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Page Two of Dermatologist's tips for Seborrheic Dermatitis: The Scalp

Medicated Ingredients in Dandruff Shampoos
Over the counter medicated shampoos basically boil down to 5 different ingredients. When you’re 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). Choose at least 3 different active ingredients and rotate the products.  The product ingredients are:

  1. Zinc Pyrithione: I really like this ingredient. I find it to be gentler on my fine hair than the other dandruff medicines. My OTB Medicated Cleanser #2 for Back Acne (with 2% Zinc Pyrithione) works beautifully as a shampoo and it’s what I use. Another of my favorite product is DHS Zinc Shampoo (2%). Other zinc pyrithione options include the many Head and Shoulders products (1% ), Zincon (1%), Herbal Essences No Flakin’ Way Pyrithione Zinc Anti-Dandruff Shampoo (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.
  2. 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), Sebulex (2% sulfur, 2% sal. acid).
  3. Ketoconazole. 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).
  4. Selenium Sulfide: This very effective ingredient has been around for years. It’s a little harsh on fine hair. Products include Selsun Blue (1%), Head and Shoulders Intensive Treatment (1%).
  5. Tar: These ingredients work 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%), 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.

Additional Recommendations for Stubborn Scalp Seborrheic Dermatitis
Sometimes medicated shampoos alone aren’t strong enough to clear stubborn scalp dandruff.  If your scalp just doesn’t clear after diligently rotated through the medicated shampoos described above, then it’s time for more intensive scalp treatments and medicated leave-on products.

Topical Leave-on Medicated Products for Scalp Dandruff
For stubborn dandruff, or faster relief than using medicated shampoos alone you can apply leave on products to the affected areas.  Non prescription medicated options include hydrocortisone and salicylic acid liquids.  Typically you use these products twice a day until your scalp clears.  Remember to follow the directions on the product labels.  Product options:

  1. Scalpicin Maximum Strength with 1% Hydrocortisone
  2. Scalpicin with 3% Salicylic Acid

Intensive Over The Counter Scalp Treatments for Thick Scale and Stubborn Dandruff
If you have stubborn plaques of really thick scale you can loosen them with oil treatments or P&S liquid.
  1. Oil Treatment:  Slightly warm mineral oil in the microwave (of course be careful not to heat it to the point that it burns your skin!).  Apply the warmed oil to the scalp plaques for 30 minutes under a towel.  Comb the plaque to loosen the scale then shampoo your scalp to remove the oil.  Use your medicated shampoo as your last lather as directed above.
  2. P&S Liquid: Apply the liquid to the scalp plaques and cover with a shower cap for 8 hours.  Then shampoo your scalp as I describe above.

Please remember that if your scalp does not improve you should see your doctor to be certain that you don’t have some other more unusual reason for an itchy and scaly scalp.

Next Time: Dermatologist's Tips for Dry, Flaky Skin on Your Face

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©2010 Cynthia Bailey, MD

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