Remedies for the Dry Itchy Scalp of Seborrheic Dermatitis, Part 2

Cynthia Bailey, MD|November 5, 2009

There are tricks to getting the best results from your dandruff products. As I mentioned in my last post, scalp dandruff is common and most people misinterpret the scale and itch as 'dry scalp'. The scalp isn't dry, it has a rash and medicated shampoos deliver the medicine necessary to treat the problem. Here are the instructions that I give my seborrheic dermatitis patients in my dermatology office:

Dr. Cynthia Bailey’s instructions for using medicated dandruff shampoos:

Shampoo Instructions

  1. Try to shampoo as often as possible. Initially, you may want to shampoo every day until your scalp is controlled. Remember, shampooing delivers medicine to the scalp skin and it also helps to remove the oils and scale that contribute to seborrheic dermatitis.
  2. Lather and rinse your hair twice with each washing.
    1. Each lathering needs to reach down to the skin of your scalp. Evenly cover the skin with suds and rub or scruff them into the scalp using your finger tips or a scalp scrubber.  I love scalp scrubbers and have the 'Cadillac' scalp scrubber.  Click here to see more, or to order this great scalp scrubber. a great plastic scalp scrubber brush
    2. Use a non-medicated shampoo for your first lather to clean dirt, oil and hair care products from your scalp and hair.
    3. Use your medicated shampoo for your second lather and allow the shampoo to stay on your scalp for about 5 minutes before rinsing.
  3. You can follow up with conditioners or the other hair care products that you like to use.
  4. Rotate your medicated dandruff shampoo active ingredients. Use a different type of medicated ingredient each time that you shampoo. Your scalp gets used to one ingredient and you need to keep rotating through at least 3 different ones. This phenomenon is called tachyphylaxis and it’s why medicines sometimes quit working.
  5. Continue using your medicated shampoos until your scalp is controlled plus at least a month. If you stop too soon, the dandruff comes back faster than if you really chase it away with persistent treatment.

Many medicated shampoos are harsh to your actual hair shafts. If you have fine or fragile hair then take care to only apply the shampoo to your scalp skin. There’s no need to lather up the full length of your hair shafts because you cleaned them with your first, non-medicated shampoo product. Medicated ingredients in dandruff shampoos Over the counter medicated shampoos basically boil down to 5 different ingredients. When your staring at the shelf of dandruff products in your drug store, realize that there are really only 5 choices. Pick the ones with the highest concentration of active ingredients (noted below in parentheses). You should pick at least 3 different active ingredients and rotate the products.  The product ingredients are:

  1. Zinc Pyrithione: I really like this ingredient. I find it to be gentler on my fine hair than the other dandruff medicines. My OTB Medicated Cleanser #2 for Back Acne(with the maximum strength of 2% Zinc Pyrithione) works beautifully as a shampoo and it’s what I use. Click here to learn more about my favorite dandruff shampoo, OTB Medicated Cleanser #2Dermatologist recommended dandruff shampoo Another of my favorite product is DHS Zinc Shampoo (2% ). Other zinc pyrithione options include the many Head and Sholders products (1% ), Zincon (1%), Herbal Essences No Flakin' Way Pyrithione Zinc Anti-Dandruff Shampoo (1% ), Neutrogena T-Gel Daily Control Dandruff Shampoo (1% ) and ZNP soap (2% ) which lathers nicely on the scalp in spite of being a bar soap.
  2. Salicylic Acid with or without Sulfur. These medicines are also fairly gentle on fine or treated hair. Products include Denorex Extra Strength (3% sal. acid), Selsun Blue Naturals (3% sal. acid), DHS Sal Shampoo (3% sal. acid), Neutrogena T/Sal Therapeutic Shampoo (3% sal. acid), P&S Shampoo (2% sal. acid), Sebulex (2% sulfur, 2% sal. acid).
  3. Ketoconazole. This is an antifungal product that used to be a prescription but is now available in half strength over the counter. It’s reasonably gentle on fine hair. The brand name product is Nizoril (1% ketoconazole)
  4. Selenium Sulfide: This very effective ingredient has been around for years. It’s a little harsh on fine hair. Products include Selsun Blue (1% ), Head and Shoulders Intensive Treatment (1%)
  5. Tar: This ingredients work really well but will yellow light colored hair. It also smells like tar and no amount of perfume can mask that smell in your hair. The tar concentration can be described with different terms. I give the coal tar concentration in parentheses. (Tar is my favorite ingredient for scalp psoriasis, which can look like seborrhea but is much more severe.) Products include Denorex (2.5%), T/Gel Therapeutic Shampoo (0.5%), T/Gel Extra Strength (1%), DHS Tar (0.5%), MG 217 Medicated Tar Shampoo (3%), Tarsum Shampoo/Gel (2%)

Please remember that if your scalp does not improve you should see your doctor to be sure that you don't have a more unusual reason for having an itchy scalp!

My Seborrheic Dermatitis Series:

Dermatologist's Tips for Dry Flaky Skin on Your Face and Scalp; Tis the Season for Seborrheic Dermatitis Remedies for the Dry Itchy Scalp of Seborrheic Dermatitis Remedies for Really Stubborn Scalp Seborrheic Dermatitis Itchy Crusty Scaly Ears; More on Seborrheic Dermatitis Dermatologist's Tips for Treating Facial Seborrheic Dermatitis: It Looks Like Dry Skin, But It's a Rash! Dr. Cynthia Bailey's Tips for Facial Seborrheic Dermatitis Control If you found this post helpful, you may also want to read: Chapped Lips: The Remedy Depends on the Cause Dermatologist's 3 Simple Steps for Sandal Ready Feet by Spring Dermatologist's Simple Tips for Athlete's Foot Fungus Treatment Brilliant Skin Care For The New Decade Essential Winter Skin Care; 2 simple tricks to healthy winter skin Making Sense Of The Vitamin D Dilemma And Sun Exposure

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