too embarrassed to get a haircut.

February 23, 2013 7:18 AM

In the last couple of months, my scalp has escalated from 'a bit dry' to 'disaster area.' What the hell is going on?

I've always gotten a little dandruffy in the middle of winter, but this year is mysteriously different, and worse. We're not talking little flakes-- my scalp is downright scaly, and if I don't pull an Ally Sheedy and shake it out thoroughly on a regular basis, it's really noticeable. Some of the detached chunks of scalp have enough area that they don't shake out, and have to be pulled out individually. It's worst around my hairline and my part, but it's definitely there all over my head.

It's even happening in my eyebrows.

I'm way, way overdue for a haircut, but I'm not bringing my gross head anywhere near a hairdresser until this gets better. What do I need to do? I don't wash my hair super often, because that seems to make it worse, though the shampoo and conditioner I use are allegedly moisturizing. Clearly Head & Shoulders is not gonna cut it. What's going on?

posted by anonymous to Health & Fitness (30 answers total)

You should see a doctor.
posted by two lights above the sea at 7:20 AM on February 23, 2013 [6 favorites]

Nizoral, or any other seriously medicated shampoo that's not prescription. Use as directed. I had the same problem, and Nizoral cleared it up.
posted by fatbird at 7:24 AM on February 23, 2013 [1 favorite]

You most likely have seborrheic dermatitis. It's a skin condition that affects the hair and eyebrows, and results in dry skin. I would try using anti-dandruff shampoo, but the thing is it's kind of a permanent condition that gets worse or better at times. Your doctor might also recommend a steroid cream. Definitely go to a doctor to confirm.
posted by tooloudinhere at 7:26 AM on February 23, 2013 [1 favorite]

Try something with selenium in it.
posted by 445supermag at 7:31 AM on February 23, 2013

As a heads up some things that have helped us with our daughter (18 months old) who is prescribed steroid cream for her dermatitis (which also affects her scalp), we do a couple of things that definitely help. We've done this since she's been 6 months old.

1. The house is at 49-60% humidity. We use 4 humidifiers in order to get it there. This is huge in preventing a flare up.
2. The temperature is as close to 70F as possible at all times. This is also huge in preventing a flare up.
3. After evening bath and breakfast, we apply vannicream (over the counter lotion) to her skin - all her skin (except her scalp)
4. If there is the start of a flare up, we also apply a mix of rhobathol (an over the counter oil for sensitive skin) and some non-steriod cream prescription cream that the doctor recommended to the areas that flair.
5. In the bath we use conditioner. I forget which one.
6. 30-40 minutes before bedtime, we apply emu oil to her scalp. Sometimes we also apply this in the morning if it is really bad. It leaves her hair a bit greasy, but it is a better trade-off than her scalp turning red, scaling, flaking, and bleeding.
7. If her skin flairs and gets out of hand, we apply a steroid cream for 7 days, and then can't use it for a month.

I remember us crying as a family until we basically found a routine that works for her skin.

Some nights we can forego emu oil, but usually after the humidity is high and we've been treating her scalp well for a few days.
posted by Nanukthedog at 7:44 AM on February 23, 2013

My head is just like yours - i've actually found myself wondering how my hair stays attached to my scalp, when my scalp is so aggressively flaking off.

I've self-diagnosed myself with scalp psoriasis, and the only drug store products that have really made a big difference are Neutrogena T-Gel (with coal tar) and Selsun Blue Extra Strength (with selenium sulfide). I tried using just one shampoo for a while, then another for a while, and eventually (having multiple bottles in my shower, including Nizoral), that the most effective solution is to shampoo first with the T-Gel, and then with the Selsun Blue. (Then i use conditioner - all that shampooing is drying. Although you should know that the flaking has nothing to do with dryness.) I started off doing that every other day until it got under control (which only took about a week), and now i do it about twice a week. Keeping that routine up is important.

Good luck!
posted by Kololo at 7:48 AM on February 23, 2013 [2 favorites]

An over-the-counter, home-remedy thing you could try is apple cider vinegar. After you wash and condition your hair, just pour some over your hair and massage into your scalp; leave it there for a minute and rinse. I get the same thing and it helps a good deal (it's not instant, but do it for a couple weeks and you'll see some results). Cider vinegar also helps with shine in your hair too, as a bonus...
posted by EmpressCallipygos at 7:53 AM on February 23, 2013

I don't understand whether you're trying a dandruff shampoo or not. Moisturizing shampoo is not what you need. You need a dandruff shampoo.
posted by bq at 8:02 AM on February 23, 2013

If you're embarrassed to go for a haircut, can I assume that you get your hair cut pretty close to the scalp? If so, let me recommend sleeping overnight with your head in a silk cap and your scalp doused in Hollywood Fantasy tea tree oil, $3-$4 in the Af-Am hair care section, twice or three times a week. It's more of a heavily diluted blend of tea tree oil, but it's cheap and available. This did a lot of good for the moisture and flaking situation on my scalp during the New England winter, but as someone with very long hair, I couldn't deal with the cleanup on an ongoing basis. I had to scrub my hair with Prell or even Dawn to get the oil out, and that is just no good. If you have short hair, this will be less of an issue for you.

