How do I treat seborrheic dermatitis?
November 28, 2023 8:11 PM Subscribe
What am I doing wrong? What other products should I use? Am I washing too much? Not enough? YANMD but maybe you have found what works for you?
I went to the dermatologist. It seems like my seborrheic dermatitis/ dandruff has actually gotten worse since I've seen her. She prescribed the generic Nizoral 2% (starts with a K). And then T Sal. What am I doing wrong? She also prescribed something to put on my scalp later but I lost it in the move and I used it a few times before then.
I went in July. I will not go back to her. She said some really offensive stuff to me and basically said, you won't get skin cancer because you're really dark. Not that it matters, I'm very pale and I burn in the sun! And I've heard that is actually not true about dark skin?
I will have a new healthcare system in January and will look for a new dermalogist then. But this dandruff is totally driving me bonkers to the point where my kid is getting grossed out by it!
I went to the dermatologist. It seems like my seborrheic dermatitis/ dandruff has actually gotten worse since I've seen her. She prescribed the generic Nizoral 2% (starts with a K). And then T Sal. What am I doing wrong? She also prescribed something to put on my scalp later but I lost it in the move and I used it a few times before then.
I went in July. I will not go back to her. She said some really offensive stuff to me and basically said, you won't get skin cancer because you're really dark. Not that it matters, I'm very pale and I burn in the sun! And I've heard that is actually not true about dark skin?
I will have a new healthcare system in January and will look for a new dermalogist then. But this dandruff is totally driving me bonkers to the point where my kid is getting grossed out by it!
I occasionally get flareups, usually around my ears and sideburns. It's difficult pin down exactly why it goes away. It kind of seems varying dandruff shampoo types kind of does it, as if my skin gets acclimated to one and then responds to the change. Also, trimming hair closer seems to help. Eyeglasses seem to aggravate the flareup when it happens. And extremes in humidity seem to cause flareups.
I've tried using various home treatments, such as a vinegar application, pre shampoo, and various essential oils (tea tree, eucalyptus, sweet birch) mixed in a jojoba carrier, all of which seem to act similarly to changing shampoo. Curiously, coal tar shampoo never seemed to do anything, though it's been years since I've tried it. Just keeping hair washed everyday in general seems the simplest course to prevention, though that might be impractical if you have nappy or brittle hair.
posted by 2N2222 at 9:00 PM on November 28, 2023
I've tried using various home treatments, such as a vinegar application, pre shampoo, and various essential oils (tea tree, eucalyptus, sweet birch) mixed in a jojoba carrier, all of which seem to act similarly to changing shampoo. Curiously, coal tar shampoo never seemed to do anything, though it's been years since I've tried it. Just keeping hair washed everyday in general seems the simplest course to prevention, though that might be impractical if you have nappy or brittle hair.
posted by 2N2222 at 9:00 PM on November 28, 2023
SD is common enough that it makes you wonder why medical science is dawdling in fixing it! The cause isn't even fully understood yet.
Other treatments for SD beyond the ketoconazole you've tried include Elidel or another nonsteroidal immunosuppressant and a different antifungal family like ciclopirox. I'm not sure what areas on your body are affected--ciclopirox has a shampoo formulation, I don't think Elidel does. These are both prescription remedies. Butenafine, available OTC as Lotrimin Ultra (yes, it's labeled for jock itch, but whatever), may also provide some relief.
A prescription drug previously approved to treat psoriasis, Zoryve, just won FDA approval in foam form for SD and should be commercially available, I'm told, around January. However, it will doubtless be pricey even if covered by your insurance's formulary (if you're switching insurance, that may be one of the things you want to compare).
If you're in dire straits, you can temporarily use OTC hydrocortisone while waiting to see your new derm, but this is not a permanent solution. Long term it's terrible for your skin.
posted by praemunire at 9:19 PM on November 28, 2023 [1 favorite]
Other treatments for SD beyond the ketoconazole you've tried include Elidel or another nonsteroidal immunosuppressant and a different antifungal family like ciclopirox. I'm not sure what areas on your body are affected--ciclopirox has a shampoo formulation, I don't think Elidel does. These are both prescription remedies. Butenafine, available OTC as Lotrimin Ultra (yes, it's labeled for jock itch, but whatever), may also provide some relief.
A prescription drug previously approved to treat psoriasis, Zoryve, just won FDA approval in foam form for SD and should be commercially available, I'm told, around January. However, it will doubtless be pricey even if covered by your insurance's formulary (if you're switching insurance, that may be one of the things you want to compare).
