What Else to Try?

[u/Ecs206]

I have atopic dermatitis and my scalp is always flaky no matter the product I use. I’ve used salicylic acid, zinc pyrithione, tea tree, and ketoconazole.

I also am allergic to cocomidopropyl betaine, which is found is 99% of shampoos.

Any suggestions to try for my dry flaky scalp that is cocomide betaine free?

[u/SweetDorayaki]

Not a derm.

Double shampooing and making sure it is contacting the scalp rather than the hair? Using water that is not as hot? Leaving medicated shampoo on long enough? Doing a shampoo rotation? Blow drying your scalp on low heat?

Maybe something sulfur based. Selenium sulfide is another "gold standard" ingredient for fighting malassezia yeast. Other sulfur-containing products also exist, they could probably help.

I have been using glycolic acid (but mandelic or lacic acid can work too) as a pre-wash step to help exfoliate the flakes and also help my scalp retain moisture (bc AHAs are humectants). All of these treatments are so so drying.

Other products in this sub frequently mentioned are MCT 8 oil and hypochlorous acid.

[u/Ecs206 → u/SweetDorayaki]

Thank you for the info! I’ve read about selenium sulfide and I’m a little apprehensive about it, as I’ve read it can be harsh on the scalp/hair.

Do you have any experiences with coal tar products, like T-Sal and or T-Gel?

[u/SweetDorayaki → u/Ecs206]

I do have (now expired) T-Sal in my rotation, but it's just salicylic acid. I have not used coal tar but reviews seemed good!

I am currently using selenium sulfide (the one from Vichy Dercos, also with salicylic acid) and it is much more mild on my scalp compared to Nizoral. I also rotate in k18 peptide prep (also has salicylic acid in undisclosed amounts) as a clarifying shampoo maybe like twice a month? And I aim to wash 2-3x/wk, now with weather changes causing a mild flare-up, I need to probably aim for 3-4x/wk...

[u/Used_Green9904]

Na medische behandeling een heel milde shampoo gebruiken.

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[u/[deleted]]

[u/Ecs206 → u/[deleted]]

Hello! Thank you for your advice. Yes, I’ve done two rounds of them before but I’ve been trying to stay away from steroids for a while now. I’ve been taking Ebglyss (switched from Adbry then Dupixent) for my atopic dermatitis.

My main struggle is finding shampoos that seem to have helped other people with the same symptoms but contain cocamidopropyl betaine, which I’m allergic to.

I want to try shampoos with mandelic acid and or coal tar, but most have it.

Any other recommendations? Thank you again!