My Problem-Scalp Line-Up

Greetings blog-readers! The blog has been quiet because while I have ideas for blog posts, they generally take more hours to carry out than I have to write them. This is not intended as medical advice and does not replace a consultation with a doctor. Use any and all treatments at your own discretion - or ask your doctor or pharmacist. Nor does it replace buying half a dozen dandruff shampoos and handing them off to a family member or friend when they don't work for you. Alas. I buy these products myself - this is not a sponsored post. Everything you see here should cost less than $25.

I have an entire page dedicated to itchy, flaky, bumpy scalp products because so many of us encounter those problems from time to time, or on a more or less constant basis.

What kind of scalp problem do I have? My skin falls into the "atopic dermatitis/eczema" category. Also "seborrheic dermatitis." I don't see those things as separate entities, there is overlap, even though eczema usually means dry skin and seborrheic dermatitis usually means oily skin. Atopic dermatitis means you have allergies, and part of your allergic reaction is your skin barrier breaks down when your skin is bombarded by allergens - things like mold spores, pollen, pet dander. But because allergies have an inflammatory component, some people's skin "learns" that inflammation reaction and will also become inflamed - dry, red, painful, peeling or flaking, raw - from exposure to wind or cold or heat or pressure (hat-wearing or headbands).

The "seborrheic dermatitis" component applies because scalps (and eyebrows, noses, cheeks, chins) can sometimes be more-oily. And sometimes the flaking and peeling of skin is a more-visible symptom in these areas. And oiliness - greasy hair. But for some people, that "oiliness" actually looks like thick, waxy, yellow flakes. Or it may feel like a waxy/powdery residue or "scalp build-up" that accumulates under your fingernails if you scratch your skin, or leaves that residue on your fingers if you rub it. Some people get "scalp acne" or bumps or cysts.

What do I use? The right treatment varies a lot from person to person. I have skin that reacts badly to a lot of products, and I have tried many dandruff treatments with very few "hits." This is what works for me, when it works and why it works.

Scalp massage: Before washing, or between washes if you go several days between washes. Nothing fancy, massage the scalp gently with the finger-pads (not the nails - if you have a very sensitive scalp, that can leave you with skin damage). Then I stroke my fingers over and through my hair - which spreads any oils over the hair and can help hair feel more-hydrated and flexible after washing.

*For people who have a waxy, thick build-up, a shampoo brush can do a great job loosening that up. Using very warm water helps to soften waxy oils (or a warm towel wrapped around the head), by bringing them closer to their melting point so they're easier to remove - but if heat makes your skin worse, just use water as warm as you can tolerate.

DHS Sal shampoo: For dry-weather peeling/flaking and humid-weather itching and bumpiness. This product contains Salicylic acid to act as an exfoliant to remove skin cells which need shedding. Those of us with problem scalps tend to need help with exfoliation because our skin is not functioning like healthy skin, and skin cells which should be shedding freely tend to stick together instead. That can provide a moist little environment for yeasts and bacteria - the ones that normally live on our scalps without causing a problem - to grow more than usual -causing itch and inflammation. FYI: Yeasts are a kind of fungus. Good exfoliation can help keep your microbial community in check.

I use this 1-2 times per week when my scalp is flaring up. I wash my hair frequently to remove allergens. This shampoo is fragrance-free and contains no conditioners - which are a problem for my skin. My hair is short, but if it were long, dry, highlighted, relaxed, dyed, heat-styled or damaged, I would want to condition it before washing as well as after to protect the hair from drying out. An oil pre-wash treatment would also protect hair from drying effects of shampoos such as this. This shampoo is meant to de-grease hair and scalp, but not all itchy and flaky scalps are especially greasy. Mine isn't. I usually wash after this with my favorite mild shampoo to make sure there will be nothing left behind to cause itch.

I can't buy this product locally, so I order it directly from Person and Covey - their shipping is quick and I'm certain to receive a product which has not been sitting in a warehouse for too long. As I write this, it costs $8.60 for a 4 oz. bottle. That skimpy little bottle lasts a long while unless more than one person is using it.

Hydrocortisone cream: For applying to itchy, peeling, red (inflamed) or flaky areas. Some people get flaking and peeling all over. My scalp will flake or peel in patches (usually) with itching. So I can spot-treat with hydrocortisone cream, which reduces inflammation and itching quickly.

Cortizone-10 is my favorite, but I'll buy a generic if the ingredients are the same. In other countries, this anti-itch medication will have different brands, but the active ingredient is Hydrocortisone 1%.


That which needs extra medicine: When hydrocortisone cream fails, in summer when it is humid, when I've been sweating, if there has been a dramatic weather change, I've been wearing a hat, etc., the yeasts on a sensitive scalp (and sometimes bacteria too) can get a little out of control and that means extra itching, inflammation - usually slightly different symptoms than during our more-dry, colder winters. Sometimes it seems to turn on an allergy response, if you're not outright allergic to molds/yeasts to begin with. In which case, your eyes might itch or get watery, you might feel tired or foggy-headed and your mind will drift to washing your scalp and it's really, really hard not to scratch. This is the muscle for really bad skin days.

Tinactin antifungal: This is what I use to spot-treat itchy areas when topical Hydrocortisone does not work. Designed for athlete's foot, a fungal skin disease - this cream works so quickly when I need it on my feet, I decided to try it in my itchy pool-ears and eyebrows and after a few applications, things are usually back to normal. Sometimes I need to use this in addition to hydrocortisone cream on an itchy/peeling spot. One could use any brand or athlete's foot treatment you like, this is the one that gets along with my skin and works very fast. I use it to spot-treat my scalp sometimes. It's a cream, and it comes in a small-ish tube, so obviously I'm not going to put this all over my scalp. The active ingredient is Tolnaftate.




Zinc, Ketoconazole and antifungal shampoo/conditioner or treatments: I like DHS zinc shampoo, but the fragrance is strong. If the itch of an itchy scalp is more than I can spot-treat, and Salicylic acid shampoo isn't getting the job done, it's time to try something anti-microbial.
Pyrithione zinc shampoos like this tend to work for lots of people by reducing yeasts on the scalp. There are Pyrithione zinc, Ketoconazole shampoos and Piroctone olamine shampoos and treatments in a list on this page. Those are also anti-yeast.
I use these "as needed" because I've been dealing with this for years and I know (mostly) how my scalp will respond - usually a few uses is enough for me if I'm using other treatments at the same time - which I do. Usually one needs to use a medicated shampoo for about 2 weeks, and then less often for maintenance after your scalp has cleared.

Antihistamines: For those of us with seasonal allergies, taking antihistamines regularly when you need them, assuming it's safe for you to take them, can help minimize the intensity of skin reactions.

There you have it - one person's strategy for dry-weather scalp problems, humid-weather scalp problems, and things in between.