Saturday, March 14, 2015

Medicated Shampoos, Conditioners, Co-washes and Treatments For Itchy Scalp, Dry Scalp, Seborrheic Dermatitis (List)

Below is a list of medicated shampoos and conditioners for troubled scalps, sorted by product type and active ingredients. If you have dry scalp - see the end of this post for ideas (scroll to the end).

Many of these shampoos have herbal ingredients which can either soothe, irritate (or do absolutely nothing). Proteins may soothe a dry scalp, but can also be irritating for some people.
Essential oils like tea tree, rosemary, thyme, sage, (neem oil is going in small letters because it's so stinky) can be antifungal if used in adequate concentrations. But they can also cause sensitivity reactions or allergic reactions.
Sometimes detergents in dandruff shampoos can irritate already-irritated skin, however, there are some detergent-free options in this post and there are medicated conditioners at the bottom of the page for people whose skin or hair does not tolerate detergents. You can wash your hair and scalp with medicated conditioners.
Not everybody with itching will have flakes, not everybody with flakes will have itching. Some people get painful or itchy bumps instead - but the treatments are usually the same.
If you're not getting relief from any of these treatments, you may be reacting badly to fragrances, preservatives or some other ingredient in hair products. Or you may be dehydrating your scalp too much - see the final paragraph after the list.
And if you're trying lots of medicated shampoos and conditioners and topical treatments with no relief, please see a doctor or dermatologist if that is an option available to you. They can prescribe medications that may be more effective.

Lets talk about rotating treatments! If you are a frequent customer in the itchy or flaky or bumpy, scaling, patchy scalp department, there is a good chance you need to have 2 or 3 different medications that work on standby. Why? Because the fungus (Malasezzia) that is strongly implicated in scaling and flaking and itchy, unhappy scalps has many different variations, if not true sub-species, then like sub-species. For example, you might use a zinc pyrithione shampoo and it works now, but it may not work as well later on. It's possible that some fungi on your scalp that were causing the itch and inflammation were not affected by that medication - or they developed some resistance to it. Each medication has a slightly different method of "attacking" fungi and some methods work better on some fungi than others. So if that happens, you need a different medication to control these fungi the next time around. Some fungi will be controlled with zinc pyrithione, others will be controlled with ketoconazole or selenium sulfide. Sometimes sulfur will get the job done and sometimes salicylic acid (with or without sulfur) works best.
Some people need to rotate between different outbreaks or flare-ups. Some people need to rotate every time they wash their hair. It's not fun, but it helps.

If you need to use medicated shampoo often and your scalp is not oily, or all the shampooing dries skin and hair - consider using a medicated conditioner as a "shampoo" - it won't lather but it might provide some relief. If you have dry or curly hair - you might love it.

The Active Ingredients: Look for the listed concentration. If concentration is not listed on the bottle - be wary, but it might still work.
  • Zinc pyrithione: Antifungal, may reduce scaling, may relieve inflammation. Effective at 1%, also effective at 0.5%, response may be slower than 1% (or not).
  • Tar: Slows proliferation of skin cells. Skin cells proliferate too quickly with dandruff - so you end up with scaling and flaking. Effective as 0.5% active tar.
  • Salicylic acid: Anti-scaling (remove scales and reduce flaking), can be anti-inflammatory and anti-septic. Effective at 1% to 1.5% and greater, sensitive skin may need 0.5% to avoid irritation. This exfoliates, so it may help with bumpy cysts if your scalp tolerates it.
  • Selenium sulfide: Antifungal, effective at 1%
  • Sulfur: Mild antifungal and antiseptic, anti-inflammatory, mild exfoliant. Effective at 2%
  • Ketoconazole: Antifungal. Effective at 1%, 2% is the most-effective, prescription dose (non-prescription outside the USA).
  • Tea tree oil: Anti-fungal, anti-septic when the concentration is adequate.
  • Rosemary oil, thyme oil, cedar oils: Anti-fungal, anti-septic, may promote healing.
  • Hydrocortisone: Inflammation is a critical part of the itchy-flaky scalp issue. Hydrocortisone reduces inflammation and relieves itching. Effective at 1%.
  • Piroctone Olamine: Antifungal, Effective at 1% (unless I find otherwise)

Note: This is organized by active ingredients. Also indicated are: Sulfate-free, silicones. Sulfates ("sulfate detergents," a class of anionic detergents) and silicone emollients/detanglers are not necessarily bad for itchy or scaly scalps, but some people avoid them so I'm just trying to help you narrow the field. "Sulfate-free" shampoos are not necessarily milder or non-drying. 

Medicated Shampoos

Tar
  • Denorex Maximum Strength: Tar 1.8%, Sulfate-free
  • Mill Creek Dandruff Control Shampoo:  Tar 0.5%
  • Neutrogena T-Gel: Tar 0.5%

Tea Tree
  • Aubrey Organics, Scalp Rescue Shampoo, Tea Tree & Primrose: Tea tree oil, concentration unspecified: Sulfate Free
  • Jason Normalizing Tea Tree Scalp Normalizing Shampoo: Tea tree oil, concentration unspecified
  • Nature's Gate Tea Tree Calming Shampoo: Tea tree oil, concentration unspecified: Sulfate Free

Zinc Pyrithione
  • AG Control Anti-Dandruff Shampoo : Zinc Pyrithione 2%
  • Aveeno Nourish + Dandruff Control: Zinc Pyrithione 1%, contains silicones
  • Avlon KeraCare Dry & Itchy Scalp Moisturizing Shampoo: Zinc Pyrithione 1%
  • Clear Scalp Therapy shampoo: Zinc Pyrithione 1%, contains silicones
  • Derma Zinc Shampoo: Zinc Pyrithione 2%
  • DHS Zinc Shampoo: Zinc Pyrithione 2%, sulfate-free
  • DS Laboratories Danderene High Performance Anti-Dandruff Shampoo: Zinc Pyrithione 2%: Sulfate Free
  • Dr. Miracle's Cleanse & Condition 2-in-1 Dandruff Shampoo: Zinc Pyrithione 1%
  • Head and Shoulders Shampoos: Zinc Pyrithione 1%, contains silicones
  • Jason Dandruff Relief 2-in-1 Shampoo+Conditioner:  Zinc Pyrithione (concentration unspecified)
  • Kenra Dandruff Shampoo :Zinc Pyrithione 1.9%
  • Mane N Tail Daily Control Anti-Dandruff shampoo: Zinc Pyrithione 1%
  • Matrix Scalptherapie Antidandruff Shampoo:  Zinc Pyrithione (concentration unspecified) contains silicones
  • Neutrogena Daily Control 2-in-1: Zinc Pyrithione 1%, water-insoluble silicone, water-soluble silicone+wheat protein
  • Nioxin Scalp Recovery Cleanser: Zinc Pyrithione 1%, contains silicones
  • Noble Formula ZInc Shampoo: Zinc Pyrithione 2%, fragrance-free
  • Redken Scalp Relief Shampoo: Zinc Pyrithione (concentration unspecified)
  • Suave Dandruff Solutions Anti Dandruff Shampoo Coconut and Shea Butter: Zinc Pyrithione, contains silicones
  • Suave Dandruff Solutions Anti Dandruff Shampoo Mint and Eucalyptus: Zinc Pyrithione,  contains silicones
  • Suave Professionals Men 2-in-1 Classic Clean Anti-Dandruff: Pyrithione 1%, contains silicones
  • Zincon: Zinc Pyrithione 1% sulfate-free

Salicylic acid
  • Avalon Organics Medicated Anti-Dandruff Shampoo: Salicylic acid 2%, 
  • Denorex Extra Strength: Salicylic acid 3%, sulfate-free
  • Giovanni Don't Be Flaky Soothing Anti-Dandruff Shampoo: 2% Salicylic acid: Sulfate Free
  • Home Health Everclean Shampoo: 1.8% Salicylic acid, available in scented and unscented
  • Jason Dandruff Relief Shampoo: Sulfur 2%, Salicylic Acid 2%: Sulfate free
  • Mineral Fusion Anti-Dandruff Shampoo: 2% Salicylic acid: Sulfate Free
  • Neutrogena T-Sal: Salicylic acid 3%, sulfate-free
  • Pure & Basic Anti-Dandruff Shampoo Tea Tree and Rosemary: 2% Salicylic acid, sulfate-free, water-soluble silicone
  • Sebex Shampoo (generic for Sebulex): Salicylic acid 2%, Sulfur 2% 
  • Shea Moisture African Black Soap Deep Cleansing Shampoo: Salicylic acid, concentration unknown, also tea tree oil. Sulfate Free (this contains soap which may or may not leave some residue if you have hard water)
  • Thicker, Fuller Hair Dandruff Sulfate-Free Shampoo: 1.8% Salicylic Acid: Sulfate Free

Sulfur
  • Jason Dandruff Relief Shampoo: Sulfur 2%, Salicylic Acid 2%: Sulfate free
  • Sulfur 8 shampoo: Sulfur
  • Sebex Shampoo (generic for Sebulex): Salicylic acid 2%, Sulfur 2%

Ketoconazole
  • Nizoral: Ketoconazole 1%, sulfate free
  • Regenepure: Ketoconazole 1%, sulfate-free, not suitable for vegetarians
  • Boots Anti-Dandruff Ketoconazole shampoo: Ketoconazole 2% - this is a UK brand

Selenium sulfide

  • Head And Shoulders Clinical Strength: Selenium sulfide 1%, silicone
  • Selsun Blue Medicated Dandruff Shampoo: Selenium sulfide 1%

Hydrocortisone
  • Dr. Marder's Total Relief Shampoo: 1% Hydrocortisone, Sulfate-free
    • See the "Spray, liquids, gels and DIY list below for more treatments with hydrocortisone
Piroctone Olamine
  • Alpecin Dandruff Killer Shampoo, also contains salicylic acid and zinc pyrithione
  • Pilfood Dandruff Shampoo 
  • SebaMed Anti Dandruff Shampoo 
  • Hegor Shampoo for Persistent Dandruff (European brand): Piroctone Olamine and Pyrithione zinc
  • Davine's Natural Tech Purifying Gel: Zinc Pyrithione 0.48%, Piroctone Olamine


Medicated Conditioners and Co-washes: 
  • Avalon Organics Medicated Anti-Dandruff Conditioner: Salicylic acid 2%
  • Avlon KeraCare Dry & Itchy Scalp Moisturizing Conditioner: Zinc Pyrithione 1%, Contains silicone
  • Dr. Marder's Total Relief Conditioner: Zinc Pyrithione 1%contains an "evaporating" silicone - less likely to build up on hair
  • Giovanni Don't Be Flaky Nourishing Conditioner: Salicylic acid 2%
  • Head and Shoulders Conditioners - not "2-in-1 shampoo plus conditioner," that is shampoo (Itchy Scalp Care, Classic Clean, Damage Rescue, Green apple, Instant Relief): Zinc Pyrithione 0.5%contains silicones
  • Head and Shoulders Moisture Care Co-Wash: Zinc Pyrithione 0.5% Contains silicone
  • Jason Normalizing Tea Tree Conditioner: Tea tree oil, concentration unspecified
  • Mane N Tail Daily Control Anti-Dandruff Conditioner:  Zinc Pyrithionecontains silicone
  • Nature's Gate Tea Tree Calming Conditioner: Tea tree oil, concentration unspecified
  • Suave Scalp Solutions Anti-Dandruff conditioner Coconut and Shea butter: Zinc Pyrithione, contains silicone
  • Sulfur 8 Medicated Light and Original formula hair/Scalp conditioner: 2% sulfur - this is not a creamy hair conditioner, it is petrolatum-based
  • Shea Moisture African Black Soap Purification Masque: Salicylic acid, concentration unspecified, also neem and tea tree oil, concentration unspecified
  • Shea Moisture African Black Soap Balancing Conditioner: Salicylic acid, concentration unspecified, tea tree oil, concentration unspecified
  • Yes To Carrots Scalp Relief Conditioner: Tea tree oil, concentration unspecified, Salicylic acid, concentration unspecified 

Non-Shampo Sprays, Liquids, topical gels or creams and DIY treatments:
  • Davine's Natural Tech Purifying Gel: Zinc Pyrithione 0.48%, Piroctone Olamine
  • Derma Zinc Cream: Zinc Pyrithione 0.25%
  • Essential oil treatments, mixed into oil and left on for a little while before washing, or mixed into your favorite shampoo:
    • Mix 3-5 drops of tea tree oil or rosemary essential oil or thyme essential oil or cedar essential oil into 1 tablespoon (15 ml) of oil such as olive oil. Apply to the scalp, leave on 10-30 minutes and shampoo out. 
    • Mix 3-5 drops of tea tree oil or rosemary essential oil or thyme essential oil or cedar essential oil into 1 tablespoon (15 ml) of shampoo or conditioner and use as you normally would - allow the shampoo or conditioner to stay on your scalp for several minutes before rinsing.
    • 3-5 drops of essential oil = up to 1/16th of a teaspoon, 0.15 ml-0.25 ml
  • Miconazole nitrate creams (for the scalp is an off-label use as an anti-fungal, use at your own discretion)
  • Noble Formula Zinc cream: Zinc Pyrithione 0.25%
  • Psoriasin gel: Tar 1.25%
  • Scalpicin 2-in-1: Salicylic acid 3%
  • Scalpicin Maximum Strength: Hydrocortisone 1%
  • Selsun Blue Scalp Itch Treatment: Hydrocortisone 1%
  • Shea Moisture African Black Soap Dandruff and Dry Scalp Elixir (Spray for the scalp): Salicylic acid, concentration unspecified, tea tree oil concentration unspecified
  • Tolnaftate Creams or liquid (for the scalp is an off-label use, use at your own discretion)


