Flakey: Finding a Dandruff Shampoo That Works

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.
For 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.