Seborrheic dermatitis, also known as dandruff, effects an astounding 5-10% of the American population alone. This article outlines 7 most essential seborrheic dermatitis shampoos currently available.
The list focuses on one seborrheic dermatitis shampoo per active ingredient. There are many other alternative shampoos currently on the market which use the same active ingredient in their products. The ones examined here are the most popular products for their respective ingredient.
This article will examine each one and briefly outline the ingredients that go into the shampoo. Additionally, my experience with each is provided.
In the end, I took a slightly different approach to getting my seborrheic dermatitis under control. The general details of my approach are provided towards the end of this article.
Update March 2016: Since the publishing of this post, I have been accumulating a lot of new research. Based on this I have created my own regimen which has been working well for me. This approach is discussed here: My Seborrheic Dermatitis Skin Regimen 2.0 (tons of useful information in the comments section of that post as well).
Table of Contents
- 1 General Usage Advice for Using Anti-fungal Shampoo for Seborrheic Dermatitis
- 2 Head and Shoulders – Pyrithione Zinc Shampoo for Seborrheic Dermatitis
- 3 Neutrogena T/Gel – Coal Tar Shampoo for Seborrheic Dermatitis
- 4 Nizoral – Ketoconazole Shampoo for Seborrheic Dermatitis
- 5 Selsun Blue – Selenium Sulfide Shampoo for Seborrheic Dermatitis
- 6 Neutrogena T/Sal – Salicylic Acid Shampoo for Seborrheic Dermatitis
- 7 Jason Natural Dandruff Relief – Sulfur Shampoo for Seborrheic Dermatitis
- 8 Paul Mitchell – Tea Tree Oil Shampoo for Seborrheic Dermatitis
- 9 Summary
- 10 My Own Experience
- 11 Conclusion
General Usage Advice for Using Anti-fungal Shampoo for Seborrheic Dermatitis
Please know that each of these solutions appears to be effective only if left on the skin for the recommended amount of time (or more). For the anti-fungal properties of a shampoo to begin to take effect, the active ingredient must be left on the skin for enough time to do their job.
What is Seborrheic Dermatitis
Seborrheic dermatitis is believed to be a chronic skin condition that affects roughly 3% of the population. When the condition affects the scalp, it is more commonly known as dandruff (believed to be a more mild form of seborrheic dermatitis with limited inflammation. though some disagreement exists).
The condition is characterized by dryness, patches of dry (often greasy) skin flakes, significant itching, and general irritation of the affected skin.
Though not universally accepted, the majority of literature on the subject concludes that seborrheic dermatitis is caused by the Malassezia fungus (1, 2). This fungus is present on the skin of healthy individuals as well, but for those of us unfortunate enough, the fungus is believed to be responsible for the seborrheic dermatitis symptoms we experience.
A thorough discussion of the condition is outside the scope of this article, but if you like to learn more about the condition, you refer to the seborrheic dermatitis owner’s manual. This is a publically accessible online eBook that documents my collective findings on the topic.
Accurate diagnosis is a critical component of successful treatment
In order for a seborrheic dermatitis shampoo to be effective, it’s important that your symptoms are indeed related to seborrheic dermatitis and not a visually similar skin condition (such as plaque psoriasis). Many individuals underestimate the importance of accurate diagnosis and spend effort trying to treat the wrong condition.
1. Head and Shoulders – Pyrithione Zinc Shampoo for Seborrheic Dermatitis
This is the single most popular shampoo for seborrheic dermatitis. In fact, it is so popular that people use it every day, even without seborrheic dermatitis or dandruff. Through effective marketing campaigns, simple product packaging, affordability, and effectiveness, it is has been able to become one of the top selling shampoos on the market.
Head and Shoulders (Procter & Gamble) has done or sponsored many studies on dandruff, seborrheic dermatitis, and scaling. They have pioneered much of the work relating to the the malassezia furfur yeast/fungus (which many researchers believe is responsible for seborrheic dermatitis).
