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.

Postpartum hair changes are incredibly common. But when shedding continues far beyond the first year, it can leave many people feeling confused, discouraged, and unsure of what’s “normal.” Board-certified dermatologist Dr. Alexandra Bowles shares insight with Parents about why long-term shedding occurs and how to help support hair recovery.

How should someone address postpartum hair loss that persists for several years?

When hair loss lasts several years beyond childbirth, it is usually a sign that something other than postpartum shedding is contributing. At that point, I encourage patients to step back and look at the whole picture so we can understand what the hair is trying to communicate. Long-term shedding can also be linked to thyroid imbalance, low iron stores, or vitamin D deficiency. The chronic stress of caring for young children can also be a contributor. These factors can quietly disrupt the hair growth cycle long after hormones have stabilized. A thorough evaluation helps identify what is keeping the follicles from moving back into a healthy growth phase. Once we have that clarity, simple steps like correcting nutritional gaps can help restore hair health. Topical treatments such as minoxidil are often effective in promoting regrowth. Additionally, creating a gentle scalp care routine supports overall hair recovery and long-term follicle health. I also remind patients to be kind to themselves during this process. Hair takes time to recover, but with support and the right plan, most people see improvement and feel more in control again.

Does the postpartum period ever truly end, or can its effects last a lifetime?

The postpartum period is not a lifelong state. However, it can feel that way when the body is still adjusting months or even years later. Hormones usually settle within the first year. But shifts in metabolism, sleep, and stress can continue to affect how someone feels well beyond that timeline.When symptoms linger—such as ongoing hair shedding, dry skin, or fatigue—it often means another factor is contributing. The most important thing is to give yourself permission to seek support if something feels off. But your body will eventually find a new balance. Addressing underlying issues allows you to move forward with confidence instead of assuming these changes will last forever.

If you’re struggling with long-term hair loss, schedule a consultation with a dermatologist to get more personalized treatment options.

Hidradenitis Suppurativa is a chronic inflammatory skin condition that causes painful bumps, abscesses, and scarring in areas where skin rubs together. Beyond the physical symptoms, it can significantly impact emotional well-being, confidence, and daily life. Learn more about the condition and how to manage flare-ups with Dr. Alexandra Bowles, featured in HealthCentral.

What are some of the symptoms of Hidradenitis Suppurativa? 

Hidradenitis Suppurativa is a chronic inflammatory skin condition that often presents as painful, deep-seated bumps in areas where skin naturally rubs together, such as the underarms, groin, buttocks, or under the breasts. These bumps can feel tender, warm, or swollen, and may progress into abscesses that drain fluid or pus. Many patients also notice “double-headed” blackheads, recurrent flares in the same locations, or scarring that develops over time. Hidradenitis Suppurativa causes these lumps because the hair follicles become clogged with keratin and bacteria, triggering inflammation beneath the skin. When that inflammation builds, the follicle can rupture, leading to a deeper immune response and an abscess. It’s important to remember that Hidradenitis Suppurativa is not caused by poor hygiene. It is a medical condition rooted in inflammation. With the right plan, we can manage flares and help protect the skin barrier.

Are there specific reasons that a person with Hidradenitis Suppurativa may need to be careful when leaving the house?

People with Hidradenitis Suppurativa sometimes have open or draining lesions, which can make activities outside the home uncomfortable, especially in warm environments or during long periods of friction. While Hidradenitis Suppurativa itself isn’t an infection, the broken skin can occasionally become secondarily infected, so keeping areas clean, covered, and protected is wise when you’re out and about. I often recommend soft, breathable clothing and gentle dressings over tender spots to prevent rubbing and irritation. It’s also helpful to plan ahead on days when symptoms are active, such as carrying extra bandages or wipes for comfort. Most importantly, Hidradenitis Suppurativa is absolutely not contagious, and you cannot spread it to others through touch or skin-to-skin contact. The condition stems from inflammation deep in the follicle, not from bacteria that can be transmitted.

What are the ways in which symptoms can affect a patient’s self-esteem or social life?

Movement can be incredibly beneficial for mental and physical health, but I understand how intimidating it can feel when exercise triggers Hidradenitis Suppurativa discomfort. I typically recommend choosing loose, breathable, moisture-wicking clothing to reduce friction in sensitive areas. Activities like walking, swimming, cycling on a recumbent bike, yoga, and Pilates are often more comfortable than high-impact workouts. If chafing is a concern, using barrier products, such as zinc oxide ointment or anti-friction balms, can help protect the skin. On days when symptoms are active, it’s perfectly okay to modify or slow down your routine. Heat and sweat can sometimes worsen flares, so taking breaks to cool off or choosing climate-controlled environments can make movement more enjoyable. The goal is to keep you moving in a way that supports your body, not aggravates it.

