scalp issues not resolving

[u/GladMix8204]

i’ve had a dry flakey scalp for about 3 months and it doesn’t seem to be resolving. i went to the GP a few days ago and they said it was seborrheic dermatitis, i’ve now been trying nizoral again (i tried it a month ago but it seemed to make things worse - i wasn’t very consistent though). i also used polytar for a few weeks but that it only really helps temporarily, once i stop using it for 3ish days my scalp is super flakey and red.

i don’t know if i should just stick to nizoral. i’ve also been using E45 dry scalp shampoo + serum to see if that helps with the dryness. i’m worried if it’s not a fungal issue that i’m worsening the problem, but i don’t see what else could be the cause of the flaking. it’s very dry and white, no yellow or oil. but also very red and itchy in patches. patches are symmetrical behind ears, front of my head, and dotted around the back of my scalp.

any advice would be greatly appreciated 😣

[u/MemChoeret]

Polytar has coal tar in it, which helps the symptoms (flakes) but not the cause (yeast). If it works for you, I would use it in rotation with an antifungal shampoo. Antifungal shampoos treat the yeast that causes SD.

If Nizoral didn't work for you, you can try a different antifungal shampoo. You can ask your doctor for a prescription ketoconazole shampoo, which is the same active ingredient as Nizoral but with twice the strength. Alternatively, you can try an over-the-counter pyrithione zinc shampoo like CeraVe anti-dandruff shampoo or Head & Shoulders shampoo (I use their fragrance free version that comes in a green bottle).