You may find, after trying a dandruff shampoo, that you're even more dried out than before. I think you should try that first, but if it doesn't do the trick, consider oil.
posted by Countess Elena at 8:06 AM on February 23, 2013

If a standard dandruff shampoo does not work, or is too stinky for your taste, try something with piroctone olamine (instead of zinc pyrithione). Absolute lifesaver for me. The most widely available is the Body Shop's Ginger Scalp Care. It's a little pricey, but not terrible-- $10 for 8.6 oz.
posted by acidic at 8:09 AM on February 23, 2013

I've got the same sort of problem. In my case, I asked my doctor whether or not I had psoriasis and he said definitely not, so it's possible for these symptoms to exist with a different cause.

Like Kololo I've found that coal tar shampoo helps. My doctor also told me to use some soap with zinc pyrithione in it, which appears as an ingredient in many anti-dandruff shampoos. Another helpful technique is to use a fine-toothed plastic comb while in the shower to sort of scrub my scalp through my hair.
posted by XMLicious at 8:17 AM on February 23, 2013

I get this. Nizoral helps quite a bit. You have a fungal bloom for whatever reason (sudden changes in temp or humidity will do it) so you can take Aspergillis (the probiotic in yogurt) to help restore balance. It has really worked for me. FWIW, it's probably the cold, dry weather that has triggered this.
posted by KokuRyu at 8:31 AM on February 23, 2013

I have a similar problem too, and this year is particularly bad for me when I had managed to pretty much "cure" it over the last five years.

I "cured" it by going no-poo several years ago. It came back as soon as I started washing a bit more frequently last summer, using a no-sulfate shampoo, and got really, unbelievably bad this winter :-/

The natural and healthy nuclear option to get the flakes off is to use a good vegetable oil, I prefer olive, and swathe several tablespoons all over your head. (It's not too expensive if you consider a bottle of olive oil costs only nominally more than one of T-gel.) Massage in the oil, let it sit for at least an hour. Then rinse it out, and put on some baking soda (sodium bicarbonate). Scrub that around, gently, rinse it out. Then do a vinegar rinse; cider vinegar works best since it leaves a nice smell.You'll probably need to sleep with your head on a towel since not all of the oil will be washed out, and that is the point: the oil is what's curing your scalp. Things will be better the next day; another baking soda wash and vinegar rinse should get the last of it.

You should only have to do that as a last resort; if you keep up with a no-poo regime, the scalp's natural balance works itself out. I did that a couple of weeks ago and my scalp has been like, "YAY I CAN BREATHE AGAIN" and there haven't been any new flakes.
posted by fraula at 8:36 AM on February 23, 2013 [2 favorites]

I used to have winters like this, but then I tried Lush's Soak and Float shampoo bar and it went away. I read about it on AskMeFi and it's made my scalp much happier. Thank goodness for the Green.
posted by shesbookish at 8:37 AM on February 23, 2013

I should add on non-preview, because it is related to the fungal stuff: olive oil and vinegar are natural anti-fungicides.
posted by fraula at 8:38 AM on February 23, 2013

You should go to the doctor and get it checked out, since there's a number of things it could be, but none of them are deathly serious. I have scalp psoriasis and wanted to second the recommendation for Neutrogena T-Gel. Finding that product seriously changed my life. (It's also recommended for seborrheic dermatitis.)
posted by daisyk at 9:32 AM on February 23, 2013

Are you using a good dandruff shampoo like Nizoral? And using it as directed and consistently? Use it on your eyebrows as well. This should bring noticeable relief after a few applications and clear things up fully in a few weeks. You do have to keep using it at a much less frequent maintenance level - for me that varies between once a week and once a month depending on how my scalp behaves. But my scalp and eyebrows do this every winter and what helps is to use this stuff and use it consistently. Absolutely use conditioner afterwards, the stuff does nothing for your hair texture but it does what you need it to do on your scalp.
posted by koahiatamadl at 9:54 AM on February 23, 2013

I can't use any product with fragrance, so when my scalp got like that, I was pretty discouraged. What ended up helping was scrubbing my scalp with a baking soda paste every day for about a week. I switched to a no- shampoo regimen and it hasn't come back. Just in case you're looking for something else to try.
posted by not that girl at 9:57 AM on February 23, 2013

my doc told me to use Nizoral but I have found that anti-bacterial Dial soap works as well as any of the over the counter things. But make sure it is the anti and not the regular Dial...use as shampoo and rinse...
posted by Postroad at 9:59 AM on February 23, 2013

Yeah, you're getting lots of good advice here. Try Nizoral and if it doesn't work, try coal tar shampoo. If that doesn't work, go see a dermatologist.

Lots of dermatologists aren't very good, and will advise lifestyle changes (eat less sugar, wash your hair more or less frequently, try a humidifer). None of that made any difference to me, and I got pretty frustrated. I also did a lot of experimentation with tea tree oil and emu oil and OTC anti-fungals, cortisone, aspirin masks, and cider vinegar. Basically, folk remedies recommended on forums. None of that helped either.

