Hair and scalp cosmetic problems – dandruff and hair fall MCQs With Answer

Hair and scalp cosmetic problems – dandruff and hair fall are common concerns affecting patient quality of life and therapy adherence. For B.Pharm students, a practical understanding of scalp microbiology, pathophysiology, diagnosis and pharmacotherapy is essential. Key topics include the role of Malassezia species, seborrheic dermatitis, androgenetic alopecia, telogen effluvium and alopecia areata; mechanisms and formulations of anti-dandruff agents (ketoconazole, zinc pyrithione, selenium sulfide, salicylic acid, coal tar) and hair growth drugs (topical minoxidil, oral finasteride); adverse effects, drug interactions and patient counseling. Emphasis on formulation design, delivery and evidence-based regimens prepares students for clinical practice. Now let’s test your knowledge with 30 MCQs on this topic.

Q1. Which lipophilic yeast genus is most associated with dandruff and seborrheic dermatitis?

• Malassezia
• Candida
• Aspergillus
• Trichophyton

Correct Answer: Malassezia

Q2. Ketoconazole exerts its antifungal action primarily by inhibiting which enzyme?

• Squalene epoxidase
• 14-alpha-demethylase (fungal CYP450)
• Beta-glucan synthase
• DNA gyrase

Correct Answer: 14-alpha-demethylase (fungal CYP450)

Q3. Zinc pyrithione in anti-dandruff shampoos primarily acts by which mechanism?

• Chelation of metal ions and disruption of membrane transport in fungi
• Direct DNA intercalation
• Inhibition of 5-alpha-reductase
• Topical vasoconstriction

Correct Answer: Chelation of metal ions and disruption of membrane transport in fungi

Q4. Selenium sulfide helps control dandruff mainly through which pharmacological effect?

• Antibacterial action against streptococci
• Keratinocyte cytostatic effect reducing epidermal turnover
• Systemic immunosuppression
• Topical steroid-like anti-inflammatory activity

Correct Answer: Keratinocyte cytostatic effect reducing epidermal turnover

Q5. Salicylic acid is included in dandruff formulations primarily for its:

• Keratolytic (descaling) activity
• Antifungal fungicidal activity
• Photosensitizing property
• Systemic antiandrogenic effect

Correct Answer: Keratolytic (descaling) activity

Q6. Coal tar treats scalp scaling by which principal action?

• Antiviral inhibition of replication
• Reducing epidermal proliferation (keratoplastic effect)
• Increasing sebum production
• Blocking conversion of testosterone to DHT

Correct Answer: Reducing epidermal proliferation (keratoplastic effect)

Q7. Which clinical feature helps distinguish seborrheic dermatitis from simple dandruff?

• Presence of scalp erythema and inflammatory lesions in seborrheic dermatitis
• Complete hair loss in dandruff
• Systemic fever only in dandruff
• Psoriatic plaques are diagnostic of dandruff

Correct Answer: Presence of scalp erythema and inflammatory lesions in seborrheic dermatitis

Q8. Finasteride reduces hair loss in androgenetic alopecia by:

• Blocking androgen receptor directly
• Inhibiting 5-alpha-reductase, decreasing dihydrotestosterone (DHT)
• Acting as a potassium channel opener
• Stimulating melanocyte activity

Correct Answer: Inhibiting 5-alpha-reductase, decreasing dihydrotestosterone (DHT)

Q9. The primary pharmacological mechanism of topical minoxidil in promoting hair growth is:

• Potassium channel opening with follicular vasodilation and prolonged anagen phase
• Direct inhibition of DHT synthesis
• Topical immunosuppression
• Inhibition of fungal lipases

Correct Answer: Potassium channel opening with follicular vasodilation and prolonged anagen phase

Q10. A common adverse effect associated with topical minoxidil therapy is:

• Systemic hypertension in most users
• Hypertrichosis and possible contact dermatitis
• Permanent scalp depigmentation
• Renal failure

Correct Answer: Hypertrichosis and possible contact dermatitis

Q11. Oral finasteride is contraindicated in which population due to teratogenic risk?

• Postmenopausal women
• Pregnant women or women of childbearing potential
• Adolescent males
• Elderly men over 70

Correct Answer: Pregnant women or women of childbearing potential

Q12. For moderate inflammatory seborrheic dermatitis of the scalp, the most appropriate short-term therapy is:

• Long-term high-potency topical corticosteroids daily for months
• Short-term topical corticosteroid course combined with antifungal shampoo
• Oral antibiotics as first-line maintenance
• Systemic antifungal therapy for life

Correct Answer: Short-term topical corticosteroid course combined with antifungal shampoo

Q13. When administered orally, ketoconazole may cause which important systemic adverse effect?

• Nephrotoxicity requiring dialysis
• Hepatotoxicity and significant CYP450 drug interactions
• Severe hyperglycemia
• Bone marrow aplasia

Correct Answer: Hepatotoxicity and significant CYP450 drug interactions

Q14. Ciclopirox olamine controls scalp fungal growth primarily by:

• Chelating polyvalent cations and inhibiting metal-dependent enzymes
• Alkylating fungal DNA
• Competitive inhibition of ergosterol uptake
• Blocking microtubule polymerization

Correct Answer: Chelating polyvalent cations and inhibiting metal-dependent enzymes

Q15. Which excipient commonly used in minoxidil topical formulations enhances percutaneous absorption but can cause contact sensitivity?

