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Flakey: Finding a Dandruff Shampoo That Works

Jun06

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Hi Amy,
I’ve been having this horrid issue for a long, long, time … way before I started reading your blog (which is to say, at least 3 years ago). I’ve tried plenty of shampoos and ‘home remedies’ but they have always been sporadic cures or so … anyway, cut to the chase — I have horrible flakey scalp. It flakes with utter dryness and when my fingers creep up to scratch these scabby flapping flakes (oh, this is really gross …) just more of it generates the next day or so. I’ve tried Head & Shoulders, Loreal Elseve Dandruff Shampoos, even salon-grade ones from Wella, none really worked. The problem disappeared once in a while (perhaps when I wasn’t actively noticing…) but it comes back, always, like a bad summer flick sequel. I’m currently using Selsun Blue, but no major changes.
I really don’t understand why my scalp is so terribly dry and flakey — I live in the hot, humid, equatorial region in Singapore (that’s in Southeast Asia) and most people are suffering from sebum and grease — and this doesn’t help at all when all the dandruff shampoos seem to be targetting grease. I’ve even tried apple cider vinegar wraps for my scalp, but the flakes go on. They’re not oily clumps but dry flakes, about 2mm square (TMI alert!). Please please please give me some of your wonderful advice on what to do because I’m really at a dead end — I even cut off 10 inches of my hair just to stop the flakes getting tangled in the hair (my hair is black, which really exacerbates the visual ugliness of it all). Thank you SO much for taking the time to read this.
Jasmine

Ah, dandruff. Alas and alack and no, I don’t know what’s up with the alliteration there; I blame a lack of coffee.
My handsome dear husband, for as long as I’ve known him (going on decades now, we be old), has suffered from it. Which has taught me a lot about the condition and allllll the many different kinds of treatments and also the fact that for some people, there is just no lifetime cure. You find something that keeps the flakes under control and you figure out how few times a week you can use it, and then you use it. Every week, for as long as it takes.
nizoral-anti-dandruff-shampoo.jpgFor my husband, it’s Nizoral. Once or twice a week, depending on the season. He has very dry, course hair and a dry scalp. No oil or grease at all, like you describe. No redness either, just itchy, large-ish flakes that are terribly visible in his very dark hair. He’s been using Nizoral since it was prescription-only, and while I never notice any flakes or dryness or any real difference in his hair the days he shampoos with Nizoral instead of his regular stuff (Rusk Moist)…I sure do know when he runs out of it.
Nizoral’s active ingredient is ketoconazole, an antifungal. In studies and trials, ketoconazole has handily beaten the active ingredient in most other dandruff shampoos — zinc pyrithione, which is what you get in Head & Shoulders, Loreal and the Wella shampoos.
So…while you tried different shampoos, you actually haven’t tried that many different treatments, because ALL THREE OF THOSE SHAMPOOS ARE ESSENTIALLY THE SAME THING. No wonder they didn’t work!
You can solidly cross zinc pyrithione off your list, because no matter what the formulation, it’s just not treating your variety of flakes. (Not surprising, since zinc pyrithione is one of the mildest treatments out there, right after baking soda and honey, best suited for occasional dandruff sufferers.)
Selsun Blue IS a different treatment, at least, because it uses selenium sulfide as its active ingredient. Although Head & Shoulders does make a selenium sulfide formula as well, so depending on which H&S you used, the Selsun may very well be another rerun treatment.
Other dandruff treatments include tar (Neutrogena TGel), tea tree oil (check your local Whole Foods or health store) and something called piroctone olamine, which is not widely available here in the States, but you might be able to find it by you. A little poking around online suggests it’s popular with the crunchy crowd who get a little wigged out by the fact that zinc pyrithione is also used in some pesticides, even though that’s not QUITE the same thing as actually putting pesticides on your head, cough, and we ARE trying to kill a FUNGUS here, which can’t exactly be done with love and rose hips and rainbows. If you want to go the natural route, baking soda and tea tree oil are probably much easier to get your hands on.
I’ve experienced dandruff only once in my life, soon after we moved from Pennsylvania to DC. I treated it with Neutrogena TGel, which Jason has tried but reported that it didn’t work nearly as well as the Nizoral. Everybody’s flakes are different, most likely caused by different triggers (an allergy to your hair products, a diet of too much junk food, etc.) and/or underlying fungal infections. MOST dandruff infections are caused by a fungus, more so than allergies or other skin conditions like dermatitis or psoriasis — with either of these you’d notice a lot of redness or flaking on places other than your scalp, like on your eyebrows or nose. So you can probably rule those out and stick with the antifungal treatments.
I’d recommend that you start with the Nizoral, if you’ve never tried it before. Follow the instructions carefully — you’ll need to use it more frequently at first when you are treating an active breakout, and then after a week or two you should be able to drop down to a less-frequent maintenance mode. Make no mistake, I highly doubt you’re ever going to say your dandruff is officially a thing of the past. It probably always will come back if you don’t keep up the occasional use of a treatment shampoo.
Remember too, that the act of shampooing actually produces more flakes, so make sure you aren’t washing anymore than is absolutely necessary.
AND! One last option, if you do blow through that entire list of active ingredients and still don’t feel like you’ve got your flakes under control…both ketoconazole and selenium sulfide are available in prescription strength versions. After comparing the Selsun Blue and the Nizoral, see if one of them seemed to be a bit more effective, and then see a dermatologist for the prescription version.

About the author

Amalah

http://www.amalah.com
Amalah is a pseudonym of Amy Corbett Storch. She is the author of the Advice Smackdown and Bounce Back. You can follow Amy's daily mothering adventures at Amalah. Also, it's pronounced AIM-ah-lah.

If there is a question you would like answered on the Advice Smackdown, please submit it to amyadvice@gmail.com.

Amy also documented her second pregnancy (with Ezra) in our wildly popular Weekly Pregnancy Calendar, Zero to Forty.

Amy is mother to rising first-grader Noah, preschooler Ezra, and toddler Ike.


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18 Responses to “Flakey: Finding a Dandruff Shampoo That Works”

  1. qwyneth Jun 06 at 12:08 pm Reply

    This sounds *exactly* like my husband’s dandruff. I’m going to pick up some Nizoral and see if it kicks the dandruff. Thanks!

  2. julie Jun 06 at 12:17 pm Reply

    This is actually one for a dermatologist. Scaley plaques of dandruff might be psoraisis.

  3. Lisa M Jun 06 at 12:59 pm Reply

    Totally different kind of dandruff…but I had eczema/allergy related dandruff for a while. the Neutrogena worked great for the initial outbreak, and then H & S kept it under control until I discovered the beauty of Zyrtec.
    Now I take Zyrtec year-round and haven’t had eczema in ages!

  4. Lizzybee Jun 06 at 1:15 pm Reply

    I had a similar issue that popped up out of nowhere. I mentioned to my regular doc at my checkup and asked her if I need to go to the dermatologist, for a special opinion, and she perscribed something herself instead. I am sorry I don’t remember what it was, but it was creepily BRIGHT RED. And… thick. But-it worked. And I haven’t had any problems since.
    So my advice is to see a professional, it sounds like you have tried a lot of over the counter shampoos, it’s time to bring out the big guns!

  5. kai Jun 06 at 1:17 pm Reply

    Nizoral works WONDERS for me. I tried a lot of other shampoos that didn’t help much – and some even seemed to make it worse. It is so nice to have found something that works & now I don’t even have to use it very often – just like Amy said! Great advice!

  6. Andrea Jun 06 at 1:36 pm Reply

    This sounds exactly like me, and I’ve tried all of the above, and Nizoral too. Tgel was so drying that it actually made the situation MUCH, MUCH, HORRIBLY worse. Avoid anything that is actually drying. The Nizoral worked like a charm at first, but stopped working after a couple of years. Now, what works is washing my hair (with a very gentle shampoo) every day – I know, that’s counterintuitive because the flakes are a “dryness” problem – and then conditioning with a very good conditioner every day. I think the moisture absorbed from the shower is extremely important, and then the conditioner to “lock the moisture in”, just like you do with a moisturizer on dry skin. You can do a combo, using Nizoral for the shampoo on whatever schedule you choose (twice a week, etc.) and then a good conditioning, and then a really gentle shampoo and excellent conditioner on other days (yes, put it on your scalp… not just the ends of your hair… you’re *moisturizing!*) and good luck! This has actually been a good solution for me, and I only have problems when I skip even ONE DAY of a shower/shampoo/conditioner combo.

  7. Amy Jun 06 at 1:57 pm Reply

    This may sound a little woo-woo-crazy to you all, but I’m an energy healer and I’ve found that dandruff and other scalp conditions seem to stem from emotional issues of guilt.
    Ask inside to see if there’s anything that you’re feeling guilty about or if you were raised in a household of guilt and emotional manipulation. If you find guilt, examine it emotionally, see if there’s a decision you can change to make yourself feel better about it, or if not, consciously decide to release the guilt.

  8. Meghan Jun 06 at 5:10 pm Reply

    “This may sound a little woo-woo-crazy to you all, but I’m an energy healer and I’ve found that dandruff and other scalp conditions seem to stem from emotional issues of guilt.”
    I’m sorry, I couldn’t let this pass. This is the most ridiculous thing I’ve ever heard. Dandruff is a fungus; it has absolutely nothing to do with how you feel emotionally. Some people are just unlucky enough to have it.
    For the OP: I use Nizoral to much benefit. It has really helped. I’ve also used TGel in the past and it worked pretty well, but it just wasn’t cutting it anymore. A tip my dermatologist told me is to put it in, get out of the shower (or take a bath and do this) and let it sit on your scalp for 15 minutes or so.
    But you may want to visit a dermatologist because like someone upthread mentioned, it could be something else, like psoriasis or eczema. And there are lots of treatment for those, as well.

  9. Beth Jun 06 at 5:17 pm Reply

    I have also suffered for as long as I can remember. I have tried everything listed above and then some. Currently I am using the Head and Shoulders Intensive Solutions 2-in-1 shampoo. I have to say that it keeps my flakes under control and it smells good. I know you mentioned that you had tried regular Head and Shoulders but maybe this would work? If I don’t use at least once a week my flakes return but so far this is working.

  10. Anonymous Jun 06 at 5:43 pm Reply

    Try Nioxin – both the shampoo and the “scalp therapy” – it’s not cheap, but it’s available at some salons and most beauty-supply stores. It’s technically for people with thinning hair (not a problem for me, but I’ve heard it actually works for that too), but I’ve had great success with it keeping the flakes away. None of the other options mentioned here worked for me over time, but I’ve been using Nioxin once a week or so for the past 6 years, and never see a flake.
    A bonus is that it smells minty and fresh, unlike some of the gross chemical-smelling alternatives.

  11. Carrie Jun 08 at 3:29 pm Reply

    I suffer from dry scalp on a regular basis. It’s not terrible but it’s not exactly fun. I stay away from Head & Shoulders because it is so harsh. I find T Gel pretty good but at the moment I’m using E45 Dry Scalp shampoo and that eases it. I also rub aqueous cream into my scalp occasionally at night to ease the itchiness.

  12. TasterSpoon Jun 09 at 5:04 pm Reply

    I agree – see a dermatologist. Psoriasis CAN be localized to your head – and if it’s that, you can get a prescription, I don’t know whether it’s for a shampoo or a pill. Someone I love has psoriasis on his head and he’s super self conscious about it…but psoriasis (as I understand it) is about skin cell production on overdrive, rather than a problem of dryness or oiliness. I try to tell him that his head is just super healthy, but he’s not buying it. He sporadically uses a prescription shampoo of some kind.
    Anyway, I was being Nature Girl and read that Borage Oil and Neem Oil are supposed to be good for dandruff, so I made him a mixture of that (got ‘em from one of those online essential oil sites). He rubs it in, leaves it for a minute, then shampoos out. He says it totally works. But the neem oil stinks to high heaven – like garlic or something. So it’s a trade off for sure.

  13. Jamie Jun 10 at 2:13 pm Reply

    As a psoriasis suffered, I urge you to see a dermatologist! I suffered for years for what I presumed to be dandruff, trying every shampoo and treatment available in the drugstore. No relief…just money down the drain.
    Since seeing a dermatologist, I use a weekly prescription foam called Olux and it has worked magic. No more flakes, no more itching. The drug is also now available in a generic, so affordable to boot.

  14. Anna Jun 11 at 12:42 pm Reply

    Not all dandruff is caused by a fungus, and not all scalp flakes are dandruff.
    It honestly sounds as if a) the shampoo you are using is too drying, and b)you might be irritated by sulphates. Not many people seem to be aware of it, but most commercial shampoos contain sulphates which are relatively harsh detergents and that is the cause of many people’s dried-out scalps and flakies.
    Check the ingredients list. Sodium lauryl sulphate is the harshest. Some people react to that but are fine with sodium laurETH sulphate (SLES). There are also quite a few brands without sulphates if you look / google the info.
    You could also try washing your hair with conditioner only. (This is not a joke.) You need to use a somewhat different technique, but conditioners also contain mild surfactants that will clean your hair. Massage in a generous amount, then leave it on a few minutes (it needs longer to work than shampoo does), then rinse it at least for 2 minutes. Some people experience an adjustment period of a week or two, but it can really be worth trying this.

  15. Jess Jun 14 at 1:24 am Reply

    What up, fellow expat. (I assume?)
    Stop using Asian shampoo. I live in South Korea and get the big dry scalp flakes if I use Korean shampoo, and it magically disappears when I use any shampoo with English letters ONLY on the bottle. They use a lot of the same brand names, but what is in the bottle is NOT THE SAME.
    You don’t have dandruff. Dandruff shampoo will make it worse. Import yourself some shampoo from North America. Any shampoo. Suave. Whatever. It will clear up.

  16. Amy Richards Jul 29 at 10:04 pm Reply

    Nizoral worked for me – Thanks Amalah!

  17. Charlie Sep 08 at 6:14 pm Reply

    I would recommend any shampoo that does not contain sodium lauryl sulphate. You may have an allergy to this substance which is found in a majority of shampoos. Try specialist brands that do not contain this ingredient, such as the ‘Naked’ range from Boots (UK), Aubrey Organics or SoOrganic.

  18. meg m Jun 30 at 1:48 pm Reply

    I have suffered with a flaky, scaly, oily scalp for several years. I tried herbal rinses, oils, etc. to no avail. I was so incredibly frustrated by wasting my money, time & hope on things that just didn’t get RID of the flakes.
    Then I tried the MADE FROM EARTH Tea + Protein Shampoo, and I was cautiously optimistic. I had read the reviews on the internet, and I really didn’t have anything to lose (except flakes, hopefully).
    I actually PRAYED for something to give me much needed relief from the constant flaking & itching. Well, I can honestly say after 1.5 months of using this every 3-4 days, my hair is *almost* completely flake free! Praise the Lord!
    This product may seem a little expensive, but for me, it is worth its weight in gold. Honestly, this is the best product on the market for people with seborrheic dermatitis (which is what I believe I have). I HIGHLY recommend it!

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