Ketokonazole

[xoam0re]

I was having some major itchy scalp and hair shed, so I went to my dermatologist a couple of weeks ago, and she diagnosed me with seborrhoeic dermatitis. She gave me an RX shampoo, ketokonazole, and a topical spray steroid, kenalog. The steroid is no biggie, but it makes my head extremely greasy and its annoying... luckily I only have to use it every other week or so. I'm to shampoo with the keto shampoo every other day until she see's me again in 4 months... I've been using it about half of a month... my issue is that my hair is literally the longest its EVER been (my bottom fairy tale ended layer is right to the top of my bra strap), and I'm having a hard time 'shampooing' with the keto shampoo because its so drying... my hair gets incredibly tangled and i can't get to my scalp, so I just do the outer hairline, which is where the majority of the thinning was anyway, but i fear its not being as effective as it could be because I can't get to my entire scalp. Does anyone have any tips or tricks for me that might be useful?

[lapushka]

Just übercondition, condition twice, that's what we do after a harsh sles/sls shampoo (that I have to use because I'm oily, and suffer from bouts of SD). Conditioning twice is an easy solution! (Don't let it touch your scalp, though!)

Just don't give up with the shampoo!

[Stray_mind]

Maybe put oil on your lenght before washing? The hair will become more slippery and maybe it won't tangle that much...

[melusine963]

When I had to use a similar shampoo for a while I made sure to thoroughly coat my hair in conditioner from the ears down before I applied the shampoo, and I made sure to only use the shampoo on my scalp. After I rinsed it all out I reapplied conditioner, and then used coconut oil (again, from the ears down) as a leave-in conditioner after my hair dried. My hair came through ok, and I'm sure yours will too. Good luck!

[Katrine]

Do you have a bottle with a pointed tip you could put it in to apply it? They are really reasonable at Sally's. I have psoriasis and the dilute shampoo mix that I use I apply with one of those bottles. It really helps me to just be able to get it right on my scalp without getting it all over the rest of my hair. I hold my length away from my head as I apply it and when I rinse it. Or, as previously suggested, you could do an oiling or CWC which would also help protect your length.

[xoam0re]

Wow thank y'all so much for the replies!! :) I will attempt these suggestions at my next wash.. I already have so much relief, It wasn't until I joined this board a month ago that it 'clicked' that something wasn't right with my scalp.. I'll just be glad when my hair line starts filling back in... I was so glad to hear my dermatologist say I wasn't balding, I had serious anxiety over it for awhile. But i never really noticed the hair shed until recently, so I'm not sure if that was just the final indicator, or what. Anywho, thank y'all again! :)

[Unicorn]

In order to get the shampoo to the scalp of my very thick locs, I dilute the shampoo with water, (about 50%/50%) and use a spray bottle to spray it directly on the scalp, lifting my hair in sections to help access to the scalp.

Unicorn

[prettyinpink]

I am so sorry! Dont worry your hair will be as good as new! :D I dont know if someone said this already but try putting conditioner on the length while you use the medicated shampoo

[Firefox7275]

Ideally you would note dilute a prescription topical, it's that concentration for a reason. Also avoid oils and butters rich in oleic acid, stearic acid or palmitic acid. You might try washing your head upside down to get better access to the scalp or sectioning the hair.

[Unicorn]

Ideally you would note dilute a prescription topical, it's that concentration for a reason. Also avoid oils and butters rich in oleic acid, stearic acid or palmitic acid. You might try washing your head upside down to get better access to the scalp or sectioning the hair.

The shampoo is diluted, in use, anyway as washing is done with water as standard, hence it is designed for use as a diluted solution. Putting it in the bottle simply adds the water a few of seconds earlier, so the shampoo is a little mixed (therefore less viscose) with the water for easier application rather than trying to do the mixing while its in the hair. The same amount of shampoo is used

Unicorn

[Firefox7275]

The shampoo is diluted, in use, anyway as washing is done with water as standard, hence it is designed for use as a diluted solution. Putting it in the bottle simply adds the water a few of seconds earlier, so the shampoo is a little mixed (therefore less viscose) with the water for easier application rather than trying to do the mixing while its in the hair. The same amount of shampoo is used

Unicorn

It's designed to be diluted by the amount of water in root hair or on the scalp, not to be diluted by half in a nozzle bottle and then by the water in hair or on the scalp as well. Sorry but I qualified in pharmacy (albeit years ago), the differential effects of the 2% versus the 1% concentration are well studied. I cannot comment on your case, if your dermatologist has advised that for your particular hair type and current severity of your scalp condition that is not the same as amateur advising someone with hair loss linked to more severe SD to do likewise.

[Unicorn]

I'm really not going to give a tutorial on such a basic aspect of washing hair Firefox727. In the 40 plus years that I didn't have locs, 1) I never once managed to get my shampoo to lather without using water. 2) I've always used far more water than the handful of shampoo needed. So even with a 50/50 dilution, more water is used in addition to that solution in order to effectively cleanse the hair. Maybe you're confusing shampoo with ointment?

Hands up anyone who washes their hair with shampoo and no water......... Have I been mislead my entire life?

Unicorn

[Firefox7275]

I'm really not going to give a tutorial on such a basic aspect of washing hair Firefox727. In the 40 plus years that I didn't have locs, 1) I never once managed to get my shampoo to lather without using water. 2) I've always used far more water than the handful of shampoo needed. So even with a 50/50 dilution, more water is used in addition to that solution in order to effectively cleanse the hair. Maybe you're confusing shampoo with ointment?

Hands up anyone who washes their hair with shampoo and no water......... Have I been mislead my entire life?

Unicorn

As I said "It's designed to be diluted by the amount of water in root hair or on the scalp, not to be diluted by half in a nozzle bottle and then by the water in hair or on the scalp as well."

[Unicorn]

As I said "It's designed to be diluted by the amount of water in root hair or on the scalp, not to be diluted by half in a nozzle bottle and then by the water in hair or on the scalp as well."

Do you seriously believe this makes sense? If so you're beyond my reach.

OP I trust your basic understanding of how hair is shampooed is such that you understood my initial advice. I've no idea what Firefox is envisioning.

Unicorn

[bubastis]

I also use a ketoconazole shampoo once a week and I used to have the same problems with it as the OP.What I do now is put conditioner on the length to protect it,then shampoo the scalp with my head upside down (I put the shampoo on my fingertips and with my hair flipped over it is somewhat easier to reach the scalp),rinse,and then condition again.The cwc really helps with the dryness. But hey,on the upside,ketoconazole is said to help with shedding as well because it is a dht blocker,so we might be getting some added benefits from it :)

[Panth]

Do you seriously believe this makes sense? If so you're beyond my reach.

OP I trust your basic understanding of how hair is shampooed is such that you understood my initial advice. I've no idea what Firefox is envisioning.

Unicorn

I think she means this:

1) Get in shower, wet hair and apply shampoo (or apply shampoo and then wet the scalp on top of the shampoo) = diluting the shampoo once, with the water you've applied to the scalp once in the shower.

2) Dilute shampoo in water in squeezy bottle, THEN getting in the shower, wetting the hair and appying the diluted shampoo (or applying the diluted shampoo and then wetting the scalp on top of the shampoo) = diluting the shampoo twice, once in the squeezy bottle then again when you apply further water to the hair either immediately before or after applying the diluted shampoo to the scalp.

In situation 2, the shampoo becomes (depending on the amount of water in the bottle) approximately twice as dilute as in situation 1. I.e. if the shampoo was 4% ketoconazole when in the bottle, situation 1 might result in in being about 2% ketoconazole when it reaches the scalp whilst situation 2 might result in it being more like 1% ketoconazole when it reaches the scalp. And the medical research demonstrates that there is a difference in efficacy depending on if the effective concentration reaching the scalp is 2% or 1%.

...I think that's what she was trying to say.

[Tea Lady]

I use this shampoo which was prescribed by my doctor. I messaged her to ask about the whole dilution issue. She said that it is fine to dilute with a little water, because it is hard to make it spread otherwise if used on a totally dry scalp (Note that my doctor is an MD who specializes in hair loss, so I tend to believe her that it is okay to use water with this product). And she said the most important thing is for the Ketaconozole to be on the hair for 5 minutes before rinsing. So what I do is this:

Get the shower going, start my phone timer for 5 minutes, right before getting in.
Lightly wet my scalp.
Pour about a 50 cent piece sized amount of Ketaconozole in my palm.
Rub my palms together briefly while holding them above my scalp (to catch any drips fall onto the scalp).
Massage into scalp, re-wetting my hands if I need more spreadability.
Leave on until the timer goes off, taking care of the rest of my shower while I wait.
Rinse the scalp while holding the length up and out of the way.
Condition hair as usual.


