Hair Loss

Does Head & Shoulders Cause Hair Loss?

Head & Shoulders is perhaps the most well-known anti-dandruff shampoo. This article will introduce Head & Shoulders and explain how it works against dandruff.

One question many Head & Shoulders users have is if it can contribute to hair loss. We will discuss the evidence for and against this. Lastly, we will offer some alternative recommendations for treating dandruff.

An Overview of Head & Shoulders Shampoo

The Head & Shoulders brand was launched in the early 1960s. It was the first commercially available dandruff treatment that was easy to apply.  Before Head & Shoulders, dandruff sufferers used coal tar or egg oil.  These were unpleasant treatments and could damage hair. Head & Shoulders was easy to use and left hair feeling and smelling pleasant. In this sense, it was a significant advance in hair care. To this day, it is one of the world’s most recognizable shampoo brands.

The Head & Shoulders range today includes various hair care products, like conditioners, oils, styling gels and many more. The shampoo also comes in various versions. For example the Clinical Strength line is for heavy dandruff and the Supreme line is for women.

All these Head & Shoulders products have a variety of different ingredients. However, most of them contain the same two basic active ingredients. We discuss them below.

There has been significant controversy over the effectiveness of Head & Shoulders products. Many men claim that Head & Shoulders products caused or exacerbated their hair loss and thinning. Before we examine these claims, it is important to understand a) exactly what dandruff is and b) how Head & Shoulders treats it.

Dandruff

What is Dandruff?

Dandruff (or Pityriasis capitis) is a common scalp condition (1). The main symptom  is the white-to-yellow, flaky skin crusts that stick to hair or fall on clothing. Around one out of every two people will experience dandruff at some point in their life (2).

We all lose dead cells off our scalp every day. This is part of normal cell life and death. These cells fall off individually and are so small that the naked eye cannot see them. In dandruff, however, the dead cells stick to each other. They then fall off in big, easily visible flakes.

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These flakes do not by themselves cause hair loss. Yet the itching and irritation they bring can make people constantly scratch their head. If left unchecked, this excessive scratching can slowly damage the follicles. Eventually this could contribute to hair loss. This is a long-term process, not something that can happen in a few weeks or even months.

Aside from possible hair loss, the dandruff flakes are also unsightly. Their presence can cause social embarrassment and  distress. It can also affect other peoples’ perceptions (3). In this sense dandruff can have a psychological impact similar – though less severe – to hair loss.

A closely related condition is seborrheic dermatitis. The main difference between dandruff and seborrheic dermatitis is that dandruff only affects the scalp. Seborrheic dermatitis can also appear in other areas, like the chest. Another difference is that seborrheic dermatitis the skin is often red with inflammation (4).

The Cause of Dandruff

Scientists do not know for sure what causes dandruff. One potential factor is a fungal species called Malassezia (5). This fungus is present in the scalp of all people. It is part of the scalp microflora: numerous bacteria and fungi that live on our skin without causing problems. In people with dandruff though, Malassezia multiplies out of control. It essentially takes over the scalp.

Scientists do not understand exactly how Malassezia causes dandruff (6). One possible reason lies in its metabolites, i.e. the chemicals it secretes as part of its biological processes. These might irritate the scalp cells and lead to the abnormal flaking.

There is more to dandruff than Malassezia, as many people with dandruff don’t have abnormal levels of Malassezia. Other likely factors are genetic predisposition and environmental triggers (7). Yet Malassezia is almost certainly involved, at least in most dandruff cases.

Ingredients of Head & Shoulders

Depending on the exact version, there are numerous ingredients in a Head & Shoulders shampoo. Yet two are the most significant active ingredients. These will also be in most of the various Head & Shoulders formulations.

They are pyrithione zinc and selenium sulfide. The manufacturer of Head & Shoulders lists these as the two main active ingredients. They have also been the subject of most scientific research and public scrutiny. We will look at these in turn.

