Alternatives to T/Sal Shampoo
In our latest question and answer, the pharmacist discusses over the counter alternatives to T/Sal shampoo.
I have been diagnosed with seborrhoeic dermatitis on my scalp. I have tried a lot of things to try and help my problem. Some of the symptoms I get are itchiness (quite bad), oily scalp/hair, and lately, a terrible amount of yellow flaking/scaling that is very, very hard to remove. I'm not sure if this is related, but the quality of my hair has greatly decreased since around the time I started having seborrheic dermatitis. I am looking for a product (or ingredient such as salicylic acid) that can help with actually breaking down the flakes, rather than just relieve itching (this is what I've been told about T-Gel). I believe T-Sal with salicylic acid is no longer being made, so I can't buy that anywhere. Do you have any ideas? It's driving me mad and I have lost so much hair already :( Thanks very much!
Aug 06, 2021- If you previously had good results with salicylic acid shampoos like T/Sal, you can find generic versions containing the same 3% salicylic acid at most drugstores. Other effective alternatives include coal tar shampoos, ketoconazole shampoos that target yeast overgrowth, and traditional anti-dandruff shampoos like Head & Shoulders or Selsun Blue. If one type of treatment isn't working for you, trying a different class of dandruff shampoo may be more effective since dandruff can be caused by different factors like fungal overgrowth rather than just dry skin.
T/Sal shampoo, by Neutrogena, contains salicylic acid 3% and is an effective treatment for controlling dandruff, as well as seborrheic dermatitis.
Recently, there has been news that T/Sal may be discontinued, or at the very least, will be in extremely short supply for the foreseeable future, making it difficult to find.
Fortunately, there are many effective alternatives to T/Sal if you can't find it online or at your local store.
How Does T/Sal Shampoo Work?
Salicylic acid topical products, like T/Sal, are therapeutically classified as 'keratolytics'.
Keratolytics have a variety of effects on the skin, including:
All of the above help with the symptoms you stated you are experiencing in your question (e.g., flaky and itchy skin on the scalp). Over time, with continued use, it generally helps reduce flaking, which you mentioned is your primary concern.
T/Sal Alternatives
As mentioned, T/Sal has been somewhat challenging to find on the market.
If you have used salicylic acid products in the past with good effects, it makes sense to try and find a similar product.
The good news is that although the brand name T/Sal may no longer be available, there is a multitude of generic versions that contain the exact same active ingredient (salicylic acid 3%). Most drug stores have their own "store" brand. Below, are a few links to some "generic" salicylic acid shampoo products:
The above products should provide similar results to the brand name Neutrogena T/Sal as they all contain 3% salicylic acid.
Now, shampoos that contain salicylic acid aren't your only option. Several other therapeutic shampoos you may find helpful include:
- Coal Tar shampoo
- Ketoconazole Shampoo
- Traditional anti-dandruff shampoos (e.g. Head & Shoulders, Selsun Blue)
Coal Tar Shampoo
Coal tar shampoos, which include Neutrogena T/Gel and Zetar, work in a similar way as salicylic acid shampoos in that they are keratolytic.
In addition to softening scaly skin, coal tar shampoos also inhibit the excessive production of epidermal cells, reducing their size and overall numbers.
While perhaps not as hydrating as salicylic acid products, coal tar generally works exceptionally well in preventing excess flaking of the skin (it does more than just reduce itching, something you stated you were concerned about).
For some, coal tar is a more effective option for controlling dandruff. Unfortunately, it is associated with an unpleasant odor and can stain clothing and less commonly, skin. Nevertheless, if you are unable to find or are not getting good effects from salicylic acid products, coal tar shampoos may be a good alternative.
Ketoconazole Shampoo
Ketoconazole is a topical anti-fungal. While many people associate dandruff and flaking skin simply to dry skin, yeast, and fungus are actually very commonly the culprits. Specifically, overgrowth of a common yeast, Pityrosporum ovale, causes itching of the scalp and flaking.
Ketoconazole shampoos are available in a variety of generic products as well as the brand-name product Nizoral.
Antifungal shampoos such as Nizoral control the overgrowth Pityrosporum ovale, leading to less dandruff and relief of itch. These shampoos have the advantage of not needing to be applied often. Ketoconazole binds to hair in-between uses and generally only needs to be used 2 to 3 times a week.
Traditional Anti-Dandruff Shampoos
Traditional anti-dandruff shampoos include:
- Head & Shoulders (Pyrithione zinc)
- Selsun Blue (Selenium sulfide)
These are classified as cytostatic agents and work in a similar way to the other products mentioned in this article, working by regulating cell growth and preventing excess flaking of the skin. While they can be mildly irritating to the skin, they are generally considered gentle options and can be used daily.
Final Words
If the salicylic acid shampoo has worked well for you before, be sure to look at local pharmacies for a generic product. If those aren't available, one of the other options I discussed may be effective for your situation.
References & sources
Glossary — Terms in This Answer
- Salicylic acid
- A chemical compound that helps remove dead skin cells and reduce excess oil on the skin.
- Seborrheic dermatitis
- A skin condition characterized by inflammation, redness, and flaking, often occurring on the scalp.
- Keratolytics
- Medications or products that work by softening and removing excess layers of dead skin.
- Stratum corneum
- The outermost layer of skin that acts as a protective barrier.
- Keratin
- A tough protein found in skin, hair, and nails that can build up and cause flaking.
- Antifungal
- A substance that kills or stops the growth of fungi and yeast on the skin.
- Pityrosporum ovale
- A common yeast that can overgrow on the scalp and cause dandruff and itching.
- Cytostatic agents
- Substances that slow down or prevent the excessive growth and division of cells.
Dr. Brian Staiger, PharmD
Doctor of Pharmacy, board certified clinical pharmacist (BCPS), American Herbalist Guild, Medication Therapy Management certified
Brian Staiger, PharmD, BCPS, is a licensed pharmacist with more than 13 years of experience across retail pharmacy, clinical pharmacy, medication safety, pharmacy program development, and healthcare administration. He is the founder of HelloPharmacist.com, where he helps patients...
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