If your atopic dermatitis feels harder to control or is starting to impact your daily life, it may be time to reassess your treatment plan. From frequent flares to newer oral therapies like JAK inhibitors, understanding your options can help you take a more effective, comprehensive approach to care. Learn more about what might be the best treatment plan for you with Dr. Alexandra Bowles in Everyday’s Health article.

How can someone with Atopic Dermatitis know they need to switch treatment? 

One of the clearest signs that it may be time to reassess treatment is when flares are frequent or increasingly difficult to control. Especially if they persist despite consistent use of topical therapies and good skincare habits. If someone is relying heavily on topical steroids and experiencing rebound flares, that can indicate that surface-level treatments alone are no longer enough. Quality-of-life factors also matter. If itching is disrupting sleep, daily activities, or work or school performance, those are important signals that the current approach may not be adequately controlling the disease.

How do you know if systemic treatment may be the right choice?

Systemic treatment is often considered when atopic dermatitis is moderate to severe, widespread, or significantly affecting a patient’s physical and emotional well-being. If eczema involves multiple body areas, is associated with intense itch, or continues despite optimized topical therapy and trigger management, systemic options may be appropriate. This is not about “giving up” on topicals. It’s about recognizing that atopic dermatitis is an inflammatory condition driven by immune pathways that sometimes need to be addressed from the inside out.

What are new oral therapies that might be a good option?

Newer oral therapies known as JAK inhibitors work by targeting specific inflammatory signaling pathways involved in atopic dermatitis. These medications can help reduce inflammation and itch more directly and often quicker than traditional treatments. They may be appropriate for adults with moderate to severe disease who have not responded well to topical therapies or other systemic options. Like any medication, they require careful patient selection and monitoring. They should always be prescribed and managed by a dermatologist familiar with these treatments.

How are these integrated with other aspects of treatment like skincare and dietary considerations?

Systemic therapies don’t replace good skincare. They work alongside it. Even when someone starts an oral medication, maintaining a gentle, consistent skincare routine remains essential. It’s still important to support the skin barrier and reduce irritation. That includes regular moisturizing, avoiding harsh cleansers, and minimizing known triggers. Dietary considerations can be helpful, especially if specific food triggers have been identified. But, diet alone rarely controls moderate to severe disease. The most effective approach is a layered one that addresses both internal inflammation and external barrier support.

What are the potential side effects of new oral therapies?

JAK inhibitors and other systemic therapies can have potential side effects. These vary depending on the specific medication and the individual patient. These may include increased risk of infections, changes in laboratory values, or other systemic effects. This makes ongoing monitoring very important. A dermatologist will review a patient’s medical history, risk factors, and lifestyle before starting treatment.They will continue to monitor labs and symptoms over time. For many patients, the benefits in symptom control and quality of life can outweigh the risks.

Flaky scalp can be frustrating, but not all flakes are created equal. Understanding whether you’re dealing with dandruff or a dry scalp is essential, because each condition has distinct causes and requires a different approach for effective treatment. Learn how to tell the difference and how to properly manage with Dr. Alexandra Bowles in NBC Select’s article.

What are the main differences between dandruff and dry scalp?

Dandruff and dry scalp can look similar, but they have very different underlying causes. Dry scalp is typically related to a lack of moisture in the skin, much like dry skin elsewhere on the body. Dandruff, on the other hand, is usually driven by excess oil, yeast overgrowth, and inflammation on the scalp. The flakes from dry scalp tend to be smaller and drier, while dandruff flakes are often larger, greasier, and yellowish. Understanding the cause is important because the treatments for each are very different. Treating dandruff like dry skin, or vice versa, often leads to frustration and persistent symptoms.

Can one cause the other?

Dry scalp and dandruff don’t directly cause each other, but they can sometimes overlap or be confused with each other. Over-cleansing or using harsh products can dry out the scalp and disrupt the skin barrier, which may then trigger inflammation that mimics dandruff. Untreated dandruff can cause irritation, leading to itching and scratching, which may make the scalp feel dry and uncomfortable. While they’re distinct conditions, poor scalp care can blur the lines between them. That’s why identifying the root cause is key before choosing a treatment. Addressing the wrong issue can prolong symptoms.

What are the signs of dandruff vs dry scalp?

Dry scalp typically presents with fine, powdery flakes and a tight or itchy feeling, especially in colder weather. The scalp skin may look dull or slightly irritated, similar to dry skin on the arms or legs. Dandruff usually causes thicker, greasy flakes that stick to the hair or scalp and may be accompanied by redness. It often worsens with stress, hormonal changes, or infrequent washing. Itching is common with both, but dandruff is more likely to involve inflammation. Paying attention to flake texture and scalp appearance can help distinguish between the two.

Is there any overlap in symptoms?

Yes, there can be some overlap, which is why these conditions are frequently misdiagnosed. Both can cause flaking, itching, and scalp discomfort. In some cases, someone may have a naturally dry scalp and also develop dandruff due to yeast overgrowth. Environmental factors like cold weather or aggressive hair care routines can exacerbate both conditions. However, overlap doesn’t mean the treatments are interchangeable. A targeted approach based on the dominant issue will always be more effective.

What are the best treatments for dandruff versus dry scalp?

Dandruff is best treated with medicated shampoos that target yeast and inflammation, such as those containing ketoconazole, zinc pyrithione, selenium sulfide, or salicylic acid. These ingredients help reduce the underlying cause rather than just masking flakes. Dry scalp, on the other hand, responds best to gentle, hydrating shampoos and moisturizers that restore the skin barrier. Ingredients like glycerin, aloe vera, ceramides, and hyaluronic acid are particularly helpful. Overwashing can worsen dry scalp, while under-washing can worsen dandruff. Matching treatment to diagnosis makes all the difference.

