Active Ingredients in Dandruff Shampoos – The Ultimate Guide

It can be difficult to interpret shampoo ingredient labels, but each of the listed compounds has a specific role e.g. texture, stability, lather. However, the single most important ingredient in a dandruff shampoo is the active ingredient it contains. It is the active ingredient that has a direct biological effect on the scalp and, with a little luck, treats the underlying condition.

As you’d probably expect, there are a number of active ingredients that can help control and prevent dandruff. Each active ingredient has different properties and behaviors, designed to tackle different root causes of dandruff. Your response to these active ingredients can vary greatly. What works for one person may not work for another, even if the symptoms look identical.

It’s frustrating, to say the least.

To help ease the frustration, we’ve put together this guide on dandruff shampoo active ingredients. To help compile this guide we spoke to 4 dermatologists and asked them to share their expert advice on dandruff control and the role these active ingredients play. In addition, we’ve reviewed over 120 dandruff shampoos.

The end result is this, the ultimate guide to active ingredients in dandruff shampoos.

We hope you enjoy it.

What’s in this article:

Ketoconazole

The underlying cause of dandruff in ‘seborrheic dermatitis’ isn’t well-understood, but the presence of Malassezia yeasts are thought to be critical [1].

Evidence for this theory is partly based on the efficacy of antifungal shampoos, which significantly improve dandruff and are particularly effective for long-term dandruff control. [4]

Board certified dermatologist Brent Thomas Goedjen M.D., founder of Live Oak Dermatology in Roswell, GA explains further, “Part of the mechanism behind seborrheic dermatitis is thought to be an inflammatory immune reaction (resulting in redness, itching, flaking) to an otherwise resident yeast that becomes overly represented on the skin.

Antifungal shampoos such as ketoconazole are useful to regulate the yeast population and therefore reduce in part the trigger for the skin inflammation. Ketoconazole is helpful for this purpose and as a generic is well covered with most insurance plans.

Some people also think the antiandrogenic effects of ketoconazole might reduce sebum production also when applied topically.”.

Ketoconazole is consistently rated as the most effective antifungal ingredient added to shampoos and numerous studies demonstrate its efficacy in treating seb derm. Among them, a 2015 Cochrane Review identified 51 studies covering over 9000 participants and found those using a ketoconazole shampoo were 31% less likely to have recurrent symptoms within four weeks compared to placebo [15]. The analysis also found that ketoconazole was more effective than ciclopirox olamine, and as effective as steroids – with significantly less adverse effects.

A very recent study published in 2018 [16] showed a 2% ketoconazole shampoo to dramatically improve symptoms of seb derm over 30 days of use – when used once every 3 or 4 days.

Perhaps unsurprisingly, given it’s proven effectiveness, ketoconazole is a recommended first-line in seborrhoeic dermatitis by the ‘American Association of Family Physicians’ (AAFP) and UK’s National Institute for Health and Care Excellence (NICE) [2, 3].

Climbazole

Climbazole is another antifungal agent providing an alternative to ketoconazole while being in the same pharmacological ‘class’. A recent Cochrane meta-analysis concluded that there was little difference in performance between the imidazoles [5], but it may be better tolerated if ketoconazole is too irritating [6]

Ciclopirox Olamine

Ciclopirox Olamine is a ‘novel’ antifungal ingredient, first discovered in the 1980s [7].

Most antifungals work by inhibiting steroid metabolism in fungal cells, but ciclopirox olamine has a complex and poorly understood mechanism. Large-scale studies have shown ciclopirox olamine is as effective as ketoconazole with similar side-effects (redness, irritation, itching) [8].

In both the UK and the US, Ciclopirox Olamine is widely available from pharmacies as ‘Oilatum’ and ‘Loprox’ respectively, although as ‘off-patent’ other brands are available.

Dr. Ben Barankin, a Toronto based board-certified dermatologist at the Toronto Dermatology Centre, utilizes the ingredient with his patients, “For more severe or stubborn dandruff, a prescription steroid shampoo or leave in lotion, and/or prescription ciclopirox olamine shampoo are nice additions.”

Selenium Sulfide

Much like ciclopirox olamine, selenium sulfide is a novel antifungal with a poorly understood mechanism.

In the USA and UK, selenium sulfide shampoos are a first-line alternative to ketoconazole, used particularly if the side effects of ketoconazole are problematic. [9].

