Seunga (Jasmine) Han, PharmD Candidate
Previously…
In the last article, we had a quick overview of what dandruff is and some other ways to manage it without using medications. We’d also mentioned that there are various products available in the market for the treatment of dandruff. In this second part of a 2-part series, we’ll take a closer look at these agents.
Antifungal Agents
As mentioned earlier, fungus is a common cause of dandruff. As a result, most first-line treatment options are antifungal agents.
#1. Ketoconazole (Nizoral®)
Topical ketoconazole is the most studied antifungal agent of its class. Nizoral® is an over-the-counter 2% ketoconazole shampoo that can be used to manage the symptoms of flaking and irritation. Since it works by slowing down the growth of fungus and skin cell turnover, it doesn’t work to cure dandruff, but rather manage its severity. It’s recommended that you use 5-10 mL of the shampoo on a wet scalp, work it into a lather, and then leave it on for 3-5 minutes before rinsing with water. Studies have shown that most individuals respond within four weeks with minimal side effects when they use the shampoo twice a week for 2-4 weeks.1
#2. Ciclopirox olamine (Stieprox®)
Ciclopirox olamine is another type of antifungal agent that’s demonstrated similar efficacy to ketoconazole. It’s often used as an alternative for people who aren’t able to tolerate ketoconazole. Although there are various concentrations of ciclopirox olamine shampoo or gel available, it seems like 1% is the best in terms of safety and effectiveness. Just like ketoconazole, use 5-10 mL of the shampoo on a wet scalp, work it into a lather, and then leave it on for 3-5 minutes before rinsing with water. Based on your response, you may use it 2-3 times a week for 2-4 weeks.1
#3. Selenium sulfide (Head and Shoulders®)
Selenium sulfide products like Head and Shoulders® can be used in the same way as ketoconazole and ciclopirox olamine containing products. They may be effective in controlling dandruff, dryness and pain, but stopping its use may cause symptoms to rebound. Additionally, it’s important that you use the product for no more than twice a week. Contrary to what you may think, more isn’t always better. Excessive use of selenium sulfide can lead to oily hair and hair loss. Instead of using it more often, you can leave the product in your hair for a longer period of time to improve efficacy.1
#4. Zinc pyrithione (Head and Shoulders®)
While zinc pyrithione works similarly to selenium sulfide, it’s recommended that you use it once a week for at least 9 weeks. Unfortunately, among all the antifungals, it may be the least favourable as it has only shown to improve symptoms without completely resolving them. Again, you can leave it on longer for more effect, but make sure to avoid excessive use.1
Other Options
If you’ve tried antifungal agents but found them ineffective, you can consider using any of the following alternatives, either alone or in combination with antifungals.
#1. Salicylic acid and sulfur
Salicylic acid and sulfur are ketolytic agents that have shown effectiveness in the treatment of dandruff. Salicylic acid 2-3% (Targel®, Head and Shoulders®, Dermarest®) offers minimal antifungal activity, but promotes the detachment of flakes from the skin and further promotes penetration of other drugs. Sulfur 3-5%, on the other hand, offers both antifungal and ketolytic activity. Hence, products containing both these ingredients may be more potent, but also more irritating. Both these agents work best when lathered into the scalp with continued rubbing for at least 5 minutes, and then rinsed thoroughly. Avoid use for more than twice a week, and be more cautious when using in younger children, as the risk of absorption through the skin can cause unwanted side effects.
#2. Topical corticosteroids
Although rarely used, topical corticosteroids may help with symptoms of dandruff by reducing itchiness and inflammation. But, due to safety concerns associated with corticosteroids, such as bruising and thinning skin, they’re only used short-term, often together with antifungals. Their use should be discontinued as soon as itching and redness resolve while continuing the use of antifungals. It’s ideal to start with weaker corticosteroids such as hydrocortisone 1% and only move to stronger ones if needed. Corticosteroids can be applied overnight with a shower cap on, where ointments are preferred for areas that are resistant to absorption, and are dry or scaly. On the other hand, creams are best for moist areas. If any acne is present in the area of dandruff, it’s best to avoid putting any corticosteroids over that area.
The Bottom Line
Of course, this is not necessarily an extensive list of treatment option for dandruff, and it’s always important to consult your healthcare provider regarding the use of these products.
We hope you took away something valuable from this piece. If you have any questions or concerns regarding this article or others, feel free to reach out to us on Instagram, Facebook, or at ask@orbishealth.ca with your feedback. We’d love to hear from you.
RESOURCES
- RxTx
- DynaMed Plus