• Propylene glycol
• Polyethylene glycol 4000
• Sodium lauryl sulfate
• Beeswax

Correct Answer: Propylene glycol

Q16. Telogen effluvium is best described as hair loss due to:

• Autoimmune destruction of follicles
• An abrupt shift of hair follicles from anagen to telogen phase triggered by stressors
• Infection by dermatophytes invading the follicle
• Excessive DHT-mediated miniaturization only

Correct Answer: An abrupt shift of hair follicles from anagen to telogen phase triggered by stressors

Q17. Alopecia areata pathogenesis primarily involves:

• Bacterial colonization of hair follicles
• Autoimmune T-cell mediated attack on hair follicles
• Vitamin D deficiency alone
• Excessive sebum production

Correct Answer: Autoimmune T-cell mediated attack on hair follicles

Q18. A positive hair pull test (excess hairs removed on gentle traction) is most indicative of:

• Androgenetic alopecia
• Telogen effluvium
• Tinea capitis only
• Permanent cicatricial alopecia

Correct Answer: Telogen effluvium

Q19. Which oral medication is FDA-approved for male pattern hair loss and decreases scalp DHT?

• Finasteride
• Oral ketoconazole
• Systemic doxycycline
• Topical coal tar

Correct Answer: Finasteride

Q20. First-line topical pharmacotherapy approved for female pattern hair loss is:

• Topical minoxidil
• Oral finasteride as primary therapy
• Topical coal tar daily
• Systemic isotretinoin

Correct Answer: Topical minoxidil

Q21. A known disadvantage of selenium sulfide shampoos is:

• Causing permanent hair growth on face
• Potential to discolor chemically treated or light-colored hair
• Inducing systemic immunosuppression
• Complete eradication of scalp flora leading to infection

Correct Answer: Potential to discolor chemically treated or light-colored hair

Q22. The pathogenesis of dandruff involves which combination of factors?

• Excessive UV exposure alone
• Increased epidermal turnover plus fungal (lipase) activity on sebum producing irritant fatty acids
• Systemic bacterial sepsis
• Vitamin A overdose causing scaling

Correct Answer: Increased epidermal turnover plus fungal (lipase) activity on sebum producing irritant fatty acids

Q23. Which clinical sign (Auspitz sign) helps differentiate psoriasis from seborrheic dermatitis?

• Bleeding when scales are removed (Auspitz sign) is typical of psoriasis
• Intense nocturnal pruritus is pathognomonic for seborrheic dermatitis
• Loss of hair only occurs in seborrheic dermatitis
• Fever and systemic symptoms indicate psoriasis

Correct Answer: Bleeding when scales are removed (Auspitz sign) is typical of psoriasis

Q24. Preferred treatment for limited patchy alopecia areata is:

• Intralesional corticosteroid injections (e.g., triamcinolone)
• Daily oral finasteride
• Topical coal tar application
• Oral ketoconazole long-term

Correct Answer: Intralesional corticosteroid injections (e.g., triamcinolone)

Q25. A common local adverse effect of topical ketoconazole shampoo is:

• Contact dermatitis or local irritation
• Systemic neutropenia
• Permanent alopecia in all users
• Severe hypoglycemia

Correct Answer: Contact dermatitis or local irritation

Q26. Ketoconazole shampoo may contribute to reduced hair shedding by which additional mechanism beyond antifungal activity?

• Topical anti-androgenic and anti-inflammatory effects on the scalp
• Increasing systemic testosterone levels
• Blocking potassium channels in follicles
• Stimulating sebum overproduction

Correct Answer: Topical anti-androgenic and anti-inflammatory effects on the scalp

Q27. Which statement about coal tar use in scalp disease is correct?

• Coal tar products are completely free of safety concerns and can be used continuously without monitoring
• Coal tar is keratoplastic but may cause odor, photosensitivity and is used cautiously due to historical carcinogenicity concerns
• Coal tar directly kills Malassezia by inhibiting ergosterol synthesis
• Coal tar increases scalp sebum production and is thus preferred in oily scalp

Correct Answer: Coal tar is keratoplastic but may cause odor, photosensitivity and is used cautiously due to historical carcinogenicity concerns

Q28. Which phase of the hair cycle corresponds to the active growth stage?

• Telogen
• Anagen
• Catagen
• Exogen

Correct Answer: Anagen

Q29. What typically happens to hair when topical minoxidil therapy is discontinued?

• Improved hair density continues indefinitely after stopping
• Regrown hair is usually lost within months and baseline progression resumes
• Permanent scarring alopecia occurs on discontinuation
• Systemic hyperpigmentation develops

Correct Answer: Regrown hair is usually lost within months and baseline progression resumes

Q30. For initial control of moderate dandruff, a reasonable patient counseling point about medicated shampoo use is:

• Use the anti-dandruff shampoo twice weekly for 2–4 weeks, then adjust to maintenance frequency
• Use daily for life without interruption
• Apply once and expect permanent cure
• Combine two antifungal shampoos daily to maximize effect

Correct Answer: Use the anti-dandruff shampoo twice weekly for 2–4 weeks, then adjust to maintenance frequency

G S Sachin

I am a Registered Pharmacist under the Pharmacy Act, 1948, and the founder of PharmacyFreak.com. I hold a Bachelor of Pharmacy degree from Rungta College of Pharmaceutical Science and Research. With a strong academic foundation and practical knowledge, I am committed to providing accurate, easy-to-understand content to support pharmacy students and professionals. My aim is to make complex pharmaceutical concepts accessible and useful for real-world application.

Mail- Sachin@pharmacyfreak.com