Dr. Bailey, I have seborrheic dermatitis and have found your website tips and information extremely helpful. I was hoping that you'd consider adding some information about the prescription shampoo Loprox to the site. I just started using this shampoo and am wondering how it fits in with your other advice (for example, should it be rotated like the other dandruff shampoos or must it be used for an uninterrupted period in order to be effective). If you have particular tips about the use of Loprox, I'd love to read your thoughts on your website or blog. Thanks, Sue K
Hello Sue, The challenging thing about dandruff is that there are as many variations on what works for it as there are people with it! This means that when I'm helping a patient, we 'test' treatment regimens to find what works
How to use different dandruff shampoos to treat dry scalp from dandruff?
When I'm integrating prescription Loprox into a regimen some of the variations I use are: Shampoo every day and have my patient rotate the Loprox with their other medicated dandruff shampoos. I always have my patients include a pyrithione zinc shampoo made with the strongest allowed concentration of 2% such as my fragrance-free Foaming Zinc Cleanser. I also recommend a scalp scrubber to help the lather get through the scalp flakes. I especially do this if the dandruff is really severe.
The 5 active ingredients in medicated dandruff shampoos available without prescription include:
- pyrithione zinc (a broad antimicrobial)
- ketoconazole (an antifungal/anti-yeast ingredient similar to Loprox)
- salicylic acid (a keratolytic that helps to remove flaking and scale)
- selenium sulfide (mildly antimicrobial and reduces flaking)
- tar (reduces flaking)
With Loprox Shampoo, I recommend including pyrithione zinc, salicylic acid and either selenium sulfide or tar. This way, all of the possible angles of treatment are covered.
The more frequently a person shampoos the better their treatment for dandruff treatment works.
To really get control of severe scalp dandruff we want to initially hit is hard, and shampooing every day is important to getting the rash under control.
Are dandruff shampoos harsh on your hair?
Shampooing every day with a dandruff shampoo can be a little hard on fine or colored hair. All shampoos can be harsh, dandruff shampoos especially.
I tell my patients to pay particular attention that they apply their medicated dandruff shampoo primarily to the scalp skin only. - Dermatologist Dr. Cynthia Bailey
The lather will rinse-off over the rest of the hair, but it will be diluted at that point.
How do you rotate Loprox with other dandruff medicated shampoos?
Since I have patients use Loprox twice a week, and since I ideally want patients to use 3 other medicated shampoos for rotation, this is perfect.
- They use the Loprox one day,
- then their first over-the-counter shampoo the next (such as Foaming Zinc Cleanser/Shampoo),
- then their second over-the-counter shampoo the next (such as a salicylic acid medicated shampoo),
- then their third over-the-counter shampoo (such as a selenium sulfide or tar shampoo) the next then back to the Loprox (there are supposed to be 3 days between Loprox applications).
They do this for the 4 week use limit on Loprox (or as directed by a treating MD).
Over-the-counter medicated shampoos need to be continued until the scalp dandruff is controlled plus at least a few weeks.
They can then taper down on their shampooing frequency if they would like. Eventually they even taper off the medicated products once their dandruff has been controlled for a few months or more (see below). As the dandruff clears, shampoo every other day or every third day and rotate the Loprox with one or two other medicated shampoo. I know that some people just are not going to shampoo every day. If their dandruff is mild then this every other day routine may work.
Loprox is ideally used twice a week, and so I have my patients pick one, two, or three other shampoo medicated ingredients to rotate with it. I try to encourage them to shampoo every other day initially. If this treatment is not working, then I recommend they ramp up to the daily shampoo with the 3-product rotation to jump start things, and then diminish shampoo frequency to every other or every third day once things are improved.
Can you use Loprox Shampoo as 'mono-therapy' twice a week to treat dandruff?
This is the 'low maintenance' approach and can actually work well if the dandruff isn't too stubborn. If it's not working then ramping-up to the two or three shampoo rotation and more frequent shampoo intervals can jump start improvement. Once the dandruff is under control treatment can be reduced to this mono-therapy.
What is the best way to keep scalp dandruff from coming back?
Dandruff will come and go, there unfortunately is no lifelong cure. I therefore like to give my patients varying treatment options that they can use as their rash waxes and wanes.
- If they are using a prescription shampoo like Loprox I don't want them to use it as maintenance treatment. I like it to be the 'big surprise' for the scalp when it's really misbehaving. That means I have them put it away after the rash has been controlled for a few months.
- They then use over-the-counter shampoos for a while, and, if the rash stays quiet, they can even stop those.
- Their dandruff will of course flare-up at some point and then they get out the over-the-counter products. If those don't work, out comes the Loprox as the 'big surprise'. If that doesn't work, up goes the shampoo frequency to everyday etc...
Remember, with dandruff, I find that my patients are more likely to have treatment success if they jump on any little flare-up early; if the dandruff gets really bad again then we start over from scratch to get it under control.
Please know that Loprox Shampoo is a prescription product and to use it a person must be under the care of a treating, licensed physician, plus there are limits on its use. Please read my disclaimers below!
If you have scalp dandruff you may have eyebrow dandruff and facial dandruff
It's true. The dry flaking skin in the eyebrows and around the nose are usually dandruff - not 'dry skin'. This skin problem is so common and misdiagnosed by people that I created my Facial Flaking and Redness Solution Kit to provide a turn-key solution. My Calming Zinc Soap contains 2% pyrithione zinc, the Green Tea Antioxidant Skin Therapy calms inflamed and red skin and the Daily Moisturizing Face Cream repairs skin barrier so that your skin can heal.
Alternate your Loprox with my Foaming Zinc Cleanser with Scalp Scrubber option for scalp seborrhea treatment. Fight facial and eyebrow seborrhea with my Facial Flaking and Redness Solution Kit and you are set to fight dandruff the way my patients do in my dermatology practice.
Cynthia Bailey MD, Dermatologist
Disclaimer: Please realize that availing yourself of the opportunity to submit and receive answers to your questions from Dr. Bailey does not confer a doctor/patient relationship with Dr. Bailey. The information provided by Dr. Bailey is general health information inspired by your question. It should not be a substitute for obtaining medical advice from your physician and is not intended to diagnose or treat any specific medical problem (and is not an extension of the care Dr. Bailey has provided in her office for existing patients of her practice). Never ignore your own doctor’s advice because of something you read here; this information is for general informational purpose only.