Small itchy patches on the scalp that stay for many months with persistent dandruff are often due to a chronic scalp condition like seborrheic dermatitis, fungal infection, or sometimes psoriasis. When Ketomac shampoo gives only temporary relief, but the problem keeps returning, it usually means the inflammation underneath the scalp skin is not fully controlled, or the diagnosis may need to be reassessed. Continuous scratching and dryness can also make these patches thicker and more stubborn over time. In such cases, shampoo alone is often not enough. The treatment may need a combination approach, such as rotating medicated shampoos, short courses of anti-inflammatory scalp lotions, or antifungal creams, depending on the exact cause. Keeping the scalp clean, avoiding heavy oiling during active itching, and washing sweat regularly can also help reduce flare-ups. Using too many harsh products at once should be avoided because it can further irritate the scalp. Since your patches have been present for a year without clear improvement, it is better to consult a dermatologist again for a detailed scalp examination. Sometimes a small change in diagnosis or treatment plan makes a big difference in long-term control.