This recommendation is based on a pivotal systematic review published in 2010, which evaluated the efficacy of ketoconazole and selenium sulfide for seborrheic dermatitis. The study reviewed six high-quality trials, ranging from 20-350 participants, and found that both ingredients were associated with an improvement in scaling, itching, redness, and dandruff [17].

This is a follow up from an earlier study which found, “Both ketoconazole 2% shampoo and selenium sulfide 2.5% shampoo are effective in the treatment of moderate to severe dandruff; however, ketoconazole 2% shampoo appears to be better tolerated.” [18]

Salicylic Acid

While antifungals target the underlying cause of dandruff, ingredients like salicylic acid act as anti-inflammatory agents. Anti-inflammatory shampoos can be effective in treating both seborrheic dermatitis and scalp psoriasis. [31]

Perhaps just as important, salicylic acid has ‘keratolytic’ properties, which removes excess flakey skin and can improve mild itching [10]. These keratolytic properties of salicylic acid are one of the reasons you’ll often see it combined with other active ingredients – it increases the penetration of these other ingredients. This can be necessary for dermatological conditions, where plaques and thickened skin prevent steroids from being absorbed into tissue – reducing efficacy [19].

Indeed, NICE recommends a tar-based shampoo as first-line treatment for scalp psoriasis but also recommend a keratolytic, such as salicylic acid, if there is significant scaling, to allow other treatments to work [3]. In the US, it is one of only two ingredients approved by the USFDA for over the counter treatment of dandruff and psoriasis [32].

As it’s such an effective combination ingredient, salicylic acid is added to many dandruff shampoos. In fact, 24% of the shampoos we’ve reviewed contain the ingredient as either a single active ingredient or in combination with another. Making it the single most widely used active ingredient we’ve encountered!

Coal Tar

Coal tar is a polarizing ingredient due primarily to its smell and texture.

Coal tar shampoos contain up to 5% coal tar added in raw or solution form. It’s is a much loved, much-used treatment that has been used medicinally for thousands of years. Despite its usage, there’s still an air of mystery with this ingredient. For example, it contains over 10,000 chemicals [20], of which only 50% have been identified [21].

Coal Tar is keratolytic [3] that works by slowing the growth of skin cells to help your skin shed dead cells from its top layer – the keratoplastic. It’s effective removing thick scales that build up in both scalp psoriasis and seb derm.

It has proven anti-fungal [22] properties, antiseptic [33] properties, anti-inflammatory [23] properties. It also appears to normalize keratin growth on the skin and reduce the formation of scales.

The ingredient is derived from coal production and so historically linked to cancer, although this has been firmly rebuked by the FDA with no evidence of increased risk [12].

That said, it’s such an important healthcare treatment that:

Board certified dermatologist, Debra Jaliman MD, based in NYC is a fan. “Coal tar can give you relief from itching and dry scalp. Coal tar extract helps with the winter dry scalp and it continues to work even hours after you have rinsed it off. It also helps who trouble with psoriasis and seborrheic dermatitis of the scalp. The coal tar causes the skin to shed dead cells from its top layer and slow down the growth of skin cells. This lessens the dryness of the scalp and helps with dandruff.”

Zinc Pyrithione

Zinc Pyrithione is one of the most widely used anti-dandruff active ingredients on the market today. In fact, 20% of the shampoos we’ve reviewed contain the ingredient.

As well as being well being an effective keratolytic agent [13], Zinc Pyrithione is effective against Malassezia yeasts – important in the treatment of seborrheic dermatitis [24].

Despite not being a prescription medication in the UK, the National Institute for Health and Care Excellence (NICE) recommend zinc pyrithione as a second-line treatment in seborrheic dermatitis if ketoconazole or selenium sulfide are not effective or tolerated [25]. This recommendation is backed by the British Association of Dermatologists, and based on several key clinical trials [26].

That said, it should be avoided in cases of scalp psoriasis due to a risk of contact dermatitis [14].

Piroctone Olamine

Piroctone Olamine is a relative newcomer to the world of dandruff control but accounts for 12% of the shampoos we’ve reviewed. It’s added because it’s well tolerated and is an effective antifungal agent [29].

A study in 2000 [30] compared shampoos containing a combination of piroctone olamine and salicylic acid with coal tar shampoo. The piroctone olamine combination shampoo achieved the largest reduction in Malassezia over an eight-week period.

What is the best active ingredient?

Anecdotally, the most popular active ingredients on this site are ketoconazole, selenium sulfide and weirdly climbazole. Although coal tar users will go the ends of the earth to find it (as we saw when it disappeared from the shelves for a while).