The company and its research team, strongly believe this small skin yeast/fungus is the main culprit behind all seborrheic dermatitis problems. In turn they’ve developed an effective anti-fungal agent which kills malassezia yeast/fungus (along with many others). While doing little harm to the natural skin cells (as they say).
Is Head and Shoulders a Safe Shampoo
Proctor and Gamble (the owners of Head and Shoulders) have funded a vast amount of safety and toxicology studies to prove that Head and Shoulders is not harmful to the average consumer. Through these studies, they have been able to demonstrate that their shampoo is safe for external use by us humans. It’s safety is also demonstrated by the fact that is sold in a very large number of countries around the world (as many countries require their own safety testing).
There is one thing I did want to point out though. Zinc Pyrithione becomes highly dangerous at high concentrations (+20%) and has even been associated with DNA damage (3). This really scared me at first, but after further research I found that the concentration of practically any substance can significantly change the substances safety.
For example, sodium chloride (salt) diluted with water presents on danger of burning the skin. However, as you increase the concentration you increase the chance of irritation. In relation to salt, I’ve also written an article that summarises my experience using it to treat my seborrheic dermatitis.
How Well Does Head and Shoulders Work
In my experience, Head and Shoulders is highly effective and the results come within hours of first use. Itchiness subsides practically right away. Irritation and dermatitis start to die down, and redness subsides right after use.
Flakiness and dryness are the symptoms which only start to disappear after more frequent usage. In fact dryness was actually increased during use for me and was only aided by moisturizers and conditioners.
Head and Shoulder works amazingly well for seborrheic dermatitis. Its active ingredient, zinc pyrithione, is very effective for treatment of seborrheic dermatitis and has been demonstrated to be safe.
However, I’ve personally found several negative aspects to its long term usage. This include things such as pale skin, sun sensitivity, and dryness.
2. Neutrogena T/Gel – Coal Tar Shampoo for Seborrheic Dermatitis
Coal tar has a long history in medicine for its use in treatment of various skin conditions (4). Additionally, there are also many more natural alternatives such as pine tar and sulfonated shale oil (which I actually highly recommend, but did not include here because it’s almost impossible to find in a commercially available product).
These tar based products work mainly by slowing skin cell reproduction, normalizing the skins inflammatory response mechanism and killing off bacteria/fungus.
Why Tar Shampoos May Not Be As Popular
The main negative point associated with these products is the strong smell and their ability to easily stain clothes.
The first one regarding the smell is true, it was quite a strong smell, but once you get used to it, you actually start to enjoy it (at-least I enjoyed the pine tar soap).
The second point regarding the staining is not as true (at least it was not for me). Yes it is brown and obviously it will make things brown if you get it on fabric. However, in my experience a thorough wash was more than enough to quickly get it out.
Are Coal Tar Shampoos Safe
Neutrogena and other manufacturers have likely done their duty and conducted a fair amount of safety research (at-least I would hope they have). I would imagine safety research for a medicated shampoo would be a requirement before going to market.
The more natural tar alternatives have much less hard data and facts regarding their safety, but seem to have been tested by time. However, some research does claim that sulphonated oils have superior safety to tar preparations (5).
There are potentially concerns regarding the neurotoxicity and carcinogenic aspects of tars, however, to date there has not been a direct connection to threat in humans (6).
How Well Does Coal Tar Work
This was actually my favorite solution out of the commercial products I’ve tried. The ingredients list was much shorter than the Head and Shoulders one and it didn’t dry the skin as much.
Overall this was probably my second most used anti-fungal shampoo product. The only reason it is not number one on this list, is that I didn’t use it nearly as long or as much (as Head and Shoulders).
Knowing everything I know now, if I was faced with seborrheic dermatitis a coal tar based shampoo would likely be my anti-fungal shampoo of choice (from the ones outlined here). However, towards the end of my issues with seborrheic dermatitis, I used a sulphonated shale oil based shampoo. That shampoo is super hard to find, thus I have chosen to exclude it from the list. This is the shampoo on Amazon, but recent reviews suggest issues with the new formula (price is high as well).
