"Alex, have you been washing your hair lately?"

The question from Dr. Gilberto Capiro, MD, my primary care physician, caught me off-guard. We'd been discussing my weight (I've lost seven pounds in a year) and my attempts to supplement my diet by drinking Ensure at least four times a week. And while I did notice that his gaze was fixed on my face, I didn't think I had any noticeable skin problems; I'd shaved and washed up with my usual Nivea For Men facial care products, and there wasn't any itching or obvious flaking that I'd noticed before leaving home an hour earlier.

Yet the good doctor must have noticed something awry, because I had, indeed, washed my hair the previous day with Clairol's Herbal Essences Anti-Dandruff shampoo (I used to do so three times a week or every other day). My hair felt clean, and there was only a bit of an itch on my scalp, which I attributed more to stress rather than my chronic dandruff problem.

"Yes, sir," I replied. "I washed my hair yesterday morning," I replied.

Dr. Capiro smiled and asked me to turn my head to one side, then the other. "You've got some serious flaking, though," he said. "The shampoo you're using is leaving your hair clean but not really doing a good job at treating your scalp." He reached for his prescription pad and jotted something down, then handed me the sheet of paper. "I want you to go to any pharmacy and get this instead of the Herbal Essences."

I looked at the sheet of paper. In his precise penmanship, Dr. Capiro had written "Nizoral A-D."

We talked a few more minutes, mostly about the lab tests he needs me to take to update my medical history for 2005 and my displeasure about last year's hearing exam, then it was time for me to go home.

A day later, my mom came back from grocery shopping and a stop at a nearby Navarro's Pharmacy; I'd given her the presciption sheet the doctor had handed me, and Mom had gone slightly out of her way to get me my shampoo. She'd done so willingly -- we get along very well and she's looked out for me for 42 years -- but was dismayed at the price ("$11 for a 4-oz. bottle of shampoo?" Mom said as she handed the container to me. "Well," she added, "if it helps control your dandruff, it'll be worth it.") in comparison to what she usually gets for my hair-care needs.

Nizoral A-D Ketoconazole Shampoo 1%

Ever since I started suffering from dandruff with the onset of puberty -- for more than 30 years -- I've tried most of the better-known over-the-counter anti-dandruff shampoos; from Head & Shoulders, Selsun Blue, Tegrin, and Herbal Essences, I've had mixed results, with some symptoms (such as excessive flaking and itching) minimized but never really eliminated. Worse, when I'm stressed (as I have been lately for mostly personal reasons), my dandruff really flares up; the itch becomes maddening and I find myself scratching my head almost obsessively. When this happens, not only can't I wear dark-colored T-shirts or jackets, but I can't focus on writing or any chore that requires any amount of concentration. Thus it was that I stepped into the shower, with my small $11 bottle of Nizoral in hand, with a large amount of skepticism and a small bright flame of hope.

After wetting my hair thoroughly as per the directions on the bottle, I turned off the shower and applied a dime-sized amount of the blue Nizoral A-D onto my hair and scalp, massaging it as well as I could and making sure it "generously lathered" as instructed. Dr. Capiro had also instructed me to let it sit for five minutes, so I carefully turned the water back on to rinse my hands, shut it off again, grabbed my battered blue pouf, applied some Dove soap, and scrubbed my body while I sang a few Billy Joel songs...slightly out of key and not loud enough to bother anyone.

With the last dying note of The Longest Time, I put down my pouf, hoping the five minutes had elapsed. My scalp was tingling a bit and the shampoo's pleasant-but-strong scent formed a subtle but discernible olfactory halo around my head. I took both of these sensory experiences as maybe-it's-working signs, but I also remembered having had such hopeful thoughts whenever Mom had brought a new and supposedly stronger (and better) anti-dandruff product. I'd had the tingly scalp/strong scent experience before and had the thought Aha! I've got this f--king dandruff problem licked now! flash before my eyes like the famous Times Square news ticker, only to have the darned itch-and-flaking flaring back even if I washed my hair three times a week.

I turned the shower back on, luxuriating in the cascade of very warm water and rinsing off the Nizoral from my head and the Dove from the rest of me. I had to keep my eyes screwed tightly shut; a shampoo that strong can really make your day miserable if a drop of Nizoral-laced water makes contact with your baby blues (or black, brown, green, hazel, or or gray); I must have rinsed every darned trace of the shampoo off, because by the time I opened my eyes to see a constellation of stars flashing before me, the warm water was gone.

(Like all shampoos, Nizoral's directions strongly suggest a second go-round, but without warm water, there was no way in hell I was going to do that. I was desperate to get rid of my dandruff, true, but we can't easily afford to be spending $11 on a single bottle of shampoo every two weeks or so, and I wasn't too keen on taking a cold shower, either.)

Preliminary Results: To my surprise, the tingly-scalp feeling didn't go away after I got out of the shower and got dressed, nor did the new shampoo's non herbal scent dissipate quickly, either. The "tingles" lingered for a few hours, fading into nothingness as I worked on whatever Epinions review I was writing. The aroma lasted longer; it's not unpleasant -- reminds me of a super-strong blend of Head & Shoulders, actually -- but something in the fumes gave me a slight but persistent headache. I fretted over this last side effect, hoping it would turn out to be a "first use" symptom rather than a recurring one.

I didn't think there would be any noticeable improvements within 24 hours, but to my surprise, when I looked in the mirror the next day before shaving, I noticed there was less evidence of flaking around my hairline, especially around my temples. There were flakes, yes, especially near the aforementioned temples (where my gray hairs seem to be proliferating) and near my browline, but not as many as the day before. Also, my scalp wasn't itching, a development which I heartily welcomed. Skepticism began turning into hope, and I began looking forward to seeing what a second application would result in.

Two days after the first use, I repeated the wet hair, apply to hair and scalp, generously lather, let stand, and rinse process. This time the tingly scalp side effect was less noticeable and the scent wasn't so prevalent (and no headache!), but I did feel that my hair was clean and manageable, plus my scalp was still not itching. I stayed in the shower till the warm water was gone again (I'm a sucker for long and warm showers), dried off and got dressed, and while I combed my hair, I examined my face and hair closely in the mirror.

Even taking into account the fact that I'd just showered and that my hair was still damp, I could see that there were no flakes visible even after combing. Usually, when I use ordinary anti-dandruff shampoos, combing will loosen any flakes that cling to my scalp and make them visible even if my hair is still wet. Not this time! There wasn't even a grain-sized flake visible, though I'm sure that at the microscopic level there may have been some dandruff in evidence. This happy state of grace has persisted without change for the past ten days; only occasionally will my scalp itch in an isolated spot, and that's if I'm really worried about something or if the ambient temperature is climbing. I don't scratch, and if I don't think about it the itch fades and goes away.

While it's still too early to tell whether Nizoral A-D will be the "silver bullet" to my dandruff problem, in the short run it has had remarkable effects. The only downside (other than the first day's headaches) has been the price. $11 per bottle is pretty steep, so I need to be very careful and not spill any while applying it.

NIZORAL A-D Ketoconazole Shampoo 1%
Drug Facts
Active ingredients Purpose
Ketoconazole 1%………..………………………………………………………Anti-dