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Medical Edge Newspaper Column from Mayo Clinic

DANDRUFF CONTROL REQUIRES REGULAR TREATMENT

DEAR MAYO CLINIC: For several months, I had terrible scalp itch. I tried everything in my medicine cabinet, kitchen cabinet and under the sink (from white vinegar to cortisone cream). I found a tube of antifungal cream with tolnaftate in my boyfriend’s cabinet, and I put it on my scalp. The next day, my skin was better! Then I read the label. It said, “Do not use on the scalp.” Why can’t I use this cream on my scalp? — Longview, Wash.

ANSWER: Scalp itching can have a variety of causes, but your prompt response to an antifungal cream raises the likely possibility that you have seborrheic dermatitis — commonly known as dandruff. Many patients believe that to have dandruff they must see obvious white flakes on their hair or clothing. In fact, seborrheic dermatitis may involve significant itching with little scaling.

One current theory holds that seborrheic dermatitis is caused by an immune reaction to a fungus growing on the skin. This theory is based on the fact that many people who have seborrheic dermatitis respond well to topical antifungals. The antifungal cream containing tolnaftate you used will not harm your scalp or hair. The manufacturer discourages you from using it on your scalp, though, because it is not reliable in treating other fungal infections involving the scalp.

Most physicians recommend antidandruff shampoos or liquids, rather than creams or ointments, because of cosmetic effects — creams or ointments often mat down hair unattractively. In general, all antidandruff shampoos have antibacterial and antifungal ingredients. Given your quick response to the antifungal cream, you may have the best results with an over-the-counter shampoo containing ketoconazole (brand name Nizoral), another antifungal medication. Tolnaftate (brand name Tinactin) is not available as a shampoo.

Because seborrheic dermatitis is usually a chronic problem, you will likely need to treat your scalp regularly to keep it under control. Many patients have success by using an antidandruff shampoo several times per week.

— James Yiannias, M.D., Dermatology, Mayo Clinic, Scottsdale, Arizona

Additional Resources:
Dandruff
Appointment Information
More Information on Dandruff

READERS: Ovarian cancer is the fifth most common cancer in women. It causes more deaths than all other cancers of the female reproductive system combined.

A woman’s risk of ovarian cancer increases with age, peaking in the early 70s. Having had breast cancer or having a family history of breast or ovarian cancer puts a woman at increased risk.

Until recently, doctors thought that early-stage ovarian cancer rarely produced symptoms. But evidence has shown that some women have signs and symptoms before the disease has spread.

The symptoms of ovarian cancer tend to mimic those of other conditions, including digestive and urinary disorders. The key is if the symptoms persist or worsen.

Here are the common warning signs:

— Abdominal or pelvic pressure, discomfort or pain

— Persistent indigestion, gas or nausea

— Feeling full even after a light meal

— Unexplained changes in bowel habits, including diarrhea or constipation

— Abdominal swelling or bloating, which can cause your clothing to feel tight

— Changes in bladder habits, including a frequent or urgent need to urinate

— Loss of appetite

— Unexplained weight loss or gain, especially in the abdominal area

— Pain during intercourse

Less common signs include a persistent lack of energy and low back pain.

See your doctor if you have persistent signs and symptoms for two or more weeks.

Additional Resources:
Ovarian Cancer
Appointments
More Information on Ovarian Cancer

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Medical Edge from Mayo Clinic is an educational resource and doesn’t replace regular medical care. To e-mail a question, go to www.mayoclinic.org, or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.