Chapter 12 409 Dandruff is more than just superficial flaking, as demonstrated by significant structural changes in the stratum corneum and changes in inflammatory biomarkers. Dandruff and seborrheic dermatitis share a similar etiology based on metabolic activity of the cutaneous commensal yeast, Malassezia globosa, the presence of sebaceous lipids, and individual susceptibility. Today, dandruff can be successfully treated by multiple antifungal or topical steroidal anti-inflammatory agents. Due to the cost, poor cosmeticity, and adverse effects of steroidal agents, they should be confined to severe or refractory cases. When considering treatment options, one must consider that long-term, chronic therapy will be required, as Malassezia are commensal microbes and will return upon cessation of treatment. This necessitates that patients be highly compliant to any therapy. As hair is a significant driver of cosmetic appeal, for any subject to remain compliant to long-term therapy the treatment must be cosmetically appealing as well as effective. References 1. AK Gupta, R Bluhm, EA Cooper, RC Summerbell, R Batra, Seborrheic dermatitis. Dermatologic Clinics Antifungal Therapy 21, 401-412 (2003). 2. JR Schwartz, CW Cardin, YM DeAngelis, TL Dawson, in Textbook of Cosmetic Dermatology, R Baran and HI Maibach, eds. pp 230-241(2010). 3. CJ Pierard Franchimont, JF Hermanns, H Degreef, GE Pierard, From axioms to new insights into dandruff, Dermatology 200, 93-98 (2000). 4. DR Bickers, et al, The burden of skin diseases: 2004, a joint project of the American Academy of Dermatology Association and the Society for Investigative Dermatology, J Am Acad Dermatol 55, 490-500 (2006). 5. JG Hickman, CW Cardin, TL Dawson, in American Academy of Dermatology Meeting. 6. CE Orfanos, R Happle, Hair and hair diseases, Springer-Verlag: Berlin (1989). 7. R Hay, R Graham-Brown, Dandruff and seborrhoeic dermatitis: causes and management, Clin Exp Dermatol 22, 3-6 (1997). 8. A Bulmer, G Bulmer, The antifungal action of dandruff shampoos, Mycopathologia 147, 63-65 (1999). 9. AM Kligman, Perspectives and problems in cutaneous gerontology, J Invest Dermatol 73, 39-46 (1979). 10. J McGrath, GM Murphy, The control of seborrhoeic dermatitis and dandruff by antipityrosporal drugs. Drugs 41, 178-184 (1991). 11. CJ Pierard Franchimont, JF Hermanns, H Degreef, GE Pierard, From axioms to new insights into dandruff, Dermatology 200, 93-98 (2000). 12. DE McOsker et al, Ultrastructural studies of dandruff-involved scalp tissue, Toilet Goods Assoc 47, 5-8 (1967).