I have seborrheic dermatitis and have found your website tips and information extremely helpful. I was hoping that you’d consider adding some information about the prescription shampoo Loprox to the site. I just started using this shampoo and am wondering how it fits in with your other advice (for example, should it be rotated like the other dandruff shampoos or must it be used for a uninterrupted period in order to be effective). If you have particular tips about the use of Loprox, I’d love to read your thoughts on your website or blog. Thanks, Sue K
The challenging thing about dandruff is that there are as many variations on what works for it as there are people with it! This means that when I’m helping a patient we ‘test’ treatment regimens to find what works When I’m integrating prescription Loprox into a regimen some of the variations I use are:
Shampoo everyday and have my patient rotate the Loprox with their other shampoos. I especially do this if the dandruff is really severe. The more frequently a person shampoos the better the treatment works. To really get control of severe scalp dandruff we want to initially hit is hard, and shampooing everyday is important to getting the rash under control. It can be a little hard on fine or colored hair because the shampoos can be harsh so I counsel patients to pay particular attention that they apply the medicated shampoo primarily to the scalp skin only (it will rinse-off over the rest of the hair, but it will be diluted at that point).
Since I have patients use Loprox twice a week, and since I ideally want patients to use 3 other medicated shampoos for rotation, this is perfect. They use the Loprox one day, then their first over-the-counter shampoo the next, then their second over-the-counter shampoo the next, then their third over-the-counter shampoo the next then back to the Loprox (there are supposed to be 3 days between Loprox applications). They do this for the 4 week use limit on Loprox (or as directed by a treating MD). Over-the-counter medicated shampoos need to be continued until the scalp dandruff is controlled plus at least a few weeks. They can then taper down on their shampooing frequency if they would like. Eventually they even taper off the medicated products once their dandruff has been controlled for a few months or more (see below).
Shampoo every other day or every third day and rotate the Loprox with one or two other medicated shampoo. Some people just are not going to shampoo everyday. If their dandruff is mild then this regimen may work. Loprox is ideally used twice a week, and so they would pick one or two other shampoo to rotate with it. I try to encourage them to shampoo every other day initially. If this treatment is not working, then I recommend they ramp up to the daily shampoo with the 3 product rotation to jump start things, and then diminish shampoo frequency to every other or every third day once things are improved.
Loprox as ‘mono-therapy’ used twice a week. This is the ‘low maintenance’ approach and can actually work well if the dandruff isn’t too stubborn. If it’s not working then ramping-up to the two or three shampoo rotation and more frequent shampoo intervals can jump start improvement. Once the dandruff is under control treatment can be reduced to this mono-therapy.
A word about scalp dandruff maintenance treatment: Dandruff will come and go, there unfortunately is no lifelong cure. I therefore like to give my patients varying treatment options that they can use as their rash waxes and wanes. If they are using a prescription shampoo like Loprox I don’t want them to use it as maintenance treatment. I like it to be the ‘big surprise’ for the scalp when it’s really misbehaving. That means I have them put it away after the rash has been controlled for a few months. They then use over-the-counter shampoos for a while, and, if the rash stays quiet they can even stop those. Their dandruff will of course flare-up at some point and then they get out the over-the-counter products. If those don’t work, out comes the Loprox. If that doesn’t work, up goes the shampoo frequency to everyday etc…
Remember, with dandruff, I find that my patients are more likely to have treatment success if they jump on any little flare-up early; if the dandruff gets really bad again then we start over from scratch to get it under control. Also Loprox is a prescription product and to use it a person must be under the care of a treating, licensed physician, plus there are limits on it’s use. Please read my disclaimers below!
For more information on over-the-counter dandruff shampoos and how exactly I tell my patients to use them for maximal results, click on this link to see my post titled: Remedies For The Dry Itchy Scalp Of Seborrheic Dermatitis
For more of my dandruff posts click here to check out the Dandruff category page on my blog.
Cynthia Bailey MD, Dermatologist
Disclaimer: Please realize that availing yourself of the opportunity to submit and receive answers to your questions from Dr. Bailey does not confer a doctor/patient relationship with Dr. Bailey. The information provided by Dr. Bailey is general health information inspired by your question. It should not be a substitute for obtaining medical advice from your physician and is not intended to diagnose or treat any specific medical problem (and is not an extension of the care Dr. Bailey has provided in her office for existing patients of her practice). Never ignore your own doctor’s advice because of something you read here; this information is for general informational purpose only.