Other tar products I’ve used, such as Grandpas Pine Tar soap have also been quite effective. They did dry the skin out more then the Neutrogena. But I actually thought the smell of those was much more natural and likeable (like a camp fire).
Neutrogena tried to mask their smell with strong perfume. What they ended up with smells somewhat strange to me, but I guess it makes it much more marketable to women.
Neutrogena T/Gel works well for seborrheic dermatitis. Its active ingredient, coal tar, is very effective at controlling seborrheic dermatitis and studies suggest it’s relatively safe. It has a fairly short ingredients list, is less drying then zinc pyrithione based products, smells strong, and is of natural origin.
3. Nizoral – Ketoconazole Shampoo for Seborrheic Dermatitis
This to me was the strongest anti-fungal shampoo I’ve ever tried for seborrheic dermatitis. When applied to the skin or hair, it felt like a nuclear bomb was just dropped and everything has been completely eradicated.
This stuff is honestly the strongest thing on this list and it also quite expensive.
It’s so strong that previously it was only available in the USA under a prescription. When used as a hair shampoo, it feels like your hair has just been turned into dead grass/straw. It nukes everything living good or bad and sucks the moisture out like nothing else I’ve used. Perhaps your experience may be different, but that was mine.
Due to how strong it was, I was only able to use this product twice. It just didn’t feel right. Yes it did eradicate redness, itchiness, flakiness, and all the bad stuff associated with seborrheic dermatitis. However, it also felt like it eradicated every single nutrient and skin cell in its way.
Are Ketoconazole Shampoos Safe
Based on all research papers I’ve read, Nizoral/Ketoconazole is completely safe if used according to the 2-3 times per week recommendations (7). However please note that the strength of the solution will play a big role in its safety. All the data I’ve looked at used a maximum concentration of 2% (which is the max you will find anywhere for sale anyway).
How Well Do Ketoconazole Shampoos Work
Th simple answer is yes it does work and it works fast. Using this stuff feels like brining a gun to a knife fight. It just seems to go over the top in its anti-fungal killing ability. Feel free to give it a try, but I couldn’t really recommend it because it seemed much too strong for me.
Studies do demonstrate that it’s almost as effective as hydro-cortisone cream though (8).
Another thing I found interesting, is that if you are losing hair in connection to your seborrheic dermatitis, Nizoral might be a very good and appealing option for you. Studies suggest that it can significantly improve hair growth in terms of both hair shaft thickness and overall hair density (9). Out of the all things they tested in one study it was the most effective thing (10). There are even reviews on Amazon of people using it to reverse/delay early balding.
Nizoral shampoo works extremely well for seborrheic dermatitis. Its active ingredient, ketoconazole, is very effective for seborrheic dermatitis and balding, however, its safety is a little bit more unclear.
It is a very drying shampoo, is quite expensive, used to be available only by prescription, increases hair growth, and is one of the strongest topical anti-fungal agents available over the counter.
4. Selsun Blue – Selenium Sulfide Shampoo for Seborrheic Dermatitis
To me this looked like one of the stranger products. It’s blue color and thick consistency make it look like slime from a kid’s move. There are many cases around the internet in which people swear by its effectiveness.
In truth, I’ve never tried the product so I do not really have my own opinion of it. The reason I didn’t try it is quite simple. By the time I learned about it, I was completely done with anti-fungal usage. Even then there were some times were I really wanted to give it a try, but didn’t. Additionally, the one thing that was always in the back of my mind, where it’s safety concerns.
Are Selenium Sulfide Shampoos Safe
Research has recently demonstrated its safety, however, there have been some inconclusive studies (11). The product is banned in Japan and in several countries around Europe. It is also considered a carcinogen by the EPA and state of California. However, this hasn’t stopped many people using it on a regular basis and swearing by its effectiveness (which is realistically the only reason I had to include it here).
