Scalp Scrubs - are they worth the hype?

Are you tired of dealing with an itchy, flaky scalp? If so, you might want to consider incorporating scalp scrubs into your hair care routine. While many people focus on conditioning and moisturizing their hair, they often neglect their scalp, which can lead to a range of issues such as dandruff, buildup, and even hair loss. Scalp scrubs are designed to gently exfoliate and remove dead skin cells, excess oil, and product buildup, leaving your scalp clean and refreshed. In this article, we'll explore the benefits and limitations of scalp scrubs, how to use them, and which ingredients to look for to achieve a healthy and balanced scalp.

Why are scalp scrubs beneficial? 

Scalp scrubs have not been rigorously studied in a clinical setting. To my knowledge there are no published studies evaluating scalp scrubs for medical indications such as dandruff, seborrheic dermatitis, or scalp psoriasis. There are anecdotal reports that scalp scrubs may improve scalp health through a couple of mechanisms. First, they may promote exfoliation, removing excess scale, dirt, oil, product buildup, and other debris present on the scalp. Second, they may improve absorption of active ingredients on the scalp for hair growth or dandruff.  

How do scalp scrubs work?  

There are two primary types of scalp scrubs: physical and chemical. Physical scalp scrubs use tiny gritty particles (such as salt, sugar, or plastic microbeads) to physically help remove dead skin cells, dirt, and oil on the scalp. Chemical scalp scrubs rely on dilute alpha and beta hydroxy acids such as salicylic acid, glycolic acid, and lactic acid to help remove excess scale.  Active ingredients commonly found in chemical scalp scrubs (such as salicylic acid) have been used in shampoos designed to remove excess scale. These shampoos have been studied and found to be effective in improving scalp health. Scalp scrubs may have similar benefits as they often share active ingredients, but they have not been studied to the same extent. Salicylic acid and sulfur are known as a keratolytic agents meaning they loosen attachments between skin cells. Charcoal and coal tar also help to disperse scale and are frequently used in both anti-dandruff shampoos and scalp scrubs. Mineral oil is another good option to remove scale from the scalp. Some additives like menthol or tea tree oil are designed to create a soothing sensation on the scalp. 

Can you share your tips for finding a good scalp scrub? What about things people should avoid in their scalp scrub? 

Unfortunately there are no published clinical trials evaluating scalp scrubs in general, much less studies comparing different scalp scrubs. In the absence of any evidence-based information, anecdotal recommendations from stylists, dermatologists, and influencers can be a reasonable place to start. For individuals concerned about environmental impacts of their personal care products, it may make sense to avoid products with plastic microbeads. For those concerned about synthetic “chemicals” a natural physical scrub with sugar or salt or a chemical scrub with charcoal/coal tar may be better choices. For individuals looking for scrubs with clinically proven ingredients, selecting a chemical scalp scrub with salicylic acid, sulfur, charcoal/coal tar would be reasonable choices.  For patients with a history of contact allergies, please read the label to avoid any potential allergens. Many scalp scrubs have natural oils that can cause contact dermatitis in susceptible patients.

How do you recommend people use them in their routine?  

I do not routinely recommend scalp scrubs in my clinical practice as there are no clinical studies supporting their benefit for scalp health. That said, if a patient had excess scale and was not responding to traditional anti-dandruff treatments, adding a scalp scrub may help with exfoliation and improve penetration of traditional anti-dandruff active ingredients. If someone was interested in trying a scalp scrub, I would recommend starting once or twice a week to avoid excessive scalp irritation. 

What are some other things people should be doing to take care of their scalp?  

I think there is a big misunderstanding when it comes to dandruff. When many people see flaking in the scalp they think their scalp is dry. Some even avoid frequent hair washing to avoid drying out the scalp when in fact the opposite is true. Most cases of dandruff are caused by seborrheic dermatitis, an inflammatory scalp condition that results from an exaggerated response to Malassezia yeast on the scalp. Malassezia thrives in oily environments like the scalp. More frequent washings, ideally with an anti-dandruff shampoo containing ketoconazole, zinc pyrithione, or selenium sulfide help reduce levels of Malassezia which will improve dandruff when used consistently over time. Incorporating exfoliating scalp scrubs without treating the underlying cause of seborrheic dermatitis can result in disappointing treatment outcomes.