Dandruff woes
July 24, 2012 1:37 PM   Subscribe

Nizoral made my dandruff worse. Help?!

I have really bad dandruff. Like really really bad. It looks like my head is snowing.

Anyway I checked askmefi and I bought nizoral based on the suggestions since head and shoulders didn't work. It's made the dandruff a lot worse. I tried using it with conditioner and without. It's just terrible.

What's weird is that my dandruff seems to only be affecting the lower half of my scalp and not the top of my head. Does anyone have any clue as to why this might be?

I don't have health insurance and I can't afford to see a dermatologist.

Does anyone have any other suggestions on what I can use on my head??? Or why dandruff only affects the lower half of my scalp?
posted by pulled_levers to Health & Fitness (25 answers total) 6 users marked this as a favorite
I had a weird patch on the front of my head that would peel and flake, but all the rest of my head was pretty much fine. My regular nurse practitioner/doctor looked at it and prescribed me some ketoconazole shampoo. I use it every couple of months for about two weeks. Cleared it right up!

Could be something similar, could be something very different. But doctors are probably the only ones who can get you started on something stronger than supermarket shampoos.
posted by Bibliogeek at 1:42 PM on July 24, 2012

When my skin issues were really bad, it was just in certain patches. Weird that Nizoral isn't working for you.

I'd recommend trying Neutrogena T/Sal.

Re: Bibliogeek, ketaconazole is what's in Nizoral.
posted by radioamy at 1:43 PM on July 24, 2012 [1 favorite]

It may not be dandruff. You could have psoriosis or some other scalp condition.

See if you can get into a clinic or something as things getting worse is never a good sign.
posted by Ruthless Bunny at 1:44 PM on July 24, 2012

Hmm...looking at wikipedia, looks like nizoral is ketoconazole. Consider disregarding everything I said. (However, I will say that I tried to clear up what I had with regular dandruff shampoos and it did absolutely nothing- only prescription strength has cleared it up for me)
posted by Bibliogeek at 1:46 PM on July 24, 2012

There are different kinds of dandruff that respond to different kinds of medications/shampoos. The psoriasis kind responds to the salicylic acid and the tar-based preparations.
posted by ClaudiaCenter at 1:46 PM on July 24, 2012

I don't have health insurance and I can't afford to see a dermatologist.

Create a Google alert for your area + dermatologist + coupon. I subscribe to way too many of those deal-of-the-day sites, and I've definitely seen dermatology come up once or twice. (Naturally, you should check out the clinic on Yelp or whatever before buying the coupon.)
posted by griphus at 1:50 PM on July 24, 2012 [2 favorites]

Yeah, Nizoral is really intended to combat a specific cause of dandruff, which I believe is a fungal bloom in your scalp. If your dandruff is not being caused by a fungal bloom, Nizoral may not work.

I typically get dandruff when traveling between Japan and Canada. My doctor suggested it was caused by extreme changes in temperature and humidity.

So, I wouldn't typically use a tar-based shampoo to exfoliate, because exfoliation is not my problem, fungal blooms are.
posted by KokuRyu at 1:52 PM on July 24, 2012

You don't need to see a dermatologist, by the way. Any good pharmacist should be able to troubleshoot and recommend a solution. It has worked for me with dandruff and skin conditions.
posted by KokuRyu at 1:53 PM on July 24, 2012 [1 favorite]

I say save up and pay cash (great idea, griphus, on the Google Alert !).

I had awful dandruff from puberty until age 35, and tried every over-the-counter treatment I could think of.

I finally saw a dermatologist who prescribed some topical steroid drops. Now I own black turtlenecks.
posted by Kakkerlak at 1:55 PM on July 24, 2012

What ClaudiaCenter said. Dandruff is a symptom that results from a variety of causes, and different active ingredients (zinc pyrithione, salycylic acid, ketaconazole, tar oil, or prescription hydrocortisone) have different outcomes bases on the cause. Ketaconazole for instance inhibits fungal causes of dandruff, others address different causes or the symptoms directly.

If a shampoo with one ingredient doesn't work or makes things worse, switch to one with another active ingredient.
posted by zippy at 2:01 PM on July 24, 2012

I actually have been able to keep occasional flakiness under control by rinsing my hair with about a half cup of apple cider vinegar after shampooing. Or if there's a patch you can get to right at the hairline, dab some on straight with a cotton ball every night.

Cider vinegar is so cheap it may be worth a shot even if you try another shampoo.
posted by EmpressCallipygos at 2:06 PM on July 24, 2012 [3 favorites]

I had scalp psoriasis, and the dermatologist prescribed Clobex (clobetasol). It's costly for what it is, but she gave me multiple samples of both the shampoo and the mousse, so the only cost was the visit. It only took 2 uses with the shampoo for it to go away, so if you can save up and manage to get in to see someone, it's possible that it's way worth all the time and wasted money on the other types of treatment. FYI, my psoriasis only acts up right around my hairline, but not other parts of my head, so it's similarly temperamental.
posted by bizzyb at 2:06 PM on July 24, 2012 [2 favorites]

Are you definitely using it as directed?

If you are and it's not worked by the time you finish the treatment phase, not sure if it's dandruff. At that point, ask a pharmacist.

