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Dandruff Problem. Dandruff Treatment Drugs
July 16, 2009 | Leave a Comment
DANDRUFF
• Soak the scalp with Listerine original-formula (amber► mouthwash
• Smear some Vicks VapoRub on itchy spots
• Make an herbal rinse with sage or rosemary ***
• Slather yogurt on the scalp
• Use a dilute vinegar rinse after washing the hair ****
• Rotate dandruff shampoos to maintain effectiveness
• Shampoo with Nizoral A-D ****
Dandruff may be dastardly, but in general, it is not a serious medical condition. Though people who have it may by frustrated by it, or even desperate for relief, doctors don’t get too excited when they see it. The flakes are not life threatening. They never require surgery. They are not contagious and, unlike flatulence, they don’t drive others away. But a bad case of dandruff makes people self-conscious, and thanks to decades of advertising, may even carry a social stigma.
Skin cells die and are sloughed off every day, all over the body. But on the scalp, they may clump together and form flakes that stick in the hair or fall to the shoulders, and are unpleasantly visible on a black polo shirt. If the flakes are especially large and numerous and the scalp is particularly itchy and red, a dermatologist might identify the problem as seborrheic der-matitis. This condition may also affect the face. In some people, patches of skin on the forehead (including the eyebrows), the sides of the nose, and the chin seem to be especially susceptible to developing reddish, itchy scales.
I fought dandruff for 30 years. Even my eyebrows itched I only bought light-colored clothing that wouldn’t show flakes.
My dermatologist recommended various shampoos that didn’t work. When I changed doctors, my new doctor said my -dandruff” was a yeast infection. She recommended Nizoral shampoo. I only have to use it about once a month and I have no more flakes or itching.
I know this story isn’t as dramatic as finding a cure for cancer, but solving an annoyance like this is truly liberating.
Dermatologists usually distinguish between dandruff and seborrheic dermatitis, but researchers now believe that both conditions can be traced to the skin’s reaction to yeast that lives on its surface. This fungus, Malassezia globo and related species, sets up housekeeping, especially where the skin is secreting oil&’66 The fungus then produces oils of its own, which irritate the skin.” The resulting reaction is the excessive flaking typical of dandruff or the redness and itching on the scalp and face that characterize seborrheic dermatitis. Presumably, the big difference between dandruff and seborrheic dermatitis is the amount of irritation that results.
Malassezia yeast normally inhabit the skin; nobody seems to know exactly why some people are more irritated by Wassezia by-products than others. It might have something to do with hormones, or diet, or the activity of the immune system. Because dermatologists don’t know how to change individual susceptibility, the basic approach has been just to kill off as many of the yeastie beasties as is practical without hurting the scalp. This not only makes sense, it actually works most of the time. And it also explains why some dandruff shampoos seem to lose effectiveness over time. Presumably, the yeast can develop resistance.
Once in a while, people taking an oral anti-fungal drug for another problem report that it gets rid of their dandruff. But even for super-dandruff (aka seborrheic dermatitis of the scalp), an oral antifungal is too big a cannon to consider seriously. Why risk potentially serious side effects over dandruff?
Q. I had dandruff for more than 20 years and tried all sorts of medicated shampoos with no success. About 2 years ago I got a fungus under the nail of my big toe. My podiatrist put me on Lamisil, a pill a day for 3 months.
While I was taking it, my dandruff cleared up and quit itching. The Lamisil did not get rid of my nail fungus, but it seems to have cured the dandruff.
A. We’re not surprised to learn that the antifungal medicine you took for your nail infection cleared up your dandruff. Dermatologists think that dandruff is caused, in part, by yeast. Antifungal medicines could eliminate the yeast.
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Home Remedies for Dandruff
Anyone who has had dandruff knows that ordinary shampooing, while it may help for a little while, just doesn’t make much difference. But a lot of people have discovered some rather interesting home remedies that can be helpful. We’ve collected a few that are low cost and low risk, even though there is not much evidence that they work more than occasionally. Use your own common sense in selecting those that seem worth a try.
