{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T01:52:44Z","timestamp":1782179564945,"version":"3.54.5"},"reference-count":40,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,3,31]],"date-time":"2025-03-31T00:00:00Z","timestamp":1743379200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004357","name":"Procter and Gamble","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004357","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intern J of Cosmetic Sci"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Clinical studies assessing the dandruff condition typically focus on the therapeutic resolution of the signs and symptoms of dandruff, starting with a symptomatic scalp as a baseline. The reverse, the progression of events leading to a scalp flare\u2010up after stopping the use of an anti\u2010dandruff (AD) shampoo, is poorly understood. This study explored onset time and progression of the signs and symptoms of dandruff in individuals who stop using an AD shampoo.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This randomized, double\u2010blind, parallel design study recruited self\u2010identified, scalp\u2010concerned adults. After a 2\u2010week run\u2010in with an AD shampoo, participants were randomized into two groups: The first continued using the AD shampoo and the second switched to a cosmetic (non\u2010AD) shampoo. At baseline and defined intervals over the 28\u2010day study period, objective measures of scalp condition were investigated: expert\u2010assessed flaking, scalp impedance, and biomarkers. These were combined with self\u2010assessments of scalp condition. A Stochastic Mixed\u2010Effect Random Forest (SMERF) machine\u2010learning algorithm was explored to model time\u2010varying technical measurements and daily self\u2010assessment responses from participants.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Switching from an AD shampoo to a non\u2010AD shampoo resulted in increased scalp <jats:italic>Malassezia<\/jats:italic> load, degree of flaking, barrier disruption, and inflammatory and oxidative stress biomarkers compared to those maintaining AD shampoo usage. Signs of declining scalp condition (histamine, complement component C3) were observed as early as 3\u2009days after ceasing AD shampoo usage despite no statistical increase in flaking (ASFS) until around 3\u2009weeks of using a non\u2010AD shampoo. These changes were accompanied by self\u2010perceived itching and flaking, reported to be significantly worse in those using the non\u2010AD shampoo compared to the AD shampoo at the end of the study. No statistically significant increase from baseline was observed for any objective measure in the AD shampoo group. In the SMERF model, markers of inflammation, oxidative stress, and <jats:italic>Malassezia<\/jats:italic> load were predictive of self\u2010perceived scalp attributes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>For the first time, a comprehensive understanding of changes that occur as scalp condition goes from asymptomatic to dandruff\u2010affected has been established. For scalp\u2010concerned individuals, regular, sustained use of an AD treatment promotes optimal scalp health. When switching to a non\u2010AD shampoo, scalp health deteriorates rapidly, even before visible flakes appear.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ics.13067","type":"journal-article","created":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T07:10:55Z","timestamp":1743491455000},"page":"703-717","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Understanding the dandruff flare\u2010up: A cascade of measurable and perceptible changes to scalp health"],"prefix":"10.1111","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3669-3617","authenticated-orcid":false,"given":"Kathryn C. 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