Tea Lady

[nerdybrunette]

I have the generic Ketoconazole 2% shampoo made by Janssen Pharmaceutica N.V. manufactured for Patriot pharmaceuticals, LLC. The shampoo is not super thick at all, it's rather runny compared to other shampoos I've used. I agree with Firefox7275. I wet the hair/scalp like normal. Put shampoo into my palms, rub my hands together a little bit, rub the shampoo into my hair and scalp, massage my scalp like normal, set the timer for 5 minutes, do other shower-stuff, then when the timer goes off I rinse my hair. The shampoo is not very thick, so I don't know why you would be having trouble applying it.

[Unicorn]

Glad you got it sorted Tea Lady, I'm still puzzled as to how others manage to wash their hair without water or what they think happens to the shampoo, if not dilution, should they happen to include water in their cleansing process.

Unicorn

[Firefox7275]

Glad you got it sorted Tea Lady, I'm still puzzled as to how others manage to wash their hair without water or what they think happens to the shampoo, if not dilution, should they happen to include water in their cleansing process.

Unicorn

Sigh. As I said "It's designed to be diluted by the amount of water in root hair or on the scalp, not to be diluted by half in a nozzle bottle and then by the water in hair or on the scalp as well." One dilution not two. Panth has explained the straightfoward concept of wetting hair then applying neat shampoo to you in greater detail, I fail to see why you persist in being obtuse, dry hair was mentioned by nobody but you!

[Unicorn]

@FireFox, do you think the chemical process is different when the water is added in the bottle or do you use less water than shampoo when washing? For me neither of these thing is true.

I didn't think anyone needed the explanation that if the shampoo already has water added, then less water need to be added to the hair in order to get the right consistency for spreading it through out the hair. I'm amazed such a detail is required. The post was about methods used to get the shampoo to spread with ease. It's an issue I've dealt with therefore I offered a solution that I've found to work. Strangely enough a qualified doctor appears to agree, one who specialises in hair loss no less, despite my being a mere 'layman' and apparently not worthy of notice.

ETA: I don't believe I mentioned dry hair, though the OP appears to have done so. The medicated shampoo appears to be making her hair dry, as they tend to do. I addressed only the issue of spreading the shampoo effectively.

Unicorn

[lapushka]

Sigh. As I said "It's designed to be diluted by the amount of water in root hair or on the scalp, not to be diluted by half in a nozzle bottle and then by the water in hair or on the scalp as well." One dilution not two. Panth has explained the straightfoward concept of wetting hair then applying neat shampoo to you in greater detail, I fail to see why you persist in being obtuse, dry hair was mentioned by nobody but you!

Plus these types of shampoos suds up *really* easily, even without adding water they start to foam up nicely. You just have to have experienced the difference!

[Tea Lady]

Glad you got it sorted Tea Lady, I'm still puzzled as to how others manage to wash their hair without water or what they think happens to the shampoo, if not dilution, should they happen to include water in their cleansing process.

Unicorn

Yes, it would be terribly hard to spread without water (if I don't use enough it just doesn't spread well), and it would mean that the user would have to use a lot more in order to get coverage on all areas. Also, all of the instructions online from the maker of the product recommend water. So I think people are okay using whatever dilution makes the shampoo work for them.

Tea Lady

[Firefox7275]

@FireFox, do you think the chemical process is different when the water is added in the bottle or do you use less water than shampoo when washing? For me neither of these thing is true.

I didn't think anyone needed the explanation that if the shampoo already has water added, then less water need to be added to the hair in order to get the right consistency for spreading it through out the hair. I'm amazed such a detail is required. The post was about methods used to get the shampoo to spread with ease. It's an issue I've dealt with therefore I offered a solution that I've found to work. Strangely enough a qualified doctor appears to agree, one who specialises in hair loss no less, despite my being a mere 'layman' and apparently not worthy of notice.