Which one is harder to treat?

Dandruff is generally more persistent and harder to manage long-term because it’s often a chronic inflammatory condition. Even when symptoms improve, they can recur without ongoing maintenance. Dry scalp is usually easier to correct once hydration and gentle care are restored. However, severe or longstanding dry scalp can take time to heal if the barrier is significantly compromised. Both conditions can be well managed with the right approach. The key challenge is recognizing which one you’re dealing with.

When is it time to visit a dermatologist about the issue?

It’s time to see a dermatologist if flakes persist despite using appropriate over-the-counter treatments for several weeks. Significant redness, thick scaling, hair shedding, or intense itching are also reasons to seek evaluation. If symptoms extend beyond the scalp or involve the face, ears, or eyebrows, a medical diagnosis is especially important. These signs may indicate seborrheic dermatitis, psoriasis, or another inflammatory condition. A dermatologist can confirm the diagnosis and tailor treatment appropriately. Early intervention often prevents worsening symptoms.

What should people look for in products to treat dandruff versus dry scalp?

For dandruff, look for products labeled as medicated or anti-dandruff with active ingredients that target yeast and inflammation. These shampoos should be used consistently and left on the scalp for several minutes before rinsing. For dry scalp, avoid harsh detergents and focus on moisturizing, sulfate-free formulas. Ingredients that support the skin barrier are especially important. Using the wrong type of product can worsen symptoms rather than improve them. Reading labels carefully makes a significant difference.

What are some products that you would recommend?

For dandruff, I often recommend ketoconazole-based shampoos like Nizoral A-D or zinc-based options such as Head & Shoulders Clinical Strength. These address the inflammatory component effectively. For dry scalp, gentle formulas like CeraVe Hydrating Shampoo or Vanicream Shampoo are excellent choices. They cleanse without stripping and help restore moisture balance. Pairing shampoo with a lightweight scalp moisturizer can also help reduce dryness. Consistency matters more than brand name.

What are some common misconceptions about a dry scalp and dandruff?

One of the most common mistakes I see is assuming that all scalp flaking is due to dryness. In reality, dandruff is often worsened by avoiding shampoo altogether. It’s also important to remember that scalp health is skin health, and it deserves the same thoughtful care as the face. Seasonal changes, stress, and product buildup all influence symptoms. Treating the scalp gently but appropriately can dramatically improve comfort and appearance.

Forehead acne often results from a mix of oil, clogged pores, bacteria, and hair-care habits. Understanding the causes and using the right products can help prevent breakouts and keep your skin clear and healthy. Dr. Alexandra Bowles breaks down her best tips and tricks, featured in Cosmopolitan’s article.

What causes forehead acne?

Forehead acne is often caused by a combination of excess oil production, clogged pores, and bacteria, but it can also be influenced by lifestyle and hair-care habits. The forehead is part of the T-zone, which naturally produces more oil, making it more prone to breakouts. Hair products like gels, oils, dry shampoos, or pomades can transfer onto the skin and clog pores, a common cause of what we call “pomade acne.” Sweat, hats, helmets, and headbands can also trap oil and bacteria against the skin. Hormonal fluctuations, stress, and diet may further contribute by increasing oil production and inflammation. In some cases, it can also be caused by overgrowth of fungus on the forehead or scalp. In some cases, underlying skin conditions like folliculitis can mimic acne and require different treatment.

What types of products help eliminate forehead acne?

The most effective products for forehead acne focus on gently clearing pores, reducing oil, and calming inflammation without over-drying the skin. Look for cleansers with salicylic acid, which helps exfoliate inside the pore and reduce congestion. Benzoyl peroxide can be helpful if bacteria are a major driver, as it reduces acne-causing bacteria on the skin. Lightweight, oil-free moisturizers are important to maintain the skin barrier and prevent rebound oil production. If breakouts are persistent, topical retinoids can help normalize cell turnover and prevent clogged pores over time. I also remind patients to check their hair products. Non-comedogenic formulas can make a big difference. If fungal acne is presumed, discussed an antifungal wash can be very effective. 

How can you tell if forehead acne is hormonal or bacterial?

Hormonal acne tends to be deeper, more cystic, and often flares cyclically, commonly around the menstrual cycle or during times of stress. It may also appear alongside acne on the jawline or chin. Bacterial or pore-related acne is more likely to show up as small whiteheads, blackheads, or uniform bumps across the forehead. If breakouts worsen with sweat, hats, or hair products, that often points toward a bacterial or follicular component. Hormonal acne is usually more stubborn and slower to respond to over-the-counter treatments. When the pattern isn’t clear, a dermatologist can help identify the root cause and tailor treatment appropriately.

How can you prevent forehead acne?

Prevention starts with consistent, gentle skincare and awareness of everyday triggers. Wash your face regularly, especially after sweating, using a non-comedogenic cleanser. Be mindful of hair products and avoid letting oils or styling products sit on the forehead. Clean hats, pillowcases, and makeup brushes frequently to reduce bacterial buildup. Avoid over-washing or harsh scrubs, which can irritate the skin and increase oil production. For patients prone to recurring breakouts, maintaining a simple routine with a retinoid or acne-preventive ingredient can help keep pores clear long-term. Always consult with a dermatologist to make sure you are addressing your acne properly. 

What is a common mistake people make when treating forehead acne?

One of the most common mistakes I see is treating forehead acne too aggressively. Over-drying the skin or layering too many actives can disrupt the skin barrier and actually worsen breakouts. Acne management is about balance, controlling oil and bacteria while keeping the skin healthy and resilient. If acne is persistent, painful, or leaving marks, that’s a sign it’s time to seek professional care. Early, targeted treatment can prevent scarring and make management much easier in the long run.