How Well Do Sulfide Shampoos Work
Based on the results people online have been able to obtain, I’ve come to the conclusion that it is highly effective for seborrheic dermatitis. Clinical studies equate it to being as effective as ketocanazole based shampoos (12). Even potentially more so then the Head and Shoulders (pyrithione zinc) and T/Gel (coal tar).
It also appears to have less effect on the skins ability to tolerate the sun (which the others strongly affect). If you are reading this and have used Selsun Blue, share your knowledge with other readers in the comments below.
Selsun Blue works extremely well for seborrheic dermatitis. Its active ingredient, selenium sulfide, is very effective for seborrheic dermatitis. There are, however, significant safety concerns of prolonged use (13). Regardless of this, many people online swear by its effectiveness. Due to the fact that I’ve personally never used it I can’t really make any first hand observations.
5. Neutrogena T/Sal – Salicylic Acid Shampoo for Seborrheic Dermatitis
Here is another effective seborrheic dermatitis (dandruff) shampoo form Neutrogena. It works by removing the dead skin and any yeast build up using a fairly strong acid.
Salicylic acid is of natural origin and is derived from the willow trees bark. Additionally, it is frequently used in many other skin care products as an effective solution for acne. At higher concentrations it is used to remove warts and corns (14).
When used for seborrheic dermatitis (dandruff), it is extremely effective at removing the flakes (15). It leaves the skin feeling very tight and bright pink.
Specifically for me, it did not seem to have very lasting results. However, one of my favorite aspects of it were how mild it was.
Are Salicylic Acid Shampoos Safe
Salicylic acid seems to be one of the safer products listed here. Its popularity in a wide variety of applications has allowed for quiet an impressive amount of safety data to be gathered around it (16). Some people with very sensitive skin have been show to experience slight discomfort from its use (likely due to its highly acidic nature).
Do Salicylic Acid Shampoos Work
Yes and no. It seems to work very well when the seborrheic dermatitis is quite mild, however, as seborrheic dermatitis becomes worse, it does very little to help. This is likely due the infection getting deeper into the pores and salicylic acid’s fairly week anti-fungal properties (17).
Also from my latest and research, salicylic acid combined with sulphur seems to be a much more effective solution for seborrheic dermatitis, then salicylic acid on its own (18).
Neutrogena T/Sal works pretty well for mild seborrheic dermatitis (dandruff). Its active ingredient, salicylic acid, is quite effective for removing the flakes and scales caused by seborrheic dermatitis. However, for aggressive seborrheic dermatitis it is far too weak in combating the yeast/fungus deep in the skins pores.
6. Jason Natural Dandruff Relief – Sulfur Shampoo for Seborrheic Dermatitis
This goes hand in hand with the suggestion from the previous section. This shampoo takes both sulfur and salicylic acid and combines them into one single shampoo formula. The smell of this shampoo is quite off-putting and will make your hair smell like rotten eggs for a while. Which would obviously be worse if your hair is longer.
The sulfur and the salicylic acid act as a perfect team. One acts to effectively remove build up and scales, while the other does the dirty work and fights the yeast/fungus.
Are Sulfur Based Shampoo Safe
Both of the ingredients in the Jason shampoo (salicylic acid and sulphur) are of natural origin and have been used for centuries. They have strong safety data and I would consider them to be one of the safest products listed here (while still being extremely effective).
The only potential safety concern I have is the very bad smell. Which can be dangerous when going out, as it could detour people away from you.
How Well Do Sulfur Based Shampoos Work
They seem to work and actually quite wonderfully. In my experience, the results was on par with Head and Shoulders. The results obtained from this shampoo also appear to stay around for longer than any of the others listed here. There is a ton of praise for this shampoo on many of the different online retailers (the bad ratings are typically from people who either have not used it consistently enough or can’t stand the smell).
Please note, it does take a little longer than the others to start working. However, once you get things under control the maintenance schedule is much more slack.