DRY SCALP? Got an especially dry or itchy scalp? Scalp needs soothing? 

  • Wash only as often as you need to to keep ahead of itching. Just wetting and drying our skin creates irritation, so don't wash your hair/scalp unless it's dirty or looks bad or is getting more itchy when you don't wash it.
  • Look for balanced shampoos and conditioners. "Balanced" in a shampoo means:

  1. Look for more than 1 detergent (that makes it milder). For example, sodium lauryl sulfate + cocamidopropyl betaine or C14-16 Olefin sulfonate + cocamidopropyl betaine; any of these + decyl glucoside, or combined with Sodium Cocoyl Isethionate
  2. You probably want some conditioning ingredients like cetrimonium chloride, polyquaternium ingredients, some emollients like plant oils or glycol distearate, sucrose cocoate, PEG-cocoate or silicones to soften skin make detergent less irritating.
  3. You also want humectant ingredients which can act as anti-irritants that will help your scalp retain moisture and reduce irritation like polyquaternium-7, panthenol, sodium PCA, glycerin, hydroxypropyltrimonium honey, aloe, propanediol, glycine betaine, urea or allantoin.  These can be great for your hair too. 
  4. In conditioners (if you put those on your scalp), look for the same things - aside from conditioning ingredients, look for those irritation-reducing humectants to round out protection for your scalp.
  5. Try applying some oil (avocado, olive, jojoba...) to your scalp or a little fragrance-free skin lotion 10 minutes before you wash your hair. This softens the skin and protects it from the drying effects of washing. CAUTION: If you have a fungal component to your scalp troubles, oil can make it worse. Dry scalp can actually be a by-product of an "ecosystem imbalance."

If you live in a dry or windy area, protect your scalp from the wind because that can be so drying to skin - even a light scarf provides a good barrier.

17 comments:

  1. This is an amazing post. While I don't have dandruff problems, this is a great reference!

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  2. Neem oil works for itchiness like nothing but the stench. Oils that tone it down: citronella, lemongrass, peppermint, ylangylang, patchouli, vetiver. Vetiver is a strong smell though, my favourite is a mixture of peppermint, ylangylang and petitgrain. I suspect menthol will work as well haven't tried it yet though. Use neem like an essential oil few drops only. First time I used it like a carrier oil. Lol. Don't bother with lavender or rosemary.

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  3. I have suffered from SD for years, and had a severe case that caused hair loss (I had a ton of hair so it wasn't too noticable, other than cleaning up clump fulls from my floor).

    SD is a fungus that lives under the scalp. This is why any of the above shampoos are meant to SIT on the scalp for a period of time so that it is absorbed by the skin.

    These factors are what I learned for my case:
    Severe cases that have silver scales and bleed when scratched require a medical professional---OTC items will not work.
    Any remedy may CAUSE itching. Like a cut, itching is a sign of healing. When I used Nizoral, I found my scalp itched like mad---the pharmacist explained that was it healing. I was able to return to Head and Shoulders and my scalp was much happier. (disclaimer: Nizoral is NOT recommended for color treated hair, Head and Shoulders is alleged to be color safe-I have had no issues with Head and Shoulder, but my hair is dark)

    Not shampooing daily caused me far more grief: The fungus that SD lives on is oil/excess sebum. Not washing that away daily, for ME, caused me to have a far angrier scalp than trying to stretch washes. Returning to washing daily has made my scalp VERY happy.

    When itching is unbearable, I HAVE found a cold water rinse soothing/helps.

    any dandruff shampoo will cause those with long hair to have the ends become drier. I highly recommend doing condition on the ends, wash, then re-condition.

    stress, high carb diet (white breads, pastas etc) and fatty foods can cause flares.

    Best of luck!!!