Sorry if this is over-obvious, my mother was complaining that her "itchy" scalp won't go away and Capasal "doesn't work" but it turns out you have to do three washes in succession, leaving it on for a few minutes at a time, and do this three days in a row (or something). She decided she didn't have time, it was too boring, etc, so she was only using it once a week or so for the one wash. Compliance!
posted by tel3path at 2:30 PM on July 24, 2012

I have actually been able to get my stubborn patches under control using regular old Listerine. Just soak cotton balls and apply to the problem areas. I'm sure there's some reason it works, but the good news is if it doesn't work, you aren't out a lot of money and...you know, it's Listerine. It ain't gonna kill you. (You will, however, smell Listerine-y so do it before bed, go to bed, and shower in the morning.)
posted by Countess Sandwich at 2:40 PM on July 24, 2012

Just as a point of consideration, I recently learned that "flakes" are not necessarily dandruff. Dandruff flakes are yellow, because there's a fungus (the same or related to athlete's foot), while dry skin/scalp is what gets you white flakes.
posted by rhizome at 3:18 PM on July 24, 2012

As bizzyb mentioned, clobetasol (which comes in a bunch of formulations, brand and generic) has really helped my dandruff - however it's rx only so you'd have to get it from a doctor.
posted by radioamy at 4:29 PM on July 24, 2012

My dandruff (which I believe is cause by seborrheic dermatitis) is almost completely gone now that I've stopped using anything that has sodium laureth sulfate (SLS) in it. If you know anyone with a Costco membership, they have great big bottles of Kirkland brand sulfate and paraben free shampoo and conditioner for cheap - something like $14/liter - and it lasts forever because it's highly concentrated.
posted by Addlepated at 5:38 PM on July 24, 2012

I would definitely check to make sure you don't have one of the other skin conditions mentioned here, but I once had a barber recommend something that I thought was crazy-talk when I was a kid but seemed to help.

I thought I had really bad dandruff. The old-school barber asked me how much shampoo I was using and I said, "oh, about a silver-dollar-sized dollop in the palm of my hand."

The barber said, "ok, first you should use about a quarter-sized amount instead, and then go back after you shampoo and rinse the first, and take a dime-sized drop and shampoo again. I bet you will have twice the lather as the first time, because you aren't actually getting all the soap out the first time."

So, I went and tried it and he was totally right. I have no idea if this just happens normally, or if it was just the really soft water I had at the time, or if that just happens normally, but to this day I think of that almost every time and try and use a bit less shampoo followed by a second double-check shampooing.

It seems to help. But then again, I also use Nizoral too (but mostly for its tertiary side-effect of possibly helping to prevent hair loss).
posted by This_Will_Be_Good at 5:41 PM on July 24, 2012 [1 favorite]

Hi, I use nizoral (ketaconazole) for a specific type of yeast infection. It is great for what it was prescribed for. If you are not getting results with nizoral, that means your dandruff is not caused by yeast (a polite name for fungus). So stop using it. Other over-the-counter dandruff shampoos have things like coal-tar in them. You might want to try one of those. But stop already with the nizoral. It isn't working. You might need to see a dermatologist. I waited about 20 years, trying different shampoos, and finally saw a specialist, who was able to look at a skin sample and tell me what I needed-- and prescribe it for me. Within a week my skin flaking (had spread to my face and neck as well) was about a thousand times better. Don't be a dummy like me and wait 20 years for an easy fix! Sometimes it is worth it to see a doctor, even if you have to pay cash out of pocket. Good luck!
posted by seasparrow at 5:46 PM on July 24, 2012

I thought I had really bad dandruff. The old-school barber asked me how much shampoo I was using and I said, "oh, about a silver-dollar-sized dollop in the palm of my hand."

Virtually all store-bought shampoo gives me dandruff and skin lesions, probably because it contains whatever chemical goodness. Head and Shoulders is tolerable, but I've had the most luck not even using shampoo and instead massaging my scalp and rinsing my hair really well.
posted by KokuRyu at 7:47 PM on July 24, 2012

I had flaky-scalp issues while pregnant (only then, which is odd), and had luck with "Scalp Benefits" by Aveda.
posted by trillian at 8:05 PM on July 24, 2012

not even using shampoo and instead massaging my scalp and rinsing my hair really well

I stopped using shampoo because my scalp would get dry and flake in the winter, especially after shampooing. Now my hair and scalp are great, I just rinse it in the shower, it never seems greasy and the flakes are gone.
posted by furtive at 9:03 PM on July 24, 2012

Another no-shampoo option is to use a baking soda solution to scrub your scalp (and get off all the oil and dead skin), and then following with diluted cider vinegar to restore the normal hair pH (and sometimes kill off some of the scalp yeast). Cheap and easy on your system! My hair has never been nicer!

(it can take a few weeks for your scalp to adapt and make less oil)
posted by acm at 7:26 AM on July 25, 2012

I had terrible dandruff when I was younger. A hairdresser friend suggested using Listerine mouthwash. I sat in the tub and applied it to my scalp with a sponge and left it on for 20 minutes, then rinsed and washed my hair. There was immediate improvement. I repeated the process a couple of times over the next two weeks and have never had a problem since!
posted by cat_link at 7:53 AM on July 25, 2012

If the Listerine doesn't work, I suggest calling different dermatologists and explain that you'll be paying out of pocket and see if they will cut you a break on an office visit. Submitting claims to insurance costs something, taking cash doesn't.

Some doctors won't but many will.

It's worth it to be rid of the problem. Also, don't be afriad to ask for samples. As others have said, Clobex costs the earth (even with Rx insurance) so plead poverty and see if your doc can help you out.
posted by Ruthless Bunny at 9:56 AM on July 25, 2012

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