How To Use Loprox Shampoo With Other Dandruff Shampoos To Treat Seborrheic Dermatitis

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, the way I usually do it is:

I have them 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 in the rotation of products. I use a trusted 2% professional strength zinc pyrithione shampoo. This 2% is the strongest allowed concentration of medicated pyrithione zinc. Pyrithione zinc works against yeast and other germs by a mechanism that is broad and does not create resistant microbes. Loprox, on the other hand, is an antifungal drug called ciclopirox and the dandruff germ (Pityrosporum, also called Malassezia) can develop resistance to this medicine. 

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. 

What are the 5 active ingredients in medicated dandruff shampoos available without prescription:

In the United States, the ingredients in dandruff shampoos include:

1. pyrithione zinc (a broad antimicrobial)
2. ketoconazole (an antifungal/anti-yeast ingredient similar to Loprox)
3. salicylic acid (a keratolytic that helps to remove flaking and scale)
4. selenium sulfide (mildly antimicrobial and reduces flaking)
5. tar (reduces flaking)

With Loprox Shampoo, I always recommend including a 2% pyrithione zinc shampoo. This can be rotated with one of the other ingredients. My top choice for a third shampoo medicine would be salicylic acid, which helps remove thick flakes. Other options are selenium sulfide or tar. Selenium sulfide can be drying and tar smells and can discolor light colored hair. 

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. Know that the flakes are present because of the rash, not because your scalp is dry! You will have better success if you shampoo daily. 

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

Lather and rinse twice, the first time with a non-medicated shampoo. This lather will remove oil, dirt and product residue on both scalp skin and your hair. The second lathering is applied to your scalp only. Allow it to sit for 5 minutes then rinse well, paying special attention to rinse lather off of your hair shafts. A layer of medicated ingredient will remain behind on your scalp skin to treat dandruff throughout the day. 

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 a zinc shampoo and perhaps a salicylic acid product, the rotation is as follows: 

• They use the Loprox on day one,
• the second day they use a zinc pyrithione shampoo,
• the third day they use the additional medicated product such as a salicylic acid shampoo, 
• then their fourth day they are back to Loprox.  

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 antifungal drug 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, always including a pyrithione zinc product. If the rash stays quiet, they can even stop this for what we call a "drug holiday" in medicine. 
• 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. 

The bottom line in treating scalp dandruff:

Alternate your Loprox with a professional strength 2% Pyrithione Zinc Shampoo and scrub the lather onto your scalp skin using a really good Scalp Scrubber. Let it sit for 5 minutes then rinse well. option for scalp seborrhea treatment.

Look to see if you also have facial dandruff and if you do, tackle it with my Facial Flaking and Redness Solution Skin Care Kit used daily. 

Warm Regards,

Cynthia Bailey MD, Dermatologist

Reference

Kaiqin Wang, Lu Cheng, Wenshuang Li, Hui Jiang, Xiaofang Zhang, Shanshan Liu, Yunli Huang, Mingyue Qiang, Tianxiang Dong, Yuye Li, Jin Wang, Shike Feng, Hongbin Li, Susceptibilities of Malassezia strains from pityriasis versicolor, Malassezia folliculitis and seborrheic dermatitis to antifungal drugs,
Heliyon, Volume 6, Issue 6, 2020, e04203, ISSN 2405-8440, https://doi.org/10.1016/j.heliyon.2020.e04203, (https://www.sciencedirect.com/science/article/pii/S2405844020310471)

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.