Herbal Products
What would you think of putting mouthwash in your hair? It may not be the first thing that comes to mind, but quite a few people assure us that Listerine (the amber-colored original formula) can banish dandruff. We first heard this idea from a man who said his veterinarian recommended a mixture of Listerine and baby oil to treat itchy “hot spots” that caused his dog to keep licking its coat. It worked well for the dog, so he experimented on himself! We caution animal lovers to check with your own vet before trying this at home. And we would be especially wary about trying anything of this sort on cats, since they groom themselves so assiduously.
Q. Have you ever heard of using Listerine for dandruff? Someone told me he heard it on the radio.
A. A gentleman called in to our public radio show with an amazing story about Listerine mixed with baby oil. His veterinarian had recommended this combination for relieving itchy spots on his Dobermans and horses. He found that it worked and tried it for his own dandruff. He told us that it gets rid of dandruff in 2 to 3 days.
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In the early 20th century and throughout the World War II era, Listerine was actually promoted as a dandruff treatment. Presumably the company dropped that claim when the FDA demanded proof. It’s not too far-fetched to believe, though. Listerine contains a number of herbal oils that have antifungal action, such as thymol, eucalyptol, and menthol. These ingredients might work together to knock down Malassezia and thus control flaking. The alcohol in Listerine might also have some antifungal action.
I have suffered from severe dandruff all of my life, and nothing helped I tried washing my hair with Listerine, and have been dandruff free since. It’s nothing short of a miracle cure.
The ingredient list for Listerine overlaps quite a bit with the list for another familiar old-fashioned product, Vicks VapoRub. Vicks contains camphor, thymol, menthol, eucalyptus oil, turpentine oil, cedarleaf oil, and nutmeg oil. Although Vicks is not promoted as working against fungus, many people find it helpful in fighting nail fungus, which is notoriously difficult to treat. Others report that it can be effective for the red, itchy flakes of seborrheic dermatitis on the face or behind the ears.
The drawback to using Vicks against dandruff is that the base is petroleum jelly. Washing this goo out of hair could be a real challenge!
People have tried a lot of different techniques to get petrolatum out of hair. The one technique that appears to be most Original Listerine contains a mixture of herbal oils with anti-fungal action. Currently, it is not promoted as a dandruff cure, but it was once marketed for this purpose. Wet the scalp well with Listerine and leave it on for 5 minutes before shampooing.
Downside: May sting on application. Mouthwash aroma might linger after shampooing.
Cost: Approximately $8 to $10 for a 11/2-liter bottle (around 150 per treatment)
reliable, and easiest, is to work mineral oil into the glop to “cut” it and then wash that out with shampoo or with Dawn dish detergent. It may take several latherings. Some folks are willing to try this treatment repeatedly, but many find that once is enough to convince them to try another method.
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Q. I’ve been suffering with scaly dandruff for 3 years. I’ve spent an enormous amount of money on medicines prescribed by the dermatologist, but none is a cure.
Last year I read in your column about people treating fungus-infected toenails with Vicks VapoRub. I thought I would try it for my problem. A bottle of Vicks cost me just over $5.
The Vicks softened those itchy scales and in just 2 weeks I have no more nasty flakes. Thank you for helping people like me on a low income.
A. We’ve never heard of using Vicks VapoRub against dandruff. This condition has been linked to yeast on the scalp, however, and is treated with antifungal shampoo.
The essential oils in Vicks are reported to have some activity against fungus. We’re glad to hear it worked for you, but we wonder: How did you wash the Vicks out?
We heard from one individual who was experimenting with coloring her hair naturally. She made an herbal tea out of sage (but did not tell us how she made it). Then she used the sage tea as a rinse after each shampoo. To her astonishment, she realized that her dandruff had disappeared. Being of a scientific turn of mind, she stopped using the sage tea rinse. Sure enough, her dandruff came right back. She was very pleased to have found an inexpensive way to treat dandruff.,
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Q. I used to rinse my hair with a decoction I made from rosemary plants that I grew in my herb garden.
My hair tends to be the “fly-away” sort, but rosemary made it manageable and also eliminated dandruff. It made my hair smell nice, too. Growing the rosemary myself made my hair rinse a renewable resource that came from my own yard and saved me money.
A. Rosemary has a reputation as being good for hair, so we are not surprised that your home remedy is helpful. *Some people are sensitive to rosemary oil, however, and may develop a rash.