Why can talking to your support system, like partners, potential partners, friends, and family members, about what you’re navigating be helpful?

Hidradenitis Suppurativa can be a physically painful and emotionally heavy condition, and sharing your experience with trusted people can create a sense of connection and relief. When others understand what you’re navigating, they’re better able to offer practical support, like helping with daily tasks during a flare, or emotional support when symptoms feel overwhelming. Open communication also removes the pressure to “hide” the condition, which can ease shame or embarrassment. Many patients tell me that once they share what Hidradenitis Suppurativa is, their loved ones respond with compassion and understanding. Talking openly can also strengthen intimacy by helping partners understand that Hidradenitis Suppurativa is not contagious and does not reflect on personal hygiene. Support systems often become an important part of a patient’s long-term coping strategy. Knowing you’re not carrying the weight alone can make a tremendous difference.

What unique tips do you have for patients navigating the mental health concerns that often come with Hidradenitis Suppurativa? 

Mental health support is a vital part of Hidradenitis Suppurativa care because the condition can affect confidence, mood, and daily life. I often encourage patients to seek out therapists who understand chronic pain or chronic illness, as they can offer tools for managing the emotional burden of flares and unpredictability. Joining a Hidradenitis Suppurativa community, whether online or in person, can also be incredibly empowering; hearing others’ stories often helps patients feel validated and less alone. Mindfulness, journaling, and stress-reduction practices may help calm the nervous system, which in turn can sometimes reduce flare frequency.

It’s also helpful to identify personal triggers, such as stress, heat, or friction, so you feel more prepared and supported day-to-day. I remind patients that their feelings are completely valid, and seeking mental-health care is a sign of strength, not weakness. Hidradenitis Suppurativa affects the whole person, and you deserve care that supports your skin and your emotional well-being.

Salt is a staple in almost every meal, but many people don’t realize how closely sodium intake is tied to skin health. From waking up with puffy under-eyes to noticing dryness, redness, or a dull complexion, what’s on your plate, especially at dinner, can show up on your skin the very next day. A high-sodium diet doesn’t just affect overall health; it can influence hydration, inflammation, and even how quickly visible signs of aging appear. Learn more with with Dr. Alexandra Bowles as she dives deeper into this topic, featured in Parade.

How does a high-sodium diet impact the skin?

A high-sodium diet can contribute to skin that looks dry, puffy, or both. When we consume excess salt, the body works to maintain balance by pulling water into the bloodstream, which can lead to fluid retention, especially around the eyes and face, where the skin is thinner and more delicate. At the same time, too much sodium can actually dehydrate the skin by drawing moisture away from the surface, leaving it feeling tight, flaky, or dull. This combination, internal water retention and surface dehydration, is why someone might wake up with puffy under eyes but still feel that their skin looks dry.

People with sensitive skin or underlying conditions like eczema may notice these changes even more quickly. I always remind my patients that staying well-hydrated, choosing whole foods when possible, and being mindful of packaged or restaurant meals can make a noticeable difference in their skin’s overall appearance. It’s a simple lifestyle adjustment that often pays off in a healthier, more balanced complexion.

A high-sodium diet can cause inflammation. How can this impact skin?

A high-sodium diet can contribute to inflammation in the body, and the skin often reflects that internal imbalance. When inflammation rises, it can worsen conditions like acne, rosacea, and eczema, making flare-ups more frequent or more intense. Excess sodium can also disrupt the skin barrier, which is essential for keeping moisture in and irritants out, so skin may become more sensitive, dry, or reactive. Some patients notice increased redness, puffiness, or a dull tone when their salt intake is consistently high. Over time, chronic inflammation can even interfere with collagen production, which affects the skin’s firmness and long-term health. I often tell my patients that while we can’t control every source of inflammation, limiting excess sodium and prioritizing whole, fresh foods can support both overall wellness and clearer, calmer skin. Small dietary shifts can truly make a visible difference.

Can a high-sodium diet accelerate signs of aging? If so, how?

Yes, a consistently high-sodium diet can contribute to the acceleration of visible aging, although it’s often more subtle and indirect than people expect. Excess sodium can dehydrate the skin, weakening the moisture barrier and making fine lines and wrinkles appear more pronounced. It can also promote low-grade chronic inflammation, which, over time, may interfere with collagen and elastin, the proteins that keep skin firm, smooth, and resilient. Inflammation and dehydration together can lead to a duller complexion, increased redness, and more noticeable under-eye puffiness, all of which can make the skin look older than it is. For patients already managing conditions like rosacea or eczema, high sodium can amplify symptoms and stress the skin even further. I always encourage focusing on hydration, balanced nutrition, and consistent skincare to counteract these effects. 

