Incorporating Patient Preference Into Treatment in a 34-Year-Old Patient With Dandruff

This case involves a 34-year-old African American woman with moderate seborrheic dermatitis, presenting primarily as persistent scalp flaking along the hairline and crown with mild to moderate itch. Her naturally tightly coiled textured hair and hair care practices—washing only once every 1 to 2 weeks due to styling preferences and scalp sensitivity—pose unique treatment challenges. She also expressed concern about topical therapies that require frequent application or leave residue, which could interfere with her styling.

This scenario highlights the importance of individualized treatment plans that respect patients’ hair types, cultural practices, and lifestyle preferences. Traditional recommendations to wash frequently or apply topical therapies daily may not be feasible or acceptable for all patients, especially those with textured hair prone to dryness and irritation from many shampoo bases or leave-on products.

Seborrheic dermatitis and dandruff exist on a spectrum, with dandruff often representing flaking without significant inflammation. This patient’s symptoms were closer to dandruff with mild inflammation, which can often be managed with intermittent antifungal shampoos rather than daily or continuous anti-inflammatory treatments.

In this patient’s case, an intermittent treatment strategy—using a 1% ketoconazole shampoo weekly in line with her washing routine—was chosen. This approach resulted in clinical improvement, with her investigator global assessment score dropping to mild and her worst itch score reducing to 1/10.

The key takeaway is that treatment success relies heavily on patient-centered discussions. Some patients prioritize efficacy and are willing to commit to more frequent applications, while others may prefer intermittent therapy integrated into their existing hair care routines to avoid dryness or disruption to styling. Understanding hair type, washing frequency, and patient preferences is crucial. Newer therapies and formulations designed for diverse hair types are emerging, but selecting the right treatment should always involve shared decision-making tailored to the individual’s lifestyle.