ETA: I don't believe I mentioned dry hair, though the OP appears to have done so. The medicated shampoo appears to be making her hair dry, as they tend to do. I addressed only the issue of spreading the shampoo effectively.

Unicorn

You suggested diluting by half and FAILED to mention somehow showering under less water which is critical to your 'advice', slight difference between that and adding "a little water" as Tea Lady's doctor suggested. I have explained why quite clearly and you are free to check the research "the differential effects of the 2% versus the 1% concentration are well studied".

Post 12
"I'm really not going to give a tutorial on such a basic aspect of washing hair Firefox727. In the 40 plus years that I didn't have locs, 1) I never once managed to get my shampoo to lather without using water. 2) I've always used far more water than the handful of shampoo needed. So even with a 50/50 dilution, more water is used in addition to that solution in order to effectively cleanse the hair. Maybe you're confusing shampoo with ointment?

Hands up anyone who washes their hair with shampoo and no water......... Have I been mislead my entire life?

Unicorn."

[Unicorn]

Yes, it would be terribly hard to spread without water (if I don't use enough it just doesn't spread well), and it would mean that the user would have to use a lot more in order to get coverage on all areas. Also, all of the instructions online from the maker of the product recommend water. So I think people are okay using whatever dilution makes the shampoo work for them.

Tea Lady

Likewise, when I've used medicated shampoos, I got through huge amounts, then found patches of hair untouched by shampoo! Adding watering really made the difference in getting complete coverage for the hair and I needed far less shampoo for effective coverage. For the drying effect of the shampoo, I increased the frequency of my overnight (pre-shampoo) olive oil soaks from around once a month to at least once a week, plus using conditioner after washing. Olive oil is more suitable for some people than others, but without it I think my hair would have crumbled to dust when I used medicated shampoos. Using these shampoos, is where I got the idea of doing it for my locs as they're of course even denser than loose hair.

For dryness, olive oil also tends to help lift any flaking skin from the scalp, so it appears to make things worse initially with most skin conditions where flaking is an issue, but that's because it just speeds up the sloughing process which also speeds up the healing process. For olive oil use, I'd certainly speak to your doctor first, as this may or may not be compatible with the particular shampoo/treatment/issue you're dealing with. Though a hair only application may be sufficient to deal with the dryness.

Unicorn

[Unicorn]

You suggested diluting by half and FAILED to mention somehow showering under less water which is critical to your 'advice', slight difference between that and adding "a little water" as Tea Lady's doctor suggested. I have explained why quite clearly and you are free to check the research "the differential effects of the 2% versus the 1% concentration are well studied".

Post 12
"I'm really not going to give a tutorial on such a basic aspect of washing hair Firefox727. In the 40 plus years that I didn't have locs, 1) I never once managed to get my shampoo to lather without using water. 2) I've always used far more water than the handful of shampoo needed. So even with a 50/50 dilution, more water is used in addition to that solution in order to effectively cleanse the hair. Maybe you're confusing shampoo with ointment?

Hands up anyone who washes their hair with shampoo and no water......... Have I been mislead my entire life?

Unicorn."

Bored Firefox? Yes (approx.) half, precisely because it is enough to thin the shampoo, but less than required to wash, therefore over dilution isn't and issue, indeed additional water is usually required. I'm sorry you find the question of, "how much water can your hair hold" so challenging, but apparently you do. I've assumed that most people don't. I also assumed that anyone who is capable of reading, typing and using the internet is also aware enough to understand that the hair can only hold a limited amount of water/liquid, without me needing to point it out to them. Clearly in your case I was mistaken. My bad. Most people have experienced that when they put water in their hair any surplus drips out. This basic physical law is what is critical to my suggestion. Those living on the moon may need this detail explained to them, but most people who have spent a lifetime living with gravity would factor this in to any suggestion.

I've no need to check the research, I know that the makers of shampoo, medicated or otherwise, are aware that people use water when washing their hair, so any formula factors that in.

Unicorn

[GoldenSilk]

I CO, but I have fine, thick hair that makes it hard to get to my scalp. I got the solution from LHC lurking (thanks GRU!) to use an applicator bottle from Sally's. It was only $2 and it works great. I do also dilute my conditioner to help reach the scalp, which is easy to do with the bottle, but go with your doctor's directions on that.