However, from the 124 shampoos we’ve reviewed, Salicylic Acid has appeared in the most dandruff shampoos we’ve reviewed. Closely followed by Zinc Pyrithione.

You can see the full breakdown in the table below.

Ciclopirox Olamine 2%
Climbazole 5%
Coal Tar 7%
Ketoconazole 4%
Piroctone Olamine 12%
Salicylic Acid 24%
Selenium Sulfide 4%
Sulfur 2%
Zinc Pyrithione 20%
Capryloyl Salicylic Acid 1%
Benzalkonium Chloride 1%
Fumaric Acid 2%
Sodium Shale Oil Sulfonate 2%
Tea Tree Oil 12%

What active ingredient should I try first?

This is the million dollar question.

Dr. Matthew Zirwas, board-certified dermatologist and founder of Bexley Dermatology in Bexley, Ohio, said, “Our experience has been that all of the OTC dandruff shampoos work about the same, on average, in terms of effectiveness. Obviously one or another works best for most individuals, but on average, they are all about the same. To improve your chances of finding a successful ingredient we’ve found that compounded shampoos that contain multiple active ingredients work much better than regular shampoos.“

This advice was mirrored by Dr. Ben Barankin who told us, “For mild-moderate dandruff, I recommend daily shampooing, and ideally alternating 3 shampoos, each with active anti-dandruff ingredients.”

His preferred over the counter dandruff ingredients include, “zinc pyrithione, selenium sulfide, ketoconazole, tar and salicylic acid.”

And if it doesn’t work, board-certified dermatologist Adam J. Friedman, MD, FAAD, assistant professor of dermatology and director of dermatologic research, Albert Einstein College of Medicine explains via the AAD, “For most people, dandruff does not require medical attention. However, sometimes the flaking and itching that appears like dandruff is actually a medical condition, such as seborrheic dermatitis, psoriasis, fungal infections of the scalp, or eczema. If you continue to have symptoms after using a dandruff shampoo, consult a board-certified dermatologist.”

By visiting a board-certified dermatologist, you can be properly diagnosed and be prescribed stronger medication than you can pick up at the pharmacy. As Dr. Ben Barankin says, “for moderate to severe cases of dandruff, a steroid shampoo or leave-in lotion can be prescribed. A prescription ciclopirox olamine lotion is often a nice option.”

References

[1] Dessinioti, C., & Katsambas, A. (2013). Seborrheic dermatitis: Etiology, risk factors, and treatments: Facts and controversies. Clinics in Dermatology, 31(4), 343-351.

[2] American Association of Family Physicians (AAFP). (2015). Diagnosis and Treatment of Seborrheic Dermatitis. |Available from: www.aafp.org

[3] National Institute for Health and Care Excellence (NICE). (2018). |Available from: cks.nice.org.uk

[4] Gupta, A. K., Nicol, K., & Batra, R. (2004). Role of antifungal agents in the treatment of seborrheic dermatitis. American journal of clinical dermatology, 5(6), 417-422.

[5] Okokon, E. O., Verbeek, J. H., Ruotsalainen, J. H., Ojo, O. A., & Bakhoya, V. N. (2015). Topical antifungals for seborrhoeic dermatitis. Cochrane Database of Systematic Reviews.

[6] Borda, L. J., & Wikramanayake, T. C. (2015). Seborrheic dermatitis and dandruff: a comprehensive review. Journal of Clinical and Investigative Dermatology, 3(2).

[7] Subissi, A., Monti, D., Togni, G., & Mailland, F. (2010). Ciclopirox. Drugs, 70(16), 2133-2152.

[8] Ratnavel, R. C., Squire, R. A., & Boorman, G. C. (2007). Clinical efficacies of shampoos containing ciclopirox olamine (1.5%) and ketoconazole (2.0%) in the treatment of seborrhoeic dermatitis. Journal of Dermatological Treatment, 18(2), 88-96.

[9] Turner, G. A., Hoptroff, M., & Harding, C. R. (2012). Stratum corneum dysfunction in dandruff. International Journal of Cosmetic Science, 34(4), 298-306.

[10] Draelos, Z. D. (2005). An evaluation of topical 3% salicylic acid and 1% hydrocortisone in the maintenance of scalp pruritus. Journal of Cosmetic Dermatology, 4(3), 193-197.

[11] Lodén, M. (2000). Keratolytics. In Dermatopharmacology of Topical Preparations, pp.255-280.

