A majority of people who have hair loss also seem to suffer from dandruff and scalp itching problems. Some get these outbreaks intermittently, while others have a daily battle on their hands. One survey found that 100-300 hairs were shed daily in dandruff sufferers, versus 50-100 hairs per day in normal subjects.
Previously, I wrote a detailed post on the best dandruff shampoos in the world. I myself have to use such shampoos twice a week in order to control my scalp itching, inflammation and flaking. Scalps with dandruff tend to have large amounts of Malassezia yeasts and flora, which can be reduced by antifungal medicated shampoos.
Natural and Alternative Dandruff Treatments
However, there also exist alternative non-chemical natural treatments for dandruff that many claim to be very effective. Most such remedies are not scientifically proven to provide long-term relief for itchy scalps. Make sure to talk to a dermatologist for best advice.
Almost all of the below are natural products. All of them are readily available at grocery stores or pharmacies without the need for a prescription.
Per my online research, the most frequently mentioned alternative dandruff reducing products are:
Apple Cider Vinegar (ACV) or just plain old vinegar. ACV is considered by many to be a miracle treatment for numerous medical and dermatological problems. Some people dilute a teaspoon of apple cider vinegar in water and drink the concoction every single day. To combat dandruff, apply a small quantity of ACV to your scalp while showering. It can be used in combination with a shampoo or conditioner.
Tea Tree Oil. This product is recommended for numerous applications because of its antifungal properties. Tea tree oil contains terpinen-4-ol, which possesses significant anti-microbial properties. It also used to kill demodex mites. Other oils such as emu, eucalyptus, olive and peppermint are also said to help reduce scalp dead skin turnover.
Baking Soda. Besides fighting fungus, baking soda powder also absorbs excess oil on the scalp. It can cause a mild burning sensation.
Listerine or other mouthwashes with antiseptic properties. The alcohol in listerine can kill off Malessezia Globosa. However, frequent use of such a product can inflame and irritate your scalp skin. Other side effects include an overly itchy and dry scalp.
Aspirin. Crush the pills and leave on the scalp for 15 minutes or more, and then wash and rinse. Dirty work, but effective according to a number of online testimonials. Note that aspirin contains acetylsalicylic acid, similar to salicylic acid. The latter is found in many anti-dandruff shampoos.
Aloe Vera Gel. Yet another widely cited natural remedy for numerous dermatological afflictions. The healing aloe plant contains antioxidants and soothes the scalp.
Lemon Juice. Said to work by temporarily altering scalp Ph levels, which can destroy the Malassezia microbe.
What other natural products have readers tried to tackle their dandruff (seborrheic dermatitis)?
Note that in some cases, you might be suffering from psoriasis or eczema rather than dandruff. Sometimes, psoriasis and sebborheic dermatitis are indistinguishable from each other and referred to as “sebopsoriasis”. Recent research has concluded that sebaceous glands are atrophied in both these skin conditions
Diets that are heavy in oil and fat can sometimes cause issues such as excess sebum and an itchy scalp.
Allergies to certain foods can also exacerbate scalp inflammation and itching. And finally, stress can worsen mild cases of flakes and dandruff.
Nizoral is an extremely popular dermatologist recommended Ketoconazole 1% based dandruff shampoo. It also has modest hair growth properties.
As of 2022, Nizoral has over 68,000 ratings on Amazon, averaging 4.6 out of 5 stars. It costs just $14, which is a very affordable price. For comparison’s sake, the popular Nioxin line of shampoos have 17,000 reviews.
Nizoral shampoo (1%) is one of the highest rated and reviewed anti-dandruff shampoos that you can buy without a prescription. I rank it as one of the 10 best hair loss shampoos in the world. You can buy it at most stores, including Walmart and Target.
Nizoral A-D Anti-Dandruff Shampoo with Ketoconazole 1%, is consistently rated as one of the best products to counter dandruff, scalp itching, flaking and fungus. We all shed millions of dead skin cells every single day. However, some people have excessive skin turnover on the scalp, leading to dandruff.
Nizoral (often misspelled as Nizarol) can improve psoriasis symptoms, scaly scalp skin, yeast infections and even foot fungus. Some reports suggest it can also benefit acne, although facial use is not recommended.
A small bottle of this highly rated antifungal anti-inflammatory product will last for many months. Note that Nizoral 2% shampoo comes in a red bottle and is a different product. The 1% Nizoral is an over-the-counter product, while the medicated 2% requires a prescription in the US.
Also worth noting, Nizoral shampoo can help reduce hair loss to a moderate extent due to its anti-androgenic properties. See the studies listed at the end of this post that support this point. Other popular hair loss shampoos include Revivogen and Shiseido Adenovital.
Ketoconazole: the Active Ingredient
To date, only two drugs with very different mechanisms of action have been approved by the US FDA to treat hair loss: Finasteride (Propecia) and Minoxidil (Rogaine). Spironolactone, while not officially approved as a hair loss treatment, is also an important drug for countering androgenic alopecia.
However, there is one other drug that has significant beneficial properties in helping hair loss sufferers. Yet it never gets sufficient credit. This drug is Ketoconazole, the active ingredient in Nizoral shampoo. It is an imidazole anti-fungal agent.
Unfortunately, Ketaconazole will likely never be officially approved to treat hair loss, because its manufacturer is unlikely to ever file for approval. With sales of Nizoral already going strong globally, it is probably not worth going through all the rigorous expensive clinical trials to get little added benefit in terms or increased revenue.
Ketoconazole is a synthetic drug that is used to treat fungal infections. In particular, the drug flushes out Malassezia (formerly known as Pityrosporum) yeast fungus. Malassezia has been implicated in problems such as dandruff and seborrheic dermatitis. The latter leads to clogged hair follicles.
Other names for similar fungal infections and overgrowth of the scalp include Pityriasis Versicolor, Pityrosporum Ovale and Malassezia Furfur. Skin conditions such as tinea and ringworm may also benefit from this product.
Ketoconazole was originally available in tablet form, but has since also been developed into topical forms such as creams, lotions and shampoos. Note that oral ingestion of Ketoconazole can lead to serious side effects such as liver damage in some patients. However, topical cream and Ketoconazole shampoo usage have generally not been linked to such side effects.
My Nizoral Experiences for Scalp Itching
A large proportion of hair loss sufferers seem to also get itchy and dry scalp conditions, including dandruff and seborrheic dermatitis. I am one of those, although the severity and frequency of my symptoms is moderate.
Some years ago, I started using Nizoral 1% anti dandruff shampoo for my itchy inflamed scalp instead of other regular shampoos. I was absolutely amazed at its effectiveness in completely eliminating my scalp itching and dandruff for at least a day or two after each application. My hair looked better and healthier, and it seemed like my daily hair shedding rate also declined.
There is some evidence that Ketoconazole blocks the synthesis of dihydrotestosterone in the scalp and acts as an antagonist of the androgen receptor (see list of studies at the bottom of this post).
Nizoral now also sells a popular deep moisturizing hair conditioner product. It is supposed to counter the drying effects of Nizoral shampoo.
The conditioner is free of sulfates, parabens, artificial fragrances and dyes. Among the key ingredients in the conditioner (which contains seven moisturizers) include:
Jojoba Seed Oil.
Tea Tree Leaf Oil.
How often Should you use Nizoral Shampoo?
I would recommend using Nizoral shampoo no more than twice a week in order to prevent excessive skin dryness. You also do not want your scalp microflora and fungi to become immune to the effects of Ketoconazole. Overuse will make your scalp skin excessively dry and make your hair brittle. I would recommending rotating between several different products among the best dandruff shampoos available.
When you do shampoo with Nizoral, make sure to keep it on your scalp for at least 3-4 minutes after lathering and before rinsing. Some people recommend rinsing hair in cold water rather than hot water in the shower. The former prevents excessive moisture loss and skin drying out.
In 2012 or so, it seemed like US drug stores and pharmacies such as Walmart, Walgreens and CVS stopped carrying Nizoral shampoo, at least when it comes to the most popular blue bottle variety (see photo further below). I thought this was because of the warnings related to side effects from taking oral Ketoconazole. I later found out that the problems with availability were due to the shampoo’s manufacturer having production issues at its main plants, rather than any issues related to side effects.
Luckily, I had sufficient supplies to last me for a while, since you only need a small amount of Nizoral shampoo to make a big difference. Most people do not need to use it more than twice a week. However, this shortage continued in 2013 and I then had to pay a significant premium to buy it from a seller on ebay. A lot of people took advantage of this situation by selling their surplus Nizoral stock online in 2012 and 2013.
In 2014, Nizoral came back on the market and the shortages finally ended. No supply issues have occurred since that time. You can read numerous favorable reviews of Nizoral online.
Nizoral Side Effects
As long as you are not taking Nizoral (i.e., Ketoconazole) orally, side effects are usually limited and transient. The main side effects that can arise from using Nizoral shampoo include:
Dry scalp skin.
An unnatural hair texture and feel.
Rashes, hives and other allergic reactions.
Red inflamed eyes in case the product accidentally gets in there.
Ketoconazole and Hair Loss Studies
You can find many studies that suggest Nizoral causes a reduction in hair loss and thinning. Ketoconazole has anti-androgenic properties that could slow the progression of androgenetic alopecia (aka male pattern baldness). Below are some such studies in order of oldest to most recent: