Medicated anti-dandruff shampoo and hair loss

Dandruff is a condition of the scalp requiring consistant treatment to control the symptoms of flaking and itching. Frequent shampooing is key to controlling these symptoms while contributing to the cosmetic appearance of the hair. This article will aim to explore:

• The different types of anti-dandruff shampoo, and 
• Can anti-dandruff shampoo cause hair loss?

Male pattern baldness, known as androgenetic alopecia (AGA), is the most prevalent type of hair loss in men and women. It involves the shrinking of hair follicles, primarily driven by a hormone called dihydrotestosterone (DHT). DHT is formed from testosterone through the action of the enzyme 5-alpha reductase (5AR). Ketoconazole is recognized for its ability to inhibit this enzyme, potentially helping with hair loss.

Ketoconazole is an antifungal agent with anti-inflammatory and DHT-lowering effects, with the 2% concentration showing clinical promise in addressing pattern hair loss. Additionally, it is also effective against scalp fungal infections caused by Malassezia spp.

In head to head controlled studies, 2% Ketoconazole was proven to be as effective as 2.5% Selenium Sulfide in the treatment of moderate to severe dandruff; however, ketoconazole 2% shampoo appears to be better tolerated.

Does Selenium Sulfide cause hair loss?

Selenium sulfide is both an anti-fungal that slows the growth of this yeast while also relieving the inflammatory effects associated with dandruff such as itching, irritation, and redness of the scalp. 

There are few reported studies suggesting indiviuals who use Selenium Sulfide for the management of dandruff also suffered hair thinning. In all cases, hair shedding stopped when use of the shampoo was discontinued. It is unclear if Selenium Sulfide is the single causative agent or whether other ingredients are involved.

For individuals experiencing hair loss, particularly those with Malassezia overgrowth or seborrheic dermatitis, incorporating 2% ketoconazole shampoo into their hair care routine could be beneficial. Seborrheic dermatitis and dandruff often contribute to increased sebum production and scalp flaking, which may exacerbate AGA by increasing scalp inflammation.

Zinc Pyrithinone vs Ketoconazole 

Zinc Pyrithione (ZPT) is a highly effective anti-fungal ingredient that kills off yeasts like Malassezia.

Malassezia feed on oil that is present on the scalp and cause skin cells to flake off. In a double-blind cross-over study enrolled by 40 women with mild to moderate dandruff, it was found participants preferred the 1% Zinc Pyrithione conditioning shampoo over the 2% ketoconazole shampoo by 75% in terms of overall acceptability. Hair-combing ease, hair smoothness, and hair frizz/flyaway were statistically significantly better in subjects who used the 1% Zinc Pyrithione  conditioning shampoo for one week versus 2% Ketoconazole.

Key takeaways

• If dandruff is your main concern and you do not have hair loss, any of the above ingredients are a good place to start 
• If you have dandruff and also hair loss, avoid Selenium Sulfide 
• If you prefer a more conditioning finish, Zinc Pyrithinone shampoo may preferred 

Disclaimer: The information provided is general and may not fit your individual circumstance. Always seek professional advice from your medical practitioner before starting any new treatment.

References:

1. Godse, G et al. "Safety, Efficacy and Attributes of 2.5% Selenium Sulfide Shampoo in the Treatment of Dandruff: A Single-Center Study." Cureus. (2024) Mar 28;16(3):e57148. doi: 10.7759/cureus.57148
2. Danby, F et al. "A randomized, double-blind, placebo-controlled trial of ketoconazole 2% shampoo versus selenium sulfide 2.5% shampoo in the treatment of moderate to severe dandruff." J Am Acad Dermatology. (1993) Dec;29(6):1008-12.
3. Grover, R et al. "Diffuse hair loss associated with Selenium Sulfide." JAMA. (1956) 160(16):1397-1398. doi:10.1001/jama.1956.02960510023006
4. Dralos, Z et al. "A Comparison of Hair Quality and Cosmetic Acceptance Following the Use of Two Anti-Dandruff Shampoos." J Invest. Dermatology. (2005) v10,p201-204.