[Firefox7275]

For dryness, olive oil also tends to help lift any flaking skin from the scalp, so it appears to make things worse initially with most skin conditions where flaking is an issue, but that's because it just speeds up the sloughing process which also speeds up the healing process. For olive oil use, I'd certainly speak to your doctor first, as this may or may not be compatible with the particular shampoo/treatment/issue you're dealing with. Though a hair only application may be sufficient to deal with the dryness.

Unicorn


Unwise in seborrhoeic dermatitis: studies suggest oleic acid is THE irritant in SD, a penetration enhancer, barrier disruptor and induces abnormal keratinisation. It may indeed speed wound healing ... by increasing inflammation, hardly desirable in a chronic inflammatory condition.


"On the other hand, application of unsaturated fatty acids, oleic acid, and palmitoleic acid induced scaly skin, abnormal keratinization, and epidermal hyperplasia. Application of triglycerides and saturated fatty acids on cultured human keratinocytes did not affect the intracellular calcium concentration ([Ca2+]i), whereas unsaturated fatty acids increased the [Ca2+]i of the keratinocytes. Moreover, application of oleic acid on hairless mouse skin induced an abnormal calcium distribution in the epidermis. These results suggest that unsaturated fatty acids in sebum alter the calcium dynamics in epidermal keratinocytes and induce abnormal follicular keratinization."
http://www.nature.com/jid/journal/v124/n5/full/5602810a.html

"Oleic acid was able to stimulate also the production of cytokine-induced neutrophil chemoattractant in inflammation 2 alpha/beta (CINC-2alpha/beta). This pro-inflammatory effect of oleic and linoleic acids may speed up the wound healing process."
http://www.ncbi.nlm.nih.gov/pubmed/17918246

"Investigation of the toxic Malassezia free fatty acid metabolites (represented by oleic acid) reveals the component of individual susceptibility."
http://www.nature.com/jidsp/journal/v10/n3/full/5640230a.html

"Permeation enhancers (PE) are frequently used in the field of dermal research and for the development of transdermal delivery products. However, their influence on skin epidermal Langerhans cells (LC) has not yet been investigated. In this work we studied the effect of four PE, oleic acid (OA), propylene glycol (PG), ethanol, and diethylene glycol monoethyl ether (DGME), and an iontophoretic treatment on the morphometric parameters of epidermal Langerhans cells (LC). Retinoic acid (RA) was used as a positive control... Treatment with 10% OA in ethanolic solution caused a severe decrease in LC density (-69.0%, P<0.01), accompanied by a decrease in dendricity as measured by the changes in SF. Ethanol had no statistically significant effect on the LC morphologic parameters tested. All other PE had a mild, if any, effect on LC morphology. SEM micrographs of the skin of IOPS hairless rats demonstrated that 24 h in vivo treatment with 10% OA in ethanolic solution resulted in the generation of pores on the surface of epidermal corneocytes."
http://www.ncbi.nlm.nih.gov/pubmed/11943383

"Oleic acid (OA) is well-known to affect the function of the skin barrier. In this study, the molecular interactions between OA and model stratum corneum (SC) lipids consisting of ceramide, cholesterol, and palmitic acid (PA) were investigated with Langmuir monolayer and associated techniques ... Results indicate that lower concentrations of OA preferentially mix with and disorder the ceramide-enriched domains, followed by perturbation of the PA-enriched domains and disruption of SC lipid domain separation at higher OA levels."
http://www.ncbi.nlm.nih.gov/pubmed/23517601

[lapushka]

When your scalp is hard to reach with shampoo, and you can't dilute the solution, which I suspect is so in this case, then just go in sections and use more shampoo. It's that simple.

[Unicorn]

I've lost interest Firefox, so I didn't bother to read your thesis after the first couple of lines, you're clearly responding for the sake of it. I hope whatever boogieman I triggered in you rests soon. Perhaps when you're feeling less combative, you'll actually read my post.

Unicorn

[lapushka]

I've lost interest Firefox, so I didn't bother to read your thesis after the first couple of lines, you're clearly responding for the sake of it. I hope whatever boogieman I triggered in you rests soon. Perhaps when you're feeling less combative, you'll actually read my post.

Unicorn

I think what she's essentially saying is that it's unwise when suffering from SD to dilute too much.

[Arctic]

How about trying scalp washing method? This way your length would remain dry.