How to know if your dandruff shampoo is effective?
November 24, 2014 8:55 PM   Subscribe

If your scalp flakes after using a dandruff shampoo does that mean the shampoo is effective?

I realize there's many past threads about dandruff (Seborrhoeic dermatitis) but my question is how to gauge if the shampoos is actually helping your condition. I've suffered with heavy dandruff for many years now and have tried many things (avoiding shampoos with sulfates, buying organic, apple cider vinegar, tea tree oil, etc) but nothing seems to help. I avoid putting any product in my hair and have experimented with shampooing daily or ever 2-3 days, (I shampoo every other day as I went into a hair loss clinic who told me shampooing daily is preferred to reduce build up. Ive gone to various dermatologists who simply prescribe me steroid topical solutions which dont get to the root of the problem and fail to work after awhile anyhow. Looking for a more holistic and healthy natural way to help reduce dandruff if possible.

What is fusterating is that I feel like my excessive dandruff is making my male pattern hair loss on my temples recede faster. Anyhow long story short I've been using this highly reviewed shampoo product, Sage Shampoo from Maple Holistics, which is actually the highest rated dandruff shampoo on amazon.

However, I've noticed that shortly after using this shampoo, my hair feels very dried out and my scalp starts to scale off and thus I can easily create a snowstorm (gross I know) of dandruff if i start scratching my scalp gently. This has been the case with other dandruff shampoos as well. So my ? is does this simply occur because the shampoo is working helping the scales and dead skin cells flake off? Or is this making my scalp worse bc it's either overdrying it or Im shampooing too often?

I have used pure 100 percent tea tree oil and applied it directly to my scalp with q tips that seems to help but the scent is a bit too strong and I worry that others may be bothered by it. Any tips or help would be greatly appreciated!
posted by HonestAsian to Health & Fitness (28 answers total) 6 users marked this as a favorite
this is the shampoo in case anyone was wondering.
posted by HonestAsian at 8:57 PM on November 24, 2014

I have no idea about your main question with evaluating the effectiveness of shampoo, but I always found that dandruff shampoo felt like it was making things worse. In the end, for me, I needed to drink around 10 cups of water a day, and exercise and my dandruff went away!

So... Only anecdotally, it's extremely hard to tell if the shampoo is working or not, and try increasing your water consumption.
posted by bbqturtle at 9:03 PM on November 24, 2014

I think it sounds like it's making it worse, also I looked at some of the reviews and they say best for mild to moderate cases of dandruff (and also claim that it reduces shedding of dead skin cells rather than enhancing it…)

Have you tried Neutrogena T/Gel or similar? You didn't mention it specifically, and that has been the best thing I've found for my seborrheic dermatitis.

Have you been to a dermatologist?
He mentions in the question that he has been to several dermatologists and gets topical steroids which haven't helped much.
posted by treehorn+bunny at 9:42 PM on November 24, 2014 [1 favorite]

Yeah, I think more dryness/dead skin flaking is a sign that it's not helping.

I've had good luck with Neutrogena T-Sal. I also find there is a big difference (for me) between summer dandruff and winter dandruff. Right now, my scalp is really prone to dryness, so I have to be more careful about not shampooing to frequently, etc. However, during the summer, I worry a lot more about build up, and I often end up showering almost every day.

Anyway, I would definitely give one of the Neutrogena shampoos a shot, although I wouldn't necessarily use them every time you wash your hair. I've also heard good things about the Trader Joe's tea tree tingle shampoo, although I haven't personally used it.
posted by litera scripta manet at 10:09 PM on November 24, 2014

I also found many dandruff shampoos as too strong for me.
A hair stylist recommended NIOXIN "Scalp Recovery" line for dandruff.
It feels very gentle and yet it cleans my hair just fine.
At the moment, I only use the shampoo as I found the conditioner to be too much product in my hair.
posted by calgirl at 10:09 PM on November 24, 2014

I have had this happen with dandruff shampoo, I don't think it means it's working, I think it's just making your scalp more dry. I would think if your scalp was really healed the flakes would wash out and not come back. I wish I had better advice. I tried about 100 types of remedies and shampoos until a giant bottle of Head and Shoulders Dry Scalp Care seems to have done the trick. I think the fact that it was a giant bottle of sustained attack helped, as opposed to the tiny specialty bottles that I would run out of and not replace fast enough.
posted by bleep at 10:11 PM on November 24, 2014 [2 favorites]

Mr. Toddles has bad dandruff and tells me that Neutrogena T/Gel does the trick and also that he doesn't see an effect right away, but rather over several days/weeks. I read him your question and he said it sounded like your current shampoo is not working and recommended switching it up.
posted by Toddles at 10:15 PM on November 24, 2014 [1 favorite]

Have you tried Head & Shoulders Extra Strength? Unlike regular H&S, it contains 2% zinc pyrithione, a key antifungal ingredient.

I know many will decry using a shampoo with sulfates, but I personally have found this particular brand to be very helpful.

I shampoo every other day as I went into a hair loss clinic who told me shampooing daily is preferred to reduce build up.

Dandruff is caused by the out-of-control growth of a yeast called Malassezia globosa. It feeds on the oils produced by your scalp, so you may want to consider washing your scalp daily.
posted by invisible ink at 10:20 PM on November 24, 2014 [1 favorite]

Also I will quote you from eMedicine's seb/derm page:

"Topical corticosteroids may hasten recurrences, may foster dependence because of a rebound effect, and are discouraged except for short-term use...corticosteroid creams, lotions, or solutions can be used for acute flares...Dandruff responds to more frequent shampooing or a longer period of lathering. Use of hair spray or hair pomades should be stopped. Shampoos containing salicylic acid, tar, selenium, sulfur, or zinc are effective and may be used in an alternating schedule.[16, 17] Overnight occlusion of tar, bath oil, or Baker's P&S solution may help to soften thick scalp plaques. Derma-Smoothe F/S oil is especially helpful when widespread scalp plaques are present. Selenium sulfide (2.5%), ketoconazole, and ciclopirox shampoos may help by reducing Malassezia yeast scalp reservoirs."
posted by treehorn+bunny at 10:33 PM on November 24, 2014 [1 favorite]

Is the rest of your skin dry? It could be some version of extreme dryness/eczema.

As a simple test, rub a tiny bit of moisturizer into your scalp for a few nights running, and see if that calms anything down. You might also try this on the weekend, and use a gentle fragrance-free shampoo (the most gentle shampoos have *no* fragrance), and see if anything shows improvement.

If not, try rotating dandruff shampoos, and see if you can track which ones make things worse, and which don't. Pay particularly attention to the ingredients in the shampoo (the anti-dandruff/medicinal bit). There are some half-a-dozen typical anti-dandruff ingredients. You may respond to one better than another, and this, too, you should track. (Make sure to take notes, otherwise it will all blur for you. Maybe make a 1-10 chart on key responses, e.g. itching, flaking, redness (if you can see it), dryness, etc.

I have very dry skin, and briefly thought I had dandruff, but it turns out I don't. Even so, I was using Nizoral for a while, and didn't think it was bad, as these things go.

Paula Begoun, is a very science-based author on skincare issues. She writes on dandruff here. You might also want to look through her articles on dry skin/eczema and men's skin. This will give you quite a bit to work with, but be patient it may take time.
posted by Violet Blue at 11:21 PM on November 24, 2014

YMMV but I'll also go on record that dandruff shampoo is mostly nonsense, and that drinking a ton of water and getting some regular exercise is probably a much better cure. Having said that, this stuff works really well, as does this (but it's way expensive).
posted by littlerobothead at 4:53 AM on November 25, 2014 [1 favorite]

I've struggled with bad dandruff / Seborrhoeic dermatitis for 30 years. For the last year I've had real good luck with Cloebetasol (prescription). I used it every day for a week or two until I got control, then I backed off to 3X a week, then 2X a week, then 1X a week, then back to 2X a week when weekly wasn't maintaining a relatively clear scalp. I shampoo every other day and condition on the off days with an organic, sulfate free shampoo and conditioner.

I'd prefer to not use a topical steroid, but I've tried every OTC product on the market, as well as every natural / home remedy ever discussed on the Internet. The only thing that allows me to safely wear a dark colored shirt is the Cloebetasol.
posted by COD at 5:24 AM on November 25, 2014

Have you tried using a 2% zinc pyrithione formulation and leaving the lather in place for a few minutes before rinsing out? Anti-microbials generally work better given prolonged contact.
posted by flabdablet at 5:25 AM on November 25, 2014

Have you tried only washing with a gentle conditioner? I thought I had dandruff, and two dermatologists said I did, but every prescription shampoo and T-gel shampoo made things worse. A friend suggested I might have really dry skin and to just co-wash instead. The key is to use a conditioner without silicones - I can post brands if that would be helpful - and pour on enough to saturate your hair, then gently scrub like you are washing with shampoo.

It was like a miracle - head stopped itching, dandruff went away, no more expensive anti-solutions.
posted by barnone at 6:43 AM on November 25, 2014

I can't answer your question, but can say that vinegar rinses finally solved my dandruff issues. I put maybe a quarter cup of vinegar in water, pour it over my head in the shower, let it sit while I wash, and then rinse.
posted by metasarah at 7:39 AM on November 25, 2014

You'll know if dandruff shampoo is working if you have less itching and flaking.

You didn't mention if you have tried any actual medicated "dandruff shampoos" (T/Gel, T/Sal, Nizorol, Selsun Blue, Head & Shoulders). Those have worked great for me. They work best when I shampoo daily and rotate between products. They will make it *seem* like your hair is falling out in the beginning, because as they lift the junk from your scalp they will take any hair attached with it. However it's not making your balding worse, just speeding up hair that was about to come out anyways.
posted by radioamy at 8:05 AM on November 25, 2014

Nizoral works really well for me. There is also apparently evidence that it (well, ketoconazole, the main ingredient) has some anti-hair loss/anti-hair thinning effect.
posted by odin53 at 8:47 AM on November 25, 2014

I shampoo every other day as I went into a hair loss clinic who told me shampooing daily is preferred to reduce build up.

Build-up of dead skin, you mean? If you mean build-up of other things then I'd suggest it's possible your shampoo is the source of the build-up. So many of them have so much stuff in them. I switched to just using water on my hair some years ago, but that's possibly easier when you keep your hair under a half inch long.

I get some flake sometimes - and I drink water like it's my job so color me skeptical about this as a solution - at which point I shampoo with some t/gel and that's it for the shampoo for another few weeks. I don't know what the quantity of your flake is but if it's just caught dry skin I'd wonder if you might not be better off with LESS shampoo and more massage & rinse. I found the majority of shampoos were thick and full of emollients and perfumes which tended to catch things in my hair.
posted by phearlez at 9:13 AM on November 25, 2014

Dandruff can be caused by many different things, so it isn't just a matter of finding the one shampoo that is best/strongest and will cure everyone. I recommend going through treehorn+bunny's list (salicylic acid, tar, selenium, sulfur, or zinc), starting with the cheapest / most-available, and try each one for a couple of weeks to see if you're happy with the results. In my case, zinc (in regular Head & Shoulders) doesn't work, but selenium (Selsun Blue, or Clinical Strength Head & Shoulders) does. Ignore brand names and look only at the active ingredient.

If none of the OTC products work, you can go to a dermatologist with the list of things you've tried, and get a prescription alternative.
posted by BrashTech at 9:38 AM on November 25, 2014

While dandruff might be caused by a number of the things mentioned here, flaking caused by shampoos seems to be an equally irksome problem. If you're getting flaking after shampooing, it may be time to change the shampoo ingredients, not just the shampoo label. Try a shampoo that has no sodium lauryl sulphate (SLS) or its derivatives.
posted by alonsoquijano at 1:59 PM on November 25, 2014

Nthing T-Gel, though I've found the much cheaper drugstore knockoffs work as well for me.
posted by SemiSalt at 4:27 PM on November 25, 2014

Not all tea-tree oil shampoos are the same. I had really annoying dandruff for years until I found the one shampoo that actually works for me (Optima Australian Organic Tea Tree Oil Anti-Dandruff Shampoo - doesn't appear to be available in the US, though). When the shop I used to get it from stopped selling it, I tried a different tea-tree oil shampoo which didn't work at all. Since then I've bought it online. Wash my hair daily (I put the shampoo on first in the shower and wash it off last, so it's on for a bit rather than washed out straight away). If I don't use it for more than a few days in a row, my scalp starts to get dry again, but skipping the odd day doesn't matter. It does seem to take a week or two to re-establish its effects once they scalp has started to get irritated again though.

Before I started using this one, more frequent hair washing would exacerbate the flakiness. I think that while you have symptoms of dandruff the scalp is damaged and easily irritated, so pretty much anything you do to it will cause some degree of inflammation/itchiness/flaking. However, once the damage starts to heal, it becomes much more resilient. i.e. Using a new shampoo frequently may make the problem worse in the short-term (a couple of weeks at most), even if it does make things better over the longer term.
posted by xchmp at 4:45 PM on November 25, 2014

It seems when I have good days, there's no consistent common denominator between the days that I don't have many flakes.

Today, I washed my hair with just water, starting with warm towards the beginning of my shower, and lukewarm/cold towards the end of my shower for good measure. This is the best dandruff day I've had in a while, almost no flakes.

Ketoconazole / Nizoral worked for me for a couple of weeks, then for some reason it stopped? Not sure why it would stop. It seems to only work sometimes now. T-Gel worked 5-10 years ago and then stopped. It seems everything I try eventually stops working effectively.

Sometimes using just water (and making sure to finish with lukewarm/cold water) seems to be the best option.

This has been a long ongoing-struggle with no clear treatment path that consistently works for me (have tried H&S, Selsun Blue, Clear for Men, etc. - and almost none of those worked at all, sometimes made it worse actually).
posted by kup0 at 6:15 PM on November 25, 2014

Drink more water, rinse with vinegar, and try T-gel.

Do you have patches of seborrhea? I have one patch about the size of a half dollar on the left top of my head. That's all. I spot shampoo with T-gel on that patch, rather than washing my whole head with it, because it does dry the rest of your scalp out. I let it sit the required time, rub well, rinse, then shampoo my hair with something gentle.
posted by BlueHorse at 6:30 PM on November 25, 2014

I've tried T-Sal (anti-dandruff, prescribed by dermatologist) and ketoconazole (anti-fungal) to no noticeable effect, although admittedly both were started after I was already on clobetasol (cortisteroid) so there might be some rebound effects going on. Clobetasol is the only thing that works reliably for me (in combination with Head & Shoulders for my regular, non-plaque dandruff) and I've tapered it down to 1x week maintenance for ~2 years now.

I also have eczema and know that my immune system goes haywire, expressing itself via my skin, when I'm stressed. That's how the steroids work, by suppressing the overactive immune response. So try to minimize stress, although that's much easier said than done since right now you're probably stressed about the dandruff.

In general, dandruff shampoos should not cause you to have more dandruff. I do notice more hair falling out, but the dandruff should be washing out in the shower.
posted by serelliya at 10:37 PM on November 25, 2014

I have scalp psoraisis - mostly itching rather than flaking - for some reason, dying my hair kills off the symptoms for a couple of weeks. Perhaps some of this is because home dye kits tend to include a rich conditioner.
posted by mippy at 5:43 AM on November 26, 2014

I'm seconding Nizoral (ketaconazole). I tried a whole variety of anti-dandruff shampoos - Neutrogena T-Gel, zinc pyrithione based ones, and others, and none of them had any real effect. Then, I started using nizoral cream on the seborrhoeic dermatitis on my face. It was super successful, so I tried the shampoo for my dandruff. After a week, my dandruff was gone, never to return.

So in short, if you are not sure your anti-dandruff shampoo is working, it means it is not working. Maybe talk to a dermatologist and get a recommendation for something aimed at your particular scalp condition.
posted by neatsocks at 8:46 AM on November 26, 2014

Ketaconazole is what was prescribed for me in a cream to deal with ucky skin crud on either side of my nose close to my nostrils. I would just scrub it off but when I mentioned it in passing to my doc he said yeah, yeast, and wrote that script. So if you see that sort of thing on your face that may be an indication this shampoo approach would work for you, FYI.
posted by phearlez at 9:58 AM on November 26, 2014

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