Jason Natural Dandruff Relief works well for seborrheic dermatitis if used properly. It’s main active ingredient, sulphur, is effective for seborrheic dermatitis only if used according to the recommended schedule. The strong smell will likely detour many consumers, especially those with longer hair. The combination of salicylic acid and sulphur works in harmony and can produce amazing results.
7. Paul Mitchell – Tea Tree Oil Shampoo for Seborrheic Dermatitis
This is another shampoo that has made the list which I’ve never used before. It has been included because many people claim that it works well for them.
I have, however, tried many other different tea tree solutions. However, for some reason they never really gave me the results I was after. Yes they did help with the scaling from the seborrheic dermatitis, but they never really helped with the redness or blotchiness (of the facial area). And I’ve even written a detailed overview of tea tree oil treatments for those seeking more information.
A product which I have tried from the same line, is their tea tree styling gel. Which, I believe did help reduce my dandruff a little bit. However, I do not think that it helped by fighting the dandruff, but by simply providing an alternative to regular styling wax which caused my scalp to become quite greasy.
Are Tea Tree Oil Shampoos Safe
Tea tree appears to be the oldest studied thing on this list (19). If you are considering this method because you are in search for a natural treatment option, be aware that Paul Mitchells shampoo does contain some negative ingredients. Which, people looking for a more natural approach generally stay away from (such as SLS and others). However, overall it much better than most other commercial shampoos.
How Well Do Tea Tree Oil Shampoos Work
Research studies evaluating the effectivness of tea tree oil shampoos for seborrheic dermatitis show good potential:
- A lab study evaluating tea tree oil’s anti-fungal potenial against malassezia showed significant supression and noted tea tree oil may be “useful in the treatment of conditions involving M. furfur” (20).
- A real-world single-blind study with 126 participants over the age of 14 years showed a 41% improvement rate (just under half of the people showed good progress). Though the scaliness component was noted to have the least imrpveoments, the study concluded that 5% tea tree oil is an “effective and well tolerated” treatment of dandruff (21).
The effectiveness of this particular shampoo for me remains unclear. I’ve read about people getting results, but after regular usage with similar products, I saw absolutely no change in my seborrheic dermatitis (nor better, not worse). The smell of the shampoo was very nice and the product did have a premium feel to it, which made usage more pleasant.
Solely based on my experience with with tea tree oil in general, I could not conclude that they are very effective for treatment of seborrheic dermatitis. However, there are studies which demonstrate its effectiveness (22). So, perhaps the concentrations in the shampoos I used were off.
All this effectiveness data and safety information is valuable when choosing a shampoo for treatment of seborrheic dermatitis, however one must not forget common sense.
First of all, each of the shampoos listed here depend on their specific active ingredient to be effective. The activate ingredient is typically a strong anti-fungal and anti-microbial agent. This sounds very good, but truth be told your skin has its own complex biologic system.
There are many other valuable micro-organisms that live on the skins surface. Many of which can also be the friendly bacteria that make up your natural skin flora. These friendly bacteria help to fight infection and disease cause by foreign invaders (pathogenic bacteria, yeast and fungus).
When you use a strong agent such as the zinc pyrithione, ketoconazole or any other anti-fungal, you unwilling kill of many of these beneficial bacteria. Some researchers are now making claims that prolonged usage can have a detrimental effect on the natural flora and cause many future issues (23).
Your Body’s Natural Defenses
This same effect is also seen in other areas of medicine, such as asthma, dysbiosis and other atopic conditions (24). What happens here, is the body’s natural defence mechanisms are damaged due to under stimulation (since you manually kill of the bad bacteria with external agents) and over sanitation. And as a results, over time, your skin/body becomes dependent on external agents to do its work for it.
Obviously, if you use these agents once in a while, you are unlikely to cause any long term damage. However, if you get in the habit of every day usage, imagine what will happen when you stop. How will your skin react to its new microbial filled world?
Truth be told, I used Head and Shoulders almost every day for several years. Not because I needed to, but because I did not know any better.
