Over the past few years, the “no-poo” method of hair care has amassed lots of believers. The idea is to discontinue (or greatly cut back on) the use of commercial shampoos, and instead use a variety of gentler alternatives, like conditioners, apple cider vinegar rinses, or even plain water to cleanse the hair. The internet is full of devotees to the method, who gather to trade tips at destinations like Reddit’s NoPoo forum, and they claim benefits such as softer, fuller hair, less breakage, and decreased oiliness over time.
But one Reddit user posed an interesting question when she asked whether the no-poo method works when you have seborrheic dermatitis, a skin condition that can affect the scalp and cause redness, itching, flaking, and pain, and which is usually managed with a medicated shampoo. Can no-poo alternatives manage the condition effectively, or will skipping shampoo just make things worse? We spoke to three experts to find out.
First, some background: Joshua Zeichner, a dermatologist and director of cosmetic and clinical research at Mount Sinai Hospital in New York City, tells Allure that seborrheic dermatitis is “caused by inflammation in the skin.” The source of inflammation is thought to be a yeast which normally lives on the skin, but warmer weather can cause heat to mix with skin oils, creating an ideal environment for the yeast to overgrow. “High levels of yeast on the skin trigger a response from our immune system that leads to flaking,” Zeichner says.
Doesn’t sound like much fun, right? Luckily, there are a variety of treatment options. Zeichner recommends a two-pronged approach, combining an antifungal scalp treatment to lower yeast levels, which he likens to “cutting the fuel source,” plus an anti-inflammatory treatment to address symptoms, which is like “using a fire extinguisher.”
Over-the-counter antifungal medications include selenium sulfide, the active ingredient in shampoos like Selsun Blue, and zinc pyrithione, found in shampoos like Head & Shoulders. Selenium sulfide and zinc pyrithione treat the source of the problem by reducing the amount of fungus on the scalp.
Another category of products that can help are keratolytics, such as coal tar and salicylic acid. Cosmetic chemist James Hammer tells Allure that these primarily “work by causing shedding of the outer layer of skin,” thus treating symptomatic flaking.
Just like in products designed for your face, shampoos containing salicylic acid (such as Neutrogena T/Sal Therapeutic Shampoo) work as “a peeling agent that helps increase cell turnover,” according to cosmetic chemist Ni’Kita Wilson. “This can help reduce flaking and break up the scaly patches,” Wilson says.
“Salicylic acid can also relieve some of the itching and will not have that ‘freshly treated boardwalk’ odor that you get with coal tar products,” Hammer says.
So, those are the typical treatment options. But for those with seborrheic dermatitis, does no-poo make the problem better or worse? It depends on the underlying cause. As Hammer points out, “In cases where the dermatitis is caused by dryness, use of a no-poo will be less likely to dry out the scalp further, so it might improve things. The increased mildness may help with some of the itching as well.” However, he says, if “dermatitis is a result of buildup of excess sebum on the scalp, a traditional medicated shampoo will likely be more effective.”
It also depends on how you choose to no-poo. As Wilson tells us, using conditioners to cleanse the hair “could exacerbate the problem because while they do clean, they also deposit higher levels of oils and conditioning agents that may increase the buildup of the scaly patches as opposed to breaking them apart.”
Wilson recommends “sticking with medicated shampoos to address the problem. Or use a medicated shampoo on the scalp and no-poo on the strands only. This process is very time consuming, but it’s an option.”
Zeichner says that striking the right balance is essential: “While high levels of skin oil create an environment that allows yeast to grow, stripping the scalp of oil will not cure dandruff. In fact, it may cause more irritation than anything else.”
Zeichner doesn’t recommend cutting out shampoo completely if you have seborrheic dermatitis because, he tells us, “many of the best treatments we have come in the form of shampoos — it’s just a question of the right product, and they need to be used properly.”
If you are concerned about harsh ingredients or stripping your hair, the key is to change the way you think about your shampoo. Zeichner recommends using medicated shampoos “as short contact therapies, left to sit on the skin for enough time to do their job.” His number one tip? “Apply the shampoo, sing the alphabet, then rinse off.”
The bottom line? While our experts didn’t recommend going full no-poo when you’re managing a condition like seborrheic dermatitis, you do have options: Try a half-and-half treatment of medicated shampoo on the scalp, and no-poo on the ends of hair. And, to manage seborrheic dermatitis without overly stripping your scalp’s oils, remember Zeichner’s advice next time you lather up — it’s as simple as A, B, C.