Do You Need Relief from a Dry, Itchy Scalp?
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:
What are Dr. Cynthia Bailey’s instructions for using medicated dandruff shampoos?
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.
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.
- Use a non-medicated shampoo for your first lather to clean dirt, oil and hair care products from your scalp and hair.
- 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.
What are the different 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:
- Zinc Pyrithione
I really like this ingredient. I find it to be gentler on my fine hair than the other dandruff medicines. My Foaming Zinc Cleanser is a shampoo and also a great cleanser for back and chest acne. It is made with the maximum allowed strength of 2% zinc pyrithione. It works beautifully, even on fine hair, and it’s what I use to control my own scalp dandruff.
Another of my favorite products 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-DandruffShampoo (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.
- 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), and Sebulex (2% sulfur, 2% sal. acid).
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).
- Selenium Sulfide
This very effective ingredient has been around for years. It’s a little harsh on fine hair. Products include Selsun Blue (1% ) and Head and Shoulders Intensive Treatment (1%).
This ingredient works 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%), and 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!
Would you like to get the full scoop on understanding and treating seborrheic dermatitis?
It’s all in my newly updated, Advice Pages on this common skin problem!
My original, seborrheic dermatitis blog post series articles are listed here:
You can find more of my treatment and skin care recommendations in my Advice Pages for Understanding and Treating Seborrheic Dermatitis here. I share my favorite tips for dandruff of the scalp, face, ears and more.