Everyone has some form of flaking on his or her scalp because of the normal process of shedding the outer layer of skin cells. But if the flaking gets obvious on your hair and clothing, it’s called dandruff. This condition is not contagious, but does have periodic flare-ups.

The medical explanation for dandruff is that it is a mild form of a skin condition called seborrheic dermatitis. This condition is caused by overactive oil glands or, in some cases, by a yeast infection. It can also be hereditary. Certain other factors can also make the dermatitis worse, such as illness, poor diet, and emotional stress. Environmental conditions like cold dry air in the wintertime, as well as over-washing your hair can also lead to dandruff flare-ups.

If your dandruff lasts a long time, or if you have unusually large flakes combined with greasy scaling on either side of your nose, behind your ears, between your eyebrows, in skin folds, or on your breast bone, you probably have a more severe form of seborrheic dermatitis. You should contact your dermatologist to get diagnosed and hear about different treatment options. There are prescription strength dandruff shampoos available as well as cortico-steriod lotions to help reduce flaking. Below are some commonly asked questions about dandruff control:

1. Do dandruff shampoos really help?

Over-the-counter dandruff shampoos can often control mild to moderate dandruff. These shampoos contain various effective ingredients, such as sulfur, salicylic acid, selenium, or tar. Remember to rinse your hair thoroughly so that no shampoo buildup occurs, since this can also cause flaking. After rinsing, apply a conditioner to smooth your hair and make it easier to comb or brush. It may also help to comb or brush your hair before shampooing to loosen the flakes so they’ll wash off more easily.

2. How can I keep dandruff away?

After your dandruff clears up, you should shampoo only as often as necessary and occasionally use the dandruff shampoo to keep it from coming back. Also keep in mind that hair products create buildup that can irritate your scalp and cause flaking. If you use a lot of hair products, and you notice flaking, try to shampoo daily. If the scales do keep coming back, your doctor may recommend that you use shampoos, lotions, creams, or ointments containing sulfur, salicylic acid, or tar to keep it under control.

3. What is cradle cap, and how is it treated?

Cradle cap, which is another form of seborrheic dermatitis, usually occurs in infants during their first month of life. It appears as dry, scaly patches on the baby’s scalp, and it may become a thick, yellow crust. Its cause is unknown. Scaly areas can also appear at the hairline, eyebrows, nose, or ears, and the dermatitis sometimes affects the diaper area or the entire body.

Treatment options vary, such as using an anti-dandruff shampoo, then oiling the scalp with a light layer of petroleum jelly (Vaseline®) to help loosen the scaly patches. However, you should first consult your dermatologist to correctly diagnose the condition and provide treatment options that are right for your baby.

Estrogen levels in women decline faster than testosterone starting in their late 20s. Now what this means for the skin is Testosterone, which is an androgenic hormone, causes the masculine qualities of testosterone to increase and become more visible. Examples include facial hair growth around the chin, jawline and cheeks, as well as oil production which can clog pores and cause blemishes. At the same time, the decrease in estrogen causes fine lines and wrinkles to develop, as well as loss of elasticity, dry and thinning skin, and a lackluster complexion. And even if you did not experience breakouts at a younger age, about a third of women will get adult acne, usually in their 30s.

As an aside, the difference between adolescent acne and adult acne is rather than presenting as painful, cystic pimples, adult (or, hormonal) acne is usually small red bumps that often run along the jaw line and around the mouth area. A few examples of how to combat hormonal acne would be to go on the birth control pill, or take spironolactone, a water pill with anti-androgenic effects.

But what exactly causes facial wrinkles? Facial wrinkles occur when the skin loses elasticity, support,and volume. This is caused by a reduction in elastic tissue, collagen, and hyaluronic acid in the skin. Basically, your skin becomes too big for the tissue underneath. The first place a woman will usually start seeing fine lines is around the eyes (the peri-orbital region) where the skin is the thinnest. Next will be the areas that crease the most when we smile or laugh, such as the nasolabial folds, which run from the corners of our nose to the outer corner of our mouth.

How do we combat the effects of Natural Hormonal Progression on the skin? I recommend a two-prong approach to anti-aging: Procedures and Products. Procedures include Botox to relax the muscles that cause creases, Laser Skin Resurfacing to smooth away fine lines and regenerate fresh new skin, and Injectible Fillers to plump deep creases, as well as plump hollows under the eyes, temples and cheeks. Depending on the look you want to achieve, a combination of different procedures might be the right solution for you.

The second prong to anti-aging is Products. If someone only uses Procedures, they are doing nothing for the quality and texture of their skin. Look for skincare products that treat all 3 causes of skin aging (time, environment and natural hormonal progression) AND contain ingredients such as Soy and Black Cohosh, which mimic the positive effects of estrogen on the skin. The key to any skincare regimen is using quality products that contain multiple active ingredients so every application is like nourishing your skin with a multivitamin.

Understanding the difference between Procedures and Products, and combining the benefits of both prongs, will give the most complete approach to fighting skin aging. And of course, limit your sun exposure!

I am interviewed frequently these days on whether I see any cosmetic trends due to the challenging economic climate. And the answer is absolutely, trends in cosmetic procedures are changing. In these challenging economic times, patients are definitely looking for the most value. For some, that means shopping for venues that have the cheapest Botox prices. However, patients learn that if Botox is too cheap, it is watered down and not effective.

Other patients understand this and either wait longer between treatments, allowing some lines to return, or have their Botox done regularly, but just have fewer areas treated each visit.

The second trend I see is more patients choosing Botox and fillers such as Juvederm, Restylane, Evolence, Radiesse, and Sculptra, as an alternative to plastic surgery. While not as dramatic as a face lift, Botox and fillers are a lot less expensive yet provide significant results, and most importantly, a result that looks natural. Botox and fillers also have no down time, which means you don’t have to miss work or use up accrued vacation. In fact, if done by a skilled physician, you achieve results that are natural and fit your face, so you can keep your family, friends and co-workers guessing!

Interestingly, laser procedures are still quite popular. I think this is because there are few alternatives to laser in terms of changing the texture and quality of our skin. Lasers are so versatile in that they smooth rough skin, improve acne, resurface and diminish scars, remove hair, and treat blood vessels.

For patients that do not need the dramatic improvement that laser gives, chemical peels are a good alternative, and reasonably priced. So I have not noticed a significant reduction in chemical peels.

Lastly, I notice patients are understanding the value of buying skincare products that contain multiple active ingredients in one bottle, rather than buying 1 product per symptom. We are a society on the go, so it only makes sense that we are trending toward quality products that are an “all-in-one” solution.

At the end of the day, we all only have one face…and looking good makes us feel better no matter what the economic situation.