My Own Experience
Once I started experiencing seborrheic dermatitis on my facial skin I started doing research. This led me to finding a temporary solution of using Head and Shoulders directly on the facial skin.
My seborrheic dermatitis quickly receded and my skin returned to normal. After a few weeks of great results things quickly deteriorated and my skin became the worst is has ever been. It was constantly pale, dry, flaky, and red at the same time. I wanted answers, I wanted to know what was happening.
Looking back now I think the head and shoulders was not truly a solution, but actually played a significant role in developing the problem.
Then I decided to develop this site and find a more workable solution. After several months of fighting myself to not use anti-fungal shampoos, my seborrheic dermatitis and dandruff became markedly worse.
My scalp was constantly flaky, my skin very oily, and the skin yeast/fungus seemed to be enjoying life on my skin. Honestly this was one of the hardest periods of my life. As I would consistently enjoy staying indoors, just because I was embarrassed and ashamed of my appearance.
The Point of No Return
After about one and a half months in this horrible state, I decided to research other solutions. After trying a myriad of natural anti-fungal solutions I decided to take a different approach. The first step in my transition was the use of a more natural mild shampoo containing the sulphonated shale oil anti-fungal agent briefly described above.
My skin slowly began producing less oil, my scalp became less flaky and in my skin tone greatly improved. Another couple of weeks went by and this is when the most progress was seen. My scalp started to actually look normal, oil was no longer a problem, dandruff was practically gone, itching and redness subdued and seborrheic dermatitis was barely there.
Since the sulphonated shale oil shampoo was so hard to find and so expensive, I decided to revamp my approach once again. This time I went against all common recommendations and purchased a relatively natural highly moisturizing shampoo (here it is on Amazon). Haven’t looked back since. I’ve been using this shampoo for about a year now and my dandruff rarely bothers me. There have been a few odd times were it would return, but things never get out of control.
However, this is a slight over simplification of how things really went. My approach was a little more comprehensive then just switching a shampoo. It took several years of intensive research (using medical journals, textbooks and not online forums).
What I Do Now – Updated September 2016
For more then a year now I’ve been fortunate enough to get my skin under control. Here is a quick breakdown of what I’ve been doing:
- Stopped using anti-fungal shampoos
- Only wash my face with water
- Follow up each face rinse with my own custom solution
- Take shorter showers
- Use the moisturizing shampoo described in the previous section
It literally took years to get to where I am now. And along the way, this website has become significant part of my daily life. Hopefully you can benefit from that work that goes into it.
Quick Overview of Other Variables
Another thing that I believe played a very significant role in helping get things under control was my fairly clean eating habits, glutamine supplementation and an H. Pylori diagnosis.
The H. Pylori was diagnosed by accident when a member of my family had issues with systemic acidity (thus the whole family got tested). I came back positive from the breath test and was prescribed antibiotics. Which, hopefully successfully got rid of it (follow up testing came back negative).
The moral of the story is please do some research and use common sense when using an anti-fungal shampoo for the treatment of seborrheic dermatitis (dandruff). Yes it might help visually and instantly, but what do you think its long term effects are.
Take the time and really learn about seborrheic dermatitis. Having a good understanding of your skin condition can be one of the biggest steps to long term recovery.
I strongly believe the best thing you can do right now, is to take the time to fully understand the condition. And a good place to start may be the comprehensive guide I’ve been working on for the past couple of years.
If going the shampoo route, the most popular shampoo for seborrheic dermatitis (dandruff) appears to be Head & Shoulders. However, more natural ones have been gaining popularity in recent years.
For me, going with a more unorthodox approach seems to have paid off in the end. However, it seems that everyone is different and seborrheic dermatitis is a complex condition that the medical community still struggles fully understand.
How much do you think the companies selling the stuff benefit/profit from your ongoing problem? What else have you been doing to control your condition? I believe there are many factors which need be to considering when deciding to use an anti-fungal shampoo long-term.
If you have any experience with any of the seborrheic dermatitis shampoos described above or a different shampoo which worked for you, leave your feedback in the comments below.