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  4. Do you know where I could buy piroctone olamine? I make my own products and would like to incorporate it a shampoo.

    ReplyDelete
    Replies
    1. Jaleesa,
      I don't know of a place for people to buy this ingredient as a raw material in small quantities. It may be classified as a pharmaceutical and therefore not be sold to the general public, and it is not commonly used. Wholeaslers like Alibaba do sell it, but that is more than most of us who make our own products want to get into.

      Delete
  5. I'm having serious bad dandruff..no itching at all just really bad white flakes all over..its super embarassing!! what do I do???

    ReplyDelete
    Replies
    1. Hello Miriam,
      If you have just flakes (and they're not flakes from products) near your scalp - the first thing to try is switching shampoos or cleansers (or conditioner). Especially if you recently changed products - sometimes a new product can cause flaking. If it's causing flaking, it's causing irritation, but you don't always feel it right away. Switching back to a product that you used when you did not have flaking can tell you a lot about what to do next.

      If that is not the case for you, then you might try one of the products with salicylic acid which is very good for reducing flaking to see if that helps. The products with zinc pyrithione are also helpful for reducing flaking - sometimes they take a little longer to work, sometimes not. Any of these remedies can help reduce flaking, which one works will depend on your scalp and the product.

      I prefer things I can put on my scalp and then wash off with my usual cleanser because I can get a longer treatment time and still use my own cleanser. But those take a few minutes to application and a lot of hair manipulation to get them on the scalp. If you prefer the simplicity of a shampoo or co-wash, start there.

      Make sure you're not drying out your scalp - look for mild, conditioning shampoos (those for color-treated hair can be a good choice), if you live in a dry or cold climate, protect your scalp from the cold air and wind with a hood or hat.
      Good luck!

      Delete
  6. Zincon has both sodium laureth sulfate and sodium lauryl sulfate in it. This should be edited to reflect that error.

    ReplyDelete
    Replies
    1. The one at my local store has no sulfate detergents, nor do the ingredient lists I can find online. But you never know when a product might go and change formulas.

      Delete
    2. I'm scared to buy online, as listed it shows both sodium lauryl and laureth sulfates in it. I can't find it locally in a drugstore, so I'm scared to purchase. I've never found a zinc shampoo without a sulfate! I want to buy it to bad if it's truly sulfate-free!

      Delete
    3. These were the inactive ingredients I found for Zincon online:

      Citric acid, cocamide MEA, deionized water, FD&C Blue 1, fragrance, glycol distearate, magnesium aluminum silicate, Methylchloroisothiazolinone, Methylisothiazolinone, propylene glycol, sodium chloride, sodium laureth sulfate, sodium lauryl sulfate.

      Delete
  7. I've been going through this list for hours, researching the ingredients. A few of these I actually have in the house, and can confirm that Nizoral is indeed not sulfate free. It has SLS/SLES in it.

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  8. Also Regenepure DR (Ketoconazole) contains dimethicone.

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  9. Are there any shampoos/conditioners like these that are also fragrance free. Right now dr. believes flakes are from allergy to fragrance, but the healing process is very slow so the itching/flaking is very bad.

    ReplyDelete
    Replies
    1. Some of these are fragrance-free. Noble Formula Zinc shampoo is fragrance-free (I found it quite drying, though). I think Zincon is fragrance-free - but check the label. Home Health Everclean shampoo (salicylic acid) is available in unscented. I know - it's crazy that there are fragrances in shampoos for troubled scalps! But so many people think consumers won't buy a product that isn't pleasant to use. And so many consumers won't.
      I have a list of fragrance-free shampoos at the end of this post (copy and paste): http://science-yhairblog.blogspot.com/2011/12/itchy-scalp-some-easy-remedies.html
      Personally, I use some of the DIY remedies or the topical antifungal creams and wash it out after 10 or 15 minutes with a mild, fragrance-free shampoo.
      My family want through a lot of over-the-counter shampoos and some very expensive prescription shampoos, only to find that they all caused more inflammation or severe dryness and then further itching due to irritating ingredients or over-cleansing. Good luck! Finding a good product when they all seem to be formulated "wrong" is very frustrating.

      Delete
  10. 2 products listed on this page under the Pyrithione Zinc shampoos as "sulfate-free" actually list sulfates in their ingredients.

    ReplyDelete
    Replies
    1. Always double-check ingredient lists. Sometimes the ingredient list I consulted is out of date, sometimes stores stock old products with different ingredients.

      Delete