If you're in dire straits, you can temporarily use OTC hydrocortisone while waiting to see your new derm, but this is not a permanent solution. Long term it's terrible for your skin.
posted by praemunire at 9:19 PM on November 28, 2023 [1 favorite]
Prescription ciclopirox shampoo works better for me now than ketoconazole ever did. OTC 1% ketoconazole shampoo is noticeably less effective than 2% prescription ketoconazole shampoo. OTC T-sal (salicylate) shampoo is good for removing flakes but can be drying if you use it more than once a week. T-gel (pine tar) shampoo is also somewhat effective, and pyrithione zinc can be, too. Selenium sulfide shampoo works but I can't bear to use it because of the rotten-egg smell, which to my nose lingers even after rinsing and drying. Any dandruff remedy works better if it's a different one than you've been using for the last year, so change it up now and then.
Mouthwash based on thymol, such as listerine, also has effectiveness against seborrheic dermatitis, so trying rubbing that on if you get desperate.
posted by metonym at 9:36 PM on November 28, 2023 [3 favorites]
Mouthwash based on thymol, such as listerine, also has effectiveness against seborrheic dermatitis, so trying rubbing that on if you get desperate.
posted by metonym at 9:36 PM on November 28, 2023 [3 favorites]
One thing I can add that no has mentioned I think is that not letting my scalp stay damp for long periods of time seems to help in preventing breakouts of SD (I have long hair that doesn't air dry quickly though). I use a hair dryer on low heat and held at a distance from my head to prevent damage to the hair, parting it in sections to get heat to the scalp bits.
Otherwise, I've found alternating between coal tar shampoos and salicylic acid ones rather than just using one when I get a flareup seems to work better.
posted by mochi_cat at 10:05 PM on November 28, 2023 [2 favorites]
Otherwise, I've found alternating between coal tar shampoos and salicylic acid ones rather than just using one when I get a flareup seems to work better.
posted by mochi_cat at 10:05 PM on November 28, 2023 [2 favorites]
Don't wash your hair every day. Talcum powder sprinkled on your scalp and then brushed out should keep your hair looking clean or use a dry shampoo if you don't like the idea of talc.
Before you wash your hair, give yourself a good scalp treatment - warm olive oil or warmed sorbolene cream. Use T/Gel or Neutrogena soap to wash your hair.
Make sure your shower is warm not hot and use sorbolene cream rather than soap on your skin.
posted by Barbara Spitzer at 10:07 PM on November 28, 2023 [1 favorite]
Before you wash your hair, give yourself a good scalp treatment - warm olive oil or warmed sorbolene cream. Use T/Gel or Neutrogena soap to wash your hair.
Make sure your shower is warm not hot and use sorbolene cream rather than soap on your skin.
posted by Barbara Spitzer at 10:07 PM on November 28, 2023 [1 favorite]
warm olive oil
Olive oil is a tasty snack for Malessezia, the fungus somehow implicated in SD. Wheat germ oil (in some sorbolene creams) also feeds it. SD is a very different condition from mere dry skin.
posted by praemunire at 10:12 PM on November 28, 2023 [4 favorites]
Olive oil is a tasty snack for Malessezia, the fungus somehow implicated in SD. Wheat germ oil (in some sorbolene creams) also feeds it. SD is a very different condition from mere dry skin.
posted by praemunire at 10:12 PM on November 28, 2023 [4 favorites]
Yes to cyclopirox shampoo. My derm also recently prescribed tacrolimus ointment for the parts on my face and this stuff is seriously magic, one application is enough to heal a bad flare. And I've got a lot of benefit out of gentle enzymatic scalp peel - the brand I use is Polish but it has papain and horsetail extract, and it's great for gently clearing up the scalp.
French pharmacy grade cosmetics for seborrheic dermatitis will be marked DS. I haven't tried the hair ones apart from occasionaly Vichy Dercos DS shampoo (nice but tangles my long hair), but Bioderma, La Roche Posay, Ducray and Uriage all make great gentle cosmetics and have DS lines. Definitely worth a try while you wait, I'd start with Vichy if it's available in the US.
And I assume you know that any active shampoo has to be on your hair for at least 5 minutes without washing off to let it actually work? Not active washing, just lather up and let it soak. 15 is better.
posted by I claim sanctuary at 11:09 PM on November 28, 2023 [3 favorites]
French pharmacy grade cosmetics for seborrheic dermatitis will be marked DS. I haven't tried the hair ones apart from occasionaly Vichy Dercos DS shampoo (nice but tangles my long hair), but Bioderma, La Roche Posay, Ducray and Uriage all make great gentle cosmetics and have DS lines. Definitely worth a try while you wait, I'd start with Vichy if it's available in the US.
And I assume you know that any active shampoo has to be on your hair for at least 5 minutes without washing off to let it actually work? Not active washing, just lather up and let it soak. 15 is better.
posted by I claim sanctuary at 11:09 PM on November 28, 2023 [3 favorites]
I appreciate this does not work for all hair types but I started to get much more dandruff during the pandemic because I washed my hair a lot less/relied more on dry shampoo. Unless I wash my hair at least every other day it is difficult to keep at bay. Every day is better. Even just using normal shampoo.
posted by koahiatamadl at 11:14 PM on November 28, 2023 [2 favorites]
posted by koahiatamadl at 11:14 PM on November 28, 2023 [2 favorites]
Chris Challis, owner of the site Dandruff Deconstructed, has had seborrheic dermatitis for 30 years, i.e., his entire adult life, and has done a deep dive on the subject in the article How to Treat Seborrheic Dermatitis, including what it is, what the symptoms are, what causes it, how to control it, and what the best treatments are. (Note: He recommends products by Free & Clear in several places; the brand is now known as Vanicream.)
I can't vouch for Challis' seb derm recommendations as I don't have it, but I can vouch for his advice in general, as the site made me aware that what I thought was dandruff was actually product buildup and needed to be treated accordingly.
posted by virago at 2:29 AM on November 29, 2023 [1 favorite]
I can't vouch for Challis' seb derm recommendations as I don't have it, but I can vouch for his advice in general, as the site made me aware that what I thought was dandruff was actually product buildup and needed to be treated accordingly.
posted by virago at 2:29 AM on November 29, 2023 [1 favorite]
Seconding that a damp scalp makes mine flare up. I find it's worse in summer and winter because of sweating and/or hats. My hair dries pretty quickly, but blow dry is a good idea. When mine flares up, I end up showering more (every other or every two days). This winter I knew it was time to shower more because I started getting it pretty intensely behind/around my ears.
My dad switches between shampoos like selsun blue and head and shoulders (though probably more about what's on sale than anything else), but I never found those to make much difference for me. I currently use a gentle vegetable oil based bar soap and it's been working fine. I also had good results with a no-poo + cider vinegar rinse for a long time.
posted by carrioncomfort at 5:20 AM on November 29, 2023 [1 favorite]
My dad switches between shampoos like selsun blue and head and shoulders (though probably more about what's on sale than anything else), but I never found those to make much difference for me. I currently use a gentle vegetable oil based bar soap and it's been working fine. I also had good results with a no-poo + cider vinegar rinse for a long time.
posted by carrioncomfort at 5:20 AM on November 29, 2023 [1 favorite]
Your mileage may vary on this, but...I have had great luck keeping my own (self-diagnosed, but educated-guess) SD in check with plain old apple cider vinegar. I started using it as a rinse when I washed my hair as a more "it will boost shine" move, but noticed it had that effect as well. I've also started getting SD in my eyebrows and sometimes use it there too (I tend to forget).
And I use the cheap stuff, too. I just keep a bottle in the shower and sploosh some on my head, then rinse it out right away. (I originally read you're supposed to dilute it half-and-half with water, but it was way easier to just do it that way.)
posted by EmpressCallipygos at 5:39 AM on November 29, 2023 [2 favorites]
And I use the cheap stuff, too. I just keep a bottle in the shower and sploosh some on my head, then rinse it out right away. (I originally read you're supposed to dilute it half-and-half with water, but it was way easier to just do it that way.)
posted by EmpressCallipygos at 5:39 AM on November 29, 2023 [2 favorites]
It sounds like you’re also a person of color (though not sure if you identify as Black), but as a Black person with SD—I’m finding it’s more common in our community thank I thought! And I’m really sorry that was your experience at the dermatologist. Definitely find a new one. People with more melanated skin can definitely get skin cancer.
I can’t wear protective styles anymore due to SD. And I have to diffuse my roots and scalp so it’s not damp as well. Ketoconazole 2%, fluocinocide liquid scalp treatment, and a mixture of crushed aspirin and apple cider vinegar really helped me. I only oil my scalp (say, if I did braid up my hair or my SD has calmed down) with oil that has tea tree and rosemary and is usually something like jojoba. I believe that mine also connected to my rosacea, as when my SD flares, that flares up too. I also saw my scalp get better when I took spironolactone, which I take for PCOS acne, it just helped with some of my oil production.
posted by buttonedup at 6:21 AM on November 29, 2023 [1 favorite]
I can’t wear protective styles anymore due to SD. And I have to diffuse my roots and scalp so it’s not damp as well. Ketoconazole 2%, fluocinocide liquid scalp treatment, and a mixture of crushed aspirin and apple cider vinegar really helped me. I only oil my scalp (say, if I did braid up my hair or my SD has calmed down) with oil that has tea tree and rosemary and is usually something like jojoba. I believe that mine also connected to my rosacea, as when my SD flares, that flares up too. I also saw my scalp get better when I took spironolactone, which I take for PCOS acne, it just helped with some of my oil production.
posted by buttonedup at 6:21 AM on November 29, 2023 [1 favorite]
It's good you're planning on seeing a new dermatologist. You may not be dealing with seborrheic dermatitis - psoriasis, for example, is often mistaken for SD.
posted by Stoof at 6:39 AM on November 29, 2023 [1 favorite]
posted by Stoof at 6:39 AM on November 29, 2023 [1 favorite]
I can't help you with the dandruff, but I have advice in case you have seborrheic dermatitis in other spots besides your scalp. I use prescription cortisone cream on the bridge of my nose and on my ears, the locations where the seborrheic dermatitis manifests itself. I only need to use it once every few weeks. My old doctor prescribed fluocinonide cream, which worked really well. The cream I use now is betamethasone valerate 0.1%. I find I have to apply it two or three days in a row before it takes effect. The betamethasone cream is OK, but I thought the fluocinonide was more effectve, and the effect lasted longer.
posted by akk2014 at 7:18 AM on November 29, 2023 [1 favorite]
posted by akk2014 at 7:18 AM on November 29, 2023 [1 favorite]
ymmv, but i got a tip from /r/sebderm a few years ago that was pretty transformational. Tea Tree Tingle shampoo & conditioner from Trader Joes! I also use a drop or two of rosemary oil on specific spots if i get a localized flare up to dry out the scab.
I have a lot of competing hair priorities as a bleach blond with seb derm flair, so I alternate between this shampoo and a purple shampoo to keep my blond hair bright, and I use various hair masks to keep my hair moisturized.
Anyway, definitely worth checking out that r/sebderm subreddit to see if anyone with your hair type/seb derm symptoms has posted.
posted by wowenthusiast at 8:27 AM on November 29, 2023 [1 favorite]
I have a lot of competing hair priorities as a bleach blond with seb derm flair, so I alternate between this shampoo and a purple shampoo to keep my blond hair bright, and I use various hair masks to keep my hair moisturized.
Anyway, definitely worth checking out that r/sebderm subreddit to see if anyone with your hair type/seb derm symptoms has posted.
posted by wowenthusiast at 8:27 AM on November 29, 2023 [1 favorite]
in addition to the Tea Tree Tingle mentioned above, I also use an ACV based PH Balanced toner/detangling mist spray after i shower. Mine is Phillip B which is kinda spendy, and maybe i could make my own, but i definitely noticed a difference after not using it for awhile, and went back to it. Looks like there's a lot of ACV scalp toner type products out there otherwise too. Hope it helps!
posted by wowenthusiast at 8:35 AM on November 29, 2023
posted by wowenthusiast at 8:35 AM on November 29, 2023
The only thing that's worked for me is The Body Shop's ginger scalp care shampoo with a little bit of tea tree oil mixed in. Nizoral OTC kinda worked, and things like Head & Shoulders or Selsun Blue actually made it much worse.
posted by indexy at 8:41 AM on November 29, 2023
posted by indexy at 8:41 AM on November 29, 2023
Agree with most of the above. In case you weren't counseled on this or aren't doing it already, dandruff "shampoos" need to be used differently from traditional shampoos in order to be effective. It's not enough to lather up and then rinse - you should lather up and then let the shampoo sit on your scalp undisturbed for at least a few minutes to give the active ingredients time to absorb before rinsing.
posted by telegraph at 1:44 PM on November 29, 2023
posted by telegraph at 1:44 PM on November 29, 2023
Many people report that their seborrheic/dandruff issues are helped by increasing sunlight in summer. UV light therapy is also reported as beneficial.
posted by BlueHorse at 4:26 PM on November 29, 2023 [1 favorite]
posted by BlueHorse at 4:26 PM on November 29, 2023 [1 favorite]
I’ve had really bad seb derm my whole life. It was definitely worse when I had long hair and my scalp would stay damp. I tried every shampoo and things like fluocinonide. Tar shampoo worked best. But the best and longest lasting relief has been just never shampooing my hair. I wash with warm/hot water every day and for the past 15 years I just don’t shampoo or condition.
My dermatologist said that can’t possibly be true and I should go back to cycling through the different OTC shampoo treatments. Shrug; not gonna.
posted by MonsieurBon at 10:50 PM on November 29, 2023 [1 favorite]
My dermatologist said that can’t possibly be true and I should go back to cycling through the different OTC shampoo treatments. Shrug; not gonna.
posted by MonsieurBon at 10:50 PM on November 29, 2023 [1 favorite]
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