampoos should be the first choice, with less cosmetically acceptable shampoos, lotions, and foams reserved for use in severe or refractory cases.73-74 Optimal treatment of D/SD requires controlling scalp flaking and itching at the lowest possible cost and inconvenience.52,65,73-74 Since the 1960s, shampoos, conditioners and treatments have been marketed as over-the-counter or prescription products for the treatment of dandruff. Many of these products not only treat the scalp, but also provide the hair grooming needs of cleansing and conditioning.56 The importance of antidandruff hair care products with no trade-offs in aesthetics is extremely important for effective therapy because they can be incorporated into a routine hair care regimen and lead to high consumer compliance.56,65