[12] Paghdal, K. V., & Schwartz, R. A. (2009). Topical tar: back to the future. Journal of the American Academy of Dermatology, 61(2), 294-302.

[13] Schwartz, J. R., Johnson, E. S., & Dawson Jr, T. L. (2015). Shampoos for Normal Scalp Hygiene and Dandruff. Cosmetic Dermatology: Products and Procedures, 2, 124-131.

[14] Jo, J. H., Jang, H. S., Ko, H. C., Kim, M. B., Oh, C. K., Kwon, Y. W., & Kwon, K. S. (2005). Pustular psoriasis and the Köbner phenomenon caused by allergic contact dermatitis from zinc pyrithione‐containing shampoo. Contact Dermatitis, 52(3), 142-144.

[15] Cochrane Library. (2015). Antifungal treatments applied to the skin to treat seborrhoeic dermatitis. [Accessed: 28/2/17] www.cochrane.org

[16] Chaijan MR1, Handjani F2, Zarshenas M3, Rahimabadi MS4, Tavakkoli A1. (2018) The myrtus communis L. solution versus ketoconazole shampoo in treatment of dandruff: A double blinded randomized clinical trial.

[17] Naldi, L., & Rebora, A. (2009). Seborrheic dermatitis. New England Journal of Medicine, 360(4), 387-396.

[18] Danby, Maddin, Margesson, Rosenthal D. (1993) 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.

[19] Williams, A. C., & Barry, B. W. (2012). Penetration enhancers. Advanced Drug Delivery Reviews, 64, 128-137.

[20] N.J. Lowe J. Breeding M.S. Wortzman The pharmacological variability of crude coal tar (1982)

[21] G. Maiganga et al. Physicochemical Characterization of Coal Tar Produced by Pyrolysis of Coal (2017) Journal of Minerals and Materials Characterization and Engineering

[22] Nenoff, P., Haustein, U. F., & Fiedler, A. (1995). The antifungal activity of a coal tar gel on Malassezia furfur in vitro. Dermatology, 191(4), 311-314.

[23] Zeichner, J. A. (2010) Use of Topical Coal Tar Foam for the Treatment of Psoriasis in Difficult-to-treat Areas. J Clin Aesthet Dermatol. 2010 Sep; 3(9): 37–40.

[24] Roques, C., Brousse, S., & Panizzutti, C. (2006). In vitro antifungal efficacy of ciclopirox olamine alone and associated with zinc pyrithione compared to ketoconazole against Malassezia globosa and Malassezia restricta reference strains. Mycopathologia, 162(6), 395-400.

[25] NICE CKS. (2013). Seborrhoeic Dermatitis. [Accessed: 6/3/17] www.cks.nice.org.uk

[26] British Association of Dermatologists. (2015). Seborrhoeic Dermatitis. [Accessed: 6/3/17] www.bad.org.uk

[29] Kim, Y., Alpmann, P., Blaum-Feder, S., Kraemer, S., Endo, T., Lu, D., & Schmidt-Wolf, I. G. (2011). ‘Increased in vivo efficacy of lenalidomide by addition of piroctone olamine.’ In vivo, 25(1), 99-103.

[30] Piérard-Franchimont, Piérard, Vroome, Lin, Appa (2000). ‘Comparative anti-dandruff efficacy between a tar and a non-tar shampoo’. Dermatology. 2000;200(2):181-4.

[31] Goldenberg Gary, MD (2013) ‘Optimizing Treatment Approaches in Seborrheic Dermatitis.’ J Clin Aesthet Dermatol. 2013 Feb; 6(2): 44–49.

[32] CFR – Code of Federal Regulations Title 21 Subpart H–Drug Products for the Control of Dandruff, Seborrheic Dermatitis, and Psoriasis www.accessdata.fda.gov

[33] The Psoriatic Arthropathy Alliance (PAA) – Coal Tar www.papaa.org

[34] 20th WHO Essential Medicines List www.who.int

Author Profile

Master of Pharmacy

Ethan graduated a number of years ago after studying pharmacy in the UK, and is now a practicing pharmacist by day.

By night he writes the most stunning articles on a whole range of pharmaceutical subjects both here, and on our sister site at safehouseholdcleaning.com

The site owner. I founded, and have ran this site for too many years now.
I have extremely sensitive skin, have suffered from seb derm for all my adult life and this site is my way of doing something about it.

Check out my sister site at safehouseholdcleaning.com

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