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One of the important components of rosemary oil is camphor (along with cineole, alpha-pinene, and limonene). It also contains rosmarinic acid and carnosol. Sage, on the other hand, contains thujone, cineole, and rosmarinic acid.”‘ If you plan to try one of these herbal teas as a scalp rinse, use a teaspoon of dried herb for a generous cup (8 or 9 ounces) of hot water. Steep sage tea for 5 minutes before straining; let rosemary tea steep for 15 minutes. If you have fresh herbs from the garden, use a tablespoon of fresh leaves for your cup of tea. Let it cool before pouring it over your scalp so you won’t scald your scalp by accident.
Kitchen Magic
People can be quite ingenious when they are faced with a problem like dandruff, so it’s little wonder that some folks have tried putting common foods on the scalp. One herbal au-After washing the hair, rinse with a tea made of sage or rosemary leaves.169
Downside: Some people may have an allergic skin reaction. To be safe, test a spot on your inner arm the day before you plan to use it on your scalp.
Cost: Varies. Using rosemary or sage from the garden is free. Buying herbs in bulk results in a cost of about 50 per dose.
thor recommends smearing yogurt onto the scalp after shampooing, allowing it to sit for 15 minutes, and then washing it oUt.170 Don’t use just any yogurt, though. It should be a type with active cultures (read the label). Yogurt is fairly acidic, and that may make the skin less appealing to fungus. Then again, perhaps those live cultures do their own bit to discourage yeast. We have not tried this remedy and don’t know how well it would work.
All my life I have used dilute vinegar to rinse my hair after shampooing. It works well against dandruff and you can also use it on your feet to stop odor. Best of all, ih; cheap!
We have heard from a number of people who use vinegar as a rinse after shampooing. Some insist upon apple cider vinegar, while others go with inexpensive white vinegar. Like yogurt, vinegar is acidic. Acid disrupts the environment for many fungi that live on human skin. It stands to reason that it would also work against Malassezia.
In fact, when the problem is a fungal infection of the ear that makes it itch, one ear-nose-and-throat specialist recommends a solution made of one part white vinegar to five parts tepid water. The ear is flushed gently three times a day, and the fungus usually responds. Such a dilution might work as a scalp rinse. Then again, it is possible that a solution as strong as one part vinegar to two or three parts water would not be too harsh for the scalp.
One other food that could be used against dandruff could make you very popular with Pooh and other fictional bears. Honey, it turns out, is active against Malassezia yeast.171 This It may take a little experimentation to find the right dilution. One partminegar to fiveparts waterwould be safe, but might not be strong enough. One,part vinegar to,one part water Would probably.be strong enough to fight the fungus, but it might also sting the. scalp. Apply the rinse after shampooing, let it stay. on the scalp for 5minutes, then rinse it with dear water to get rid of the vinegar aroma.
Side effect: Possible skin irritation
Downside: Without the final water rinse, you might smell like a pickle.
Cost: About. $1 per quart
might be a lot more convenient to use against seborrheic dermatitis on the face than on the scalp to treat dandruff. But if one were feeling brave, or extra-sweet, it would be possible to mix honey with water, apply it to the scalp for 10 or 15 minutes, and then wash it off. Honey probably wouldn’t be much messier than yogurt, though it certainly would be more expensive than vinegar.
Over-the-Counter Remedies
Dandruff shampoos are readily available, and most are backed up by research showing that they affect yeast on the scalp and reduce flaking and itching. Keep in mind, though, that Malassezia may develop resistance to shampoos they are exposed to on a regular basis. As a result, it makes sense to rotate the type of medicated shampoo you use every month or two.
You might start, for example, with a shampoo such as Head & Shoulders, Pert Plus for dandruff, or Suave Dandruff 2 in 1 that contains zinc pyrithione. Research has shown that zinc pyrithione kills Malassezia and other fungi,”‘ which is why these shampoos are usually effective for dandruff. After 6 weeks or so, though, you should switch to an entirely different category of dandruff shampoo.
A medicated shampoo like Nizoral A-D, which contains ketoconazole, would be one option. This antifungal drug also kills Malassezia and has some anti-inflammatory action as well. 173 This shampoo is to be used twice a week at first, then only as often as necessary once the flakes are under control. Keep the suds away from the eyes, of course, but you can use Nizoral to wash any skin affected by fungus (patches of seborrheic dermatitis, jock itch, athlete’s foot, and the like).
Selenium sulfide is yet another antifungal ingredient. It is found in Selsun Blue, Glo-Sel, and Exsel shampoos.
There are two other categories of dandruff shampoo. One contains coal tar (a category that includes Denorex, Ionil T Plus, Neutrogena T/Sal, and Zetar). This ingredient acts against flaking and helps quell itching as well. The other contains salicylate acid and sulfur, which loosen the flakes and help them break into smaller (and thus less visible) pieces. These are shampoos such as Meted, Pernox, and Sebulex.
It surely doesn’t make sense to try all of these medicated shampoos, or even all of the various categories. Switching back and forth among three different categories would probably be just fine. The idea is simply not to let Malassezia get too accustomed to whatever it is you are using.
Give any dandruff shampoo enough time to fight the fungus. That is, after first washing off the surface dirt with any shampoo you please, lather up the medicated shampoo and leave it on for at least 5 minutes. This is harder than it sounds. After all, you may not want to waste water in the shower, but standing around wet and shivering for 5 minutes is also not appealing. You’ll have to use your ingenuity to solve this problem, but if you can, you’ll find the dandruff shampoo is far more effective. Here’s a hint: Shampoo first, then wash the rest of your body while you let the suds sink in.
arjiJ A - D
This shampoo contains the antifungal drug ketoconazole. (Make sure you buy the medicated shampoo. Nonmedicated Nizoral A-D is also available, but it won’t fight dandruff.) Nizoral shampoo is also available by prescription at twice the strength (2 percent).
Side effects: Rash, allergic reaction. To be safe, test a spot on your inner arm before you use it on your scalp.
Downside: Relatively expensive
Cost: Approximately 80o to $1.30 per wash When you are done washing your hair, resist the urge to blow it dry, at least once in a while. Hair dryers are hard on the scalp and seem to make flaking worse.
Prescription Shampoos
A stronger formulation of Nizoral shampoo is available by prescription. Doctors have a couple of other prescription possibilities as well, in case the other options aren’t effective enough. One of these is Loprox shampoo (ciclopirox). This antifungal agent also has some anti-inflammatory activity, which is useful when skin is itchy and red.”‘ Needless to say, a prescription shampoo is more expensive than the nonprescription approaches. No head-to-head studies have been done to compare it and find out if it is also more effective.
Conclusions
Dandruff and seborrheic dermatitis both seem to result from a-reaction to yeast that normally live on the skin. Scientists don’t know why some people react while others do not, nor are they sure why Malassezia yeast seems to grow more vigorously on some people’s skin than on others’. But research has shown that making life hard for the yeast usually controls the flaking and itching that are so bothersome. If any of these remedies make matters worse, stop the treatment right away and give your skin time to recover before you try anything else. When in doubt, check with a dermatologist!
• Drench the scalp with Listerine original (amber) mouthwash before shampooing. The herbal oils and alcohol in Listerine discourage the growth of yeast on the scalp.
• Smear some Vicks VapoRub on itchy, red, scaly spots. It contains many of the same antifungal herbal oils as Listerine. It can be very difficult to remove Vicks from hair, though.
• Brew some herbal tea with sage or rosemary. Use it as a rinse after shampooing your hair.
• Slather yogurt containing live cultures on the scalp. Leave it for 15 minutes before shampooing it out. Unlike the petrolatum in Vicks VapoRub, yogurt should be fairly easy to wash out.
• Make a rinse with vinegar diluted at least two to one in water. Some people prefer apple cider vinegar, while others use the cheapest white vinegar.
• Switch from one type of dandruff shampoo to another every 6 to 8 weeks. Don’t give Malassezia a chance to adapt.
• Try using Nizoral A-D shampoo twice a week, then cut back and use it only as often as needed to keep flaking under control.
• If none of this helps, check with your doctor. Perhaps your condition is not ordinary dandruff.
*A prescription shampoo such as Loprox may help when other measures have failed.