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When patients come with complaints of hair loss in my clinic, I always end up asking them: “what have you done till now to treat your hair loss?”. The answer in most of the cases is: “hair loss shampoo from supermarket or pharmacy.”
Shampoos are easily the most sold products over the counter against hair loss. However, there is a huge mismatch between the amount of scientific literature available and the number of shampoos marketed for hair loss.
But do these shampoos really help against hair loss, or is this just a marketing play? Read on to find out more:
Why choosing the right shampoo is important?
The condition of the scalp directly affects hair growth. Hair growing from an unhealthy scalp is rigid, rough, and particularly prone to breakage. While shampoo’s primary function is to clean the scalp, it also plays an important role in maintaining scalp health.
Just like any other organ of the body, the scalp also undergoes aging. Oxidative stress is the release of free oxygen radicals, which can cause DNA damage and hence aging. Studies have demonstrated an association between hair loss and oxidative stress .
A shampoo too harsh can dry out the skin on the scalp, cause itching, and shampoo too weak would not clean the scalp enough to remove all the dirt, leading to eczema and overgrowth of oil loving Malassezia.
Choosing a mild shampoo does not mean throwing away everything that contains sulfate as an ingredient. Many modern shampoos with sulfates are formulated in a way that the harshness of sulfates is canceled by other mild ingredients. Many shampoos with sulfate could actually be milder than shampoos without sulfates.
While choosing a shampoo, the most important factor that I suggest keeping in mind is pH. Choosing a shampoo with a pH of less than 5.5 helps maintain the scalp’s natural health.
Anti-dandruff shampoo and hair loss
The condition of dandruff or, the extreme form of it, seborrheic dermatitis is caused due to a group of fungi called Malassezia. But since these are also physiological residents of our scalp, it is also not an infection. It is just over colonization of these fungi, which causes inflammation and dead skin to shed.
This active inflammation results in itching and scratching, dislodge the hair from hair follicles, causing hair loss. Several studies found poor scalp health like dandruff could turn into one of premature hair loss causes .
Another way Malassezia can cause hair loss is by speeding up the scalp’s aging process by causing oxidative stress. As mentioned above, oxidative stress could directly increase hair loss.
Thus anti-dandruff shampoos or the shampoos that decrease the colonization of Malassezia on the scalp could help in reducing hair loss.
1-2% ketoconazole shampoo:
A study comparing 2% ketoconazole shampoo to unmedicated shampoo, with or without 2% minoxidil for androgenetic alopecia in males, showed that hair density and the increase in the proportion of hair in the growth phase were pretty similar in both ketoconazole and minoxidil groups .
The surprising element here was the improvement shown by ketoconazole, even in the absence of dandruff.
Apart from the anti-Malassezia action, ketoconazole also inhibits the DHT, which is directly responsible for androgenetic alopecia (male and female pattern hair loss).
1% zinc pyrithione shampoo:
Zinc pyrithione (ZPTO shampoo – Head & Shoulders®) shampoo in a 6-month, 200 patients study showed that the shampoo’s hair growth potential only slightly less than half of minoxidil 5% after nine weeks of treatment, and the results were sustained during the entire study period.
1% Piroctone olamine:
In a study with 150 men with hair loss due to dandruff, 1% Piroctone olamine, hair loss was decreased by around 16% after six months . Compared to ketoconazole and zinc pyrithione, the piroctone olamine group saw the most significant increase in the number of hair in the growth phase (anagen).
In contrast to zinc pyrithione, piroctone olamine also showed an increase in hair thickness at the end of the treatment period.
Other popular shampoo ingredients against hair loss
Caffeine counteracts the effect of androgens on hair growth, increases the growth phase duration (anagen), and increases the hair follicle’s growth factors. Female hair loss appears to be more sensitive to caffeine than male hormonal hair loss.
The use of caffeine shampoo against hair loss was first brought in the news by German shampoo called Alpecin. The pharma industry has financially aided many studies conducted on this topic, therefore it has to be taken with a grain of salt.
A study with 30 male subjects with androgenetic alopecia showed a reduction in hair loss and increased hair strength after six months of caffeine shampoo use . Around 67% percent of subjects were satisfied with the results.
A phyto-caffeine shampoo was put to study against a non-caffeine control shampoo in female patients with androgenetic alopecia showed that after 6 months the hair pull test in females using caffeine shampoo (a clinical test to demonstrate the severity of hair loss) was significantly better than the ones using a shampoo containing no caffeine .
Caffeine shampoo was also very well tolerated. The patients also noticed an increase in hair strength after using the shampoo for six months.
But does caffeine in a rinse-off, short contact formula penetrates into the hair follicle where it can exert its action? The answer is yes. A small experiment showed that caffeine shampoo deposits active ingredients in the hair follicle after two minutes of contact duration. However, if the concentration deposited is enough for it to work on hair growth is pretty unclear.
Amino acids are building blocks of keratin that form the framework of the hair. Oral amino acids have shown demonstrable effects in hair loss, but their use as shampoo ingredients remains controversial.
In Rogaine’s roundtable conference 2009, it was discussed that the replacement of amino acids via shampoo could increase hair strength, thus reducing hair breakage and promoting an increase in density of the hair. This, however, is not supported by any evidence.
Licorice is another much-hyped ingredient in hair loss shampoos. There is no evidence supporting any role of licorice in shampoo. In fact, a small study showed that using licorice shampoo brought no change in hair loss in 87% of the subjects .
Biotin is perhaps the most overhyped and over-prescribed product in hair loss treatment. Its use, even as an oral supplement, in hair loss, is questionable. In healthy individuals with no biotin deficiency, biotin supplementation is proven to provide no added benefit, except perhaps a placebo effect .
One can even argue the presence of some, albeit not strong, studies in favor of biotin supplementation, but the evidence of biotin shampoo helping in hair loss is nonexistent.
The addition of biotin in shampoo is just cashing on the hype of biotin and serves no function other than adding to the shampoo’s cost.
Other vitamins and antioxidants
As mentioned above, since aging does play a role in hair loss, antioxidants should theoretically work against hair loss.
But due to water dilution and a concise contact time, anti-aging ingredients fail to show any effect in shampoos. Most antioxidants in shampoo, such as vitamin C and E, are to prevent the oxidation of shampoo itself and have minimal to no effect on the scalp .
Vitamin B5 (panthenol) in shampoo just works to moisturize the hair shaft to reduce breakage, but a benefit in hair loss is not known.
Ginseng, as an ingredient, has shown some promise in promoting hair growth and is used in traditional Asian medicine to treat hair loss.
Shampoos in telogen effluvium
According to an expert consensus, shampoos do not play any role in the treatment of telogen effluvium .
Use of mild shampoo is recommended to avoid disturbing the skin’s condition on the scalp and worsening hair loss. In the case of dandruff present concomitantly, mild shampoos with anti-dandruff shampoos could be used.
Shampoos to reduce hair breakage
Hair breakage is not technically a type of hair loss. But excessive breakage could reduce the density of hair and may cause an illusion of hair loss. Hair breakage is mostly due to dryness, open cuticles, and weathering due to chemical/ heat treatments.
Depending on the reason for hair breakage, a shampoo containing silicon (like dimethicone or amodimethicone) or moisturizing ingredients like panthenol could reduce the hair breakage. This effect is most noticeable when paired with a good conditioner.
Shampooing habits for hair loss reduction
Apart from anti-dandruff shampoos and ‘perhaps’ caffeine, no other shampoos really play a role in reducing hair loss or promoting hair growth.
However, choosing a good shampoo remains important to maintain scalp health because scalp health is directly related to hair growth. Choose a mild well-formulated shampoo, but don’t splurge on gimmicky anti-hair loss shampoos.