Finally, after years of having this problem, I found a great dermatologist. He prescribed Doryx (antibiotic, I think), which cleared my skin and scalp in 24 hours, and a prescription-strength salicylic acid lotion and Elidel cream, which has kept it clear in the two years since. It turned out my problem was I had seborrheic dermatitis (diagnosed early) but also mild rosacea (diagnosed only by the last good doctor). I don't know what you've got --it could be either of those or psoriasis-- but my point is, I only fixed the problem with prescription-strength medication. So I'd advise you to find a good dermatologist who specializes in skin conditions like those three.

Good luck.
posted by Susan PG at 9:59 AM on February 23, 2013 [2 favorites]

When I had something similar, I tried a million things. It takes so long to see if each one works, though, and there really are *so many* things you could try, in different combinations or frequencies or strengths or whatever, and everyone has a different, new recommendation based on what worked for them. You can really drive yourself crazy. So this is what I say:

1. Pick any two OTC shampoos that are geared toward psoriasis or seborrheic dermatitis (coal tar, salicylic acid, ketoconazole, zinc pyrithione, and tea tree oil are some of the main options that I remember).
2. Try each one (on its own) for 2-3 weeks to see if it helps.
3. If neither helps, just go to a doctor. I wish I had gone to a doctor so much sooner than I did (she gave me a steroid hair mousse, and it was gone in 2 days), though I recognize that these OTC shampoos can help a lot of people.
posted by unknowncommand at 10:12 AM on February 23, 2013

Or exactly what Susan PG said.
posted by unknowncommand at 10:15 AM on February 23, 2013

If you want to go the natural route - try heating up some olive or coconut oil, then rubbing into your scalp. Leave for an hour (or overnight) and then wash your hair with something gentle (like Aveeno shampoo) in the morning. This was recommended by my dermatologist (I'm pregnant and didn't want to use any OTC or prescription medicines).

If you don't mind meds, then get yourself to a dermatologist or GP as soon as possible.

And really don't worry about getting your haircut, they've seen everything.
posted by echo0720 at 1:19 PM on February 23, 2013

Definitely see a doctor and I say this because I had the same thing years ago and actually discovered it was a symptom of undiagnosed Celiac disease.
posted by kinetic at 2:03 PM on February 23, 2013

A blogger I like, Sal at Already Pretty, recently covered this. It was a hair stylist who ultimately who figured out what worked for Sal's own flake problem (something called Moroccan Oil), so getting a haircut might not be a bad thing. Stylists have seen it all before and are used to trouble shooting this kind of thing. There are other good recommendations in the comments on that blog post.
posted by sweltering at 3:53 PM on February 23, 2013

If they are big chunky chunks then it might be psoriasis, in which case try a coal tar shampoo or betnovate (or similar ointment). You should see your doctor, regardless, if that's not too much of a hugely expensive issue for you.
posted by goo at 7:35 PM on February 23, 2013

If you find that coal tar shampoo works, which it does for me [your problem sounds just like mine], Target's house brand is 1/3 the price of Neutrogena [and half the price of Walgreen's house brand].
posted by chazlarson at 10:06 PM on February 23, 2013

I wash my head like this:

First, thorough scalp washing with st ives anti-blackead scrub. The scrub is exfoliating with little grains and it also has salicylic acid or something like that. I use a dollar-sized amount in total, applied with my fingertips in small sections, and thoroughly scrub my scalp with it. Then rinse.

Next, standard dandruff shampoo. I massage it thoroughly into my scalp and leave it there for at least 3 minutes, then rinse.

Next, baby shampoo on scalp and the length of my hair. Rinse.

Next, condition the length. I'm curly so I don't wash out the conditioner.

Squeeze out excess water and I gently brush my hair. Don't brush your hair while it's wet unless you have curly hair.

Next, I grab a jar of ponds cold cream. I dab the tip of each finger in the jar and rub the cold cream on my scalp with the tips of my fingers. Cold cream is thick enough that it's fairly easy to control and shouldn't drip everywhere. I massage the cream in thoroughly and go back for more as many times as I need to to do my whole head.

This routine I do about once a week and it keeps the gross flakes and tight, itchy feeling under control.
posted by windykites at 5:37 AM on February 24, 2013

Treatment of Seborrheic Dermatitis

This article has an extensive chart that lists many types of treatment that includes cost and application instructions.
posted by OsoMeaty at 5:44 PM on February 24, 2013

Chiming in a bit late here. One of the things that has almost cured my sebderm completely is removing the use of SLS (sodium laurel/laureth sulfate) shampoo and soap from my skin. I will occasionally have some flakiness if I'm really stressed, and for that I've got some steroid mousse stuff that I use very sparingly. Trying all the dandruff shampoos and coal tar stuff only ended up making me worse because, I'm guessing, they all have SLS in them.
posted by Addlepated at 8:54 PM on March 14, 2013