Pyrithione Zinc

The first main active ingredient in Head & Shoulders is zinc pyrithione. This substance is common in many other personal care products. It is an antifungal, and lowers levels of Malassezia in the scalp (8). This relieves the flaking and brings the dandruff under control.

Pyrithione zinc has a wide antimicrobial action that is not limited to just fungi. There is also research to suggest zinc pyrithione may serve as an antibacterial. For this reason it is a common ingredient in skin hygiene products(9).

Selenium Sulfide

This is another antifungal chemical (10). Like pyrithione zinc, it stops fungi from growing on the skin. It is sold alone or as an ingredient in more complex formulas, like Head & Shoulders. Just like pyrithione zinc, researchers have found it effective in relieving the symptoms of dandruff (11).

Other Ingredients

  • Sodium Laureth Sulfate (SLES) and Sodium Lauryl Sulfate (SLS) are two common ingredients of shampoos, body washes, and facial cleansers. They are surfactants (cleansers). This means they trap dirt and oil on the hair. The water then easily washes this away, leaving the hair clean. Due to their chemical properties, manufacturers put SLES and SLS not only in personal health care lines, but also in household cleaning products. You can find them in industrial cleaning products and detergents as well.These chemicals are not without problems. SLS is a skin irritant (12). It can cause contact dermatitis, which includes changes in skin color (erythema) and barrier function. SLES is slightly milder but it can also irritate the skin. The reaction can last up to seven days after use (13). If you already suffer from skin sensitivity, these ingredients may worsen the problem.
  • Methylisothiazolinone is an active ingredient in a variety of household products typically advertised as having antimicrobial capabilities. This chemical can be found in many personal care products, hand soap, dish soap, and even products marketed towards children. Methylisothiazolinone has been linked to nerve damage (14). Researchers have cautioned that the long-term damage to the nervous system is unknown, especially in younger people and pregnant women. To this day it continues to be utilized as an active ingredient in hundreds of household and personal care products (15).In Korea, there have been cases of injury associated with this potentially hazardous chemical in humidifier disinfectants (16, 17). The injuries were to various organs including the lungs, kidney, eyes, and skin. Close to one hundred people died (18).

How Head & Shoulders May Effect Hair Growth

The makers of Head & Shoulders do not market it as a treatment for hair loss. They advertise it as a solution for scalp dryness and dandruff. Published research backs up its effectiveness against dandruff (19, 20)

Over the years, however, there have been numerous claims that Head & Shoulders promotes either hair growth or hair loss. We will look at the evidence for each of these claims below.

Potential for hair growth

The manufacturers of Head & Shoulders do not claim that their product can directly promote hair growth. Their claim is indirect (21):

Dandruff can also lead to thinning hair by causing the scalp to become itchy. As you scratch your scalp, you can damage the individual strands of hair, causing breakage and, in some cases hair fall. So by treating one of the root causes of dandruff, you can calm any itching and in turn, keep your hair looking full and thick.

The logic in this statement is correct, but it applies to all dandruff treatments. Anything that works against dandruff will relieve itching and scratching. It will also improve overall scalp hygiene and provide a better growth environment for the hair follicles.

When it comes to active ingredients, specifically in the H&S formulation, there is limited evidence for hair growth. A  2003 study identified the potential for zinc pyrithione to affect hair density in moderately balding men (22). These men used a 1% pyrithione zinc shampoo daily. After 6 months, they showed statistically significant regrowth. Compared to another group of men that used a daily 5% minoxidil solution, these men had about half the regrowth: 5.7 new hairs per centimeter squared, compared to 12.3 for minoxidil. 

As hair loss treatments go, this figure of 5.7 new hairs per centimeter squared is not impressive. Yet it does suggest that zinc pyrithione has at least some beneficial effect on hair growth.

Potential for hair loss

There are no published clinical studies that report hair loss following Head & Shoulders usage. As per the public record, no researcher has investigated this. This means we must look for indirect evidence of a link between this shampoo and hair loss.

The first piece of such evidence is the large number of harsh chemicals in the Head & Shoulder bottle. The manufacturer breaks these into the following categories:

  • the active ingredients against dandruff (discussed above)
  • cleansers and lather-building agents (surfactants)
  • stabilizers and preservatives
  • conditioners
  • thickening and pH balance
  • color and scent additives

This long list explains the subjective impression a user will get when pouring the product out of the bottle: a highly processed, artificial white color, and rich texture. Many of these ingredients make for a pleasant, easy to use, manufacture, and store product. They will not however be beneficial to the health of the scalp or hair follicles.

For example, many shampoos use either SLES or SLS as the main surfactant. Head & Shoulders uses both. This makes for a rich foam. On the other hand, these are harsh chemicals, and using both might not be ideal for the health of the scalp.  Some individuals may be particularly susceptible to these chemicals’ harmful effects. Over time, these chemicals could – theoretically – exacerbate any underlying hair loss.

 

 

A man with hair loss

 

Testimonials from Users

Another cause of concern is the large number of users who report hair fall after using Head & Shoulders. Hair loss forums and comments sections are filled with testimonials from users who experienced abnormal hair loss after switching to Head & Shoulders. For most, the hair loss started relatively quickly, after a few weeks or months of use. Other report using the shampoo for years before noticing hair loss.

It is very difficult to distinguish correlation from causation in these cases. Head & Shoulders is one of the most popular shampoos in the world. It is marketed to users who are already experiencing hair problems. As such, we can expect that many of these men will have gone on to develop hair loss regardless of which particular shampoo they used.

On the other hand, the quantity and quality of users’ testimonials are significant. They suggest Head & Shoulders might exacerbate hair loss problems. This might be true, at least for a minority of users who are sensitive to some of the ingredients.

Recommendations If You Have Dandruff

Head & Shoulders has been used for many years in the treatment of scalp dandruff. It is also one of the most widely known treatments and is over-the-counter. All these factors make it one of the first solutions a man with dandruff is likely to turn to.

Yet there are other options available. For example tar-based, salicylic acid or ketoconazole shampoos can also be effective in treating dandruff. You will find many of these medicated shampoos sold in pharmacies.

Aside from shampoos and other treatments, good scalp hygiene is essential to controlling the symptoms of dandruff. If possible avoid or eliminate hair styling products like gels, mousses and waxes. These will leave your scalp greasy and susceptible to Malassezia.

Research also suggests the use of all-natural tea tree oil as an additive to shampoo which can help reduce dandruff caused by fungal infections (23). Another useful step is to reduce your daily amount of stress. Stress can contribute to dandruff as well as hair loss (24).

When to See a Doctor

Dandruff is often a condition that one can treat at home. Yet there may come a point where you should seek professional help.

This can be when you have tried various over-the-counter or lifestyle changes and the problem persists. Especially if the dandruff is exacerbating to the point of interfering with your daily life or causing significant distress.

Conclusion

There is no hard evidence that Head and Shoulders shampoo causes hair loss. Yet Head & Shoulders contains a long list of ingredients, some of which are potential irritants or even toxic at high doses. Users who are susceptible to one or more of these chemicals may experience adverse reactions. Hair loss is one potential adverse reaction. The evidence for such a link is indirect and speculative at present.

Fortunately, there are other steps you can take if you are struggling with dandruff. These include alternative anti-dandruff shampoos and lifestyle changes. If all these fail, a visit to the doctor should be the next step.

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You can follow a few hair hygiene tips to make your hair less likely to fall out: Avoid hairstyles that pull on the hair - Avoid high-heat hair styling tools - Don't chemically treat or bleach your hair - Use a shampoo that's mild and suited for your hair - Use a soft brush made from natural fibers - Try low-level light therapy.

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