If someone is going to have food with a lot of salt, are there ways they can minimize the impact the salty meal will have on their skin?

If you’re going to enjoy a salty meal, there are definitely ways to soften its impact on your skin. First, hydrate well before and after. Water helps balance sodium levels and reduces the likelihood of next-day puffiness or dryness. Pairing salty foods with potassium-rich choices like bananas, avocado, or leafy greens can also help counteract water retention. I often recommend avoiding alcohol with a high-sodium meal, since the combination can be especially dehydrating for the skin. A gentle, hydrating skincare routine that evening, think a soothing cleanser and a barrier-supporting moisturizer, can also help keep the skin calm. If puffiness tends to be an issue, a cool compress or chilled jade roller around the eyes the next morning can be very helpful. And most importantly, enjoy these meals in moderation; small lifestyle tweaks can go a long way in keeping your skin balanced and healthy.

Is consuming salt always bad?

One thing I always like to remind patients is that skin health is a reflection of overall balance. What we eat, how we hydrate, how we sleep, and how we care for our skin all work together. Salt isn’t “bad,” but being mindful of how much we consume and how our body responds can make a noticeable difference in puffiness, dryness, and inflammation. If you’re seeing recurring changes in your skin, it’s worth paying attention to patterns in your diet and daily habits. And as always, if something feels persistent or out of the ordinary, checking in with a dermatologist can provide clarity and peace of mind.

Dandruff is common and often caused by a combination of factors like scalp yeast overgrowth, oil imbalance, and dry skin. Using the right ingredients and consistent care can help control flaking, itching, and irritation. If you struggle with this, discover some shampoos to add into your routine recommended by Dr. Alexandra Bowles, featured in HuffPost’s article.

What are some of the main causes of dandruff?

Dandruff is incredibly common, and it often stems from a combination of factors rather than one single cause. One of the biggest contributors is an overgrowth of Malassezia, a yeast that naturally lives on the scalp but can become irritating when it multiplies. This irritation leads to flaking, itching, and inflammation. Dry skin, especially in colder months, can also make dandruff worse, as can excess oil production, which creates an environment where yeast thrives. Some hair products may trigger sensitivity or buildup, leading to even more irritation. Stress and changes in hormones can also play a role, which is why dandruff can flare during busy or stressful periods. Overall, dandruff is rarely about “poor hygiene.” It’s usually about how your scalp responds to oils, yeast, and environmental factors.

Are there key ingredients that people should look for when trying to treat their dandruff?

Several ingredients do a wonderful job at calming dandruff and restoring balance to the scalp. Pyrithione zinc and selenium sulfide help reduce scalp yeast, which is often the root cause of flaking and itching. Ketoconazole is another powerful antifungal option, especially for more stubborn cases. If inflammation is a big issue, salicylic acid can gently exfoliate flakes while helping other active ingredients penetrate better. And for people with sensitive skin, formulas containing tea tree oil can offer natural antimicrobial and soothing benefits. The key is choosing a shampoo that directly addresses your type of dandruff and using it consistently to keep symptoms under control.

What are some shampoos you recommend to help control symptoms?

Nizoral A-D (1% ketoconazole): This is one of my top recommendations for more persistent dandruff because ketoconazole is a strong antifungal ingredient that helps control yeast on the scalp. You have to let it sit on the scalp for it to work!

Head & Shoulders Clinical Strength: A great option for moderate to severe flaking, and it also helps calm itching and redness while restoring moisture balance.

Neutrogena T/Sal: Perfect for people with thicker scale or buildup because the salicylic acid breaks up flakes without being too harsh.

Selsun Blue: Another reliable choice that reduces inflammation and helps regulate oil production, which is especially helpful for oily or irritated scalps.

What daily habits and tips can help effectively manage dandruff and support overall scalp health?

Consistency is key when treating dandruff. Most people see the best results when they use their medicated shampoo several times a week and allow it to sit on the scalp for five minutes before rinsing. Avoiding heavy styling products can also help, since buildup can worsen flaking and irritation. If your scalp feels dry, pairing your dandruff shampoo with a gentle, hydrating conditioner on the ends of your hair, not the scalp, can keep hair soft without disrupting treatment. Managing stress, getting adequate sleep, and maintaining a healthy diet can also support overall scalp health. And if your flaking doesn’t improve after a few weeks, or if you notice redness, pain, or hair shedding, it’s a good idea to see a dermatologist to rule out another condition. My biggest message is that dandruff is very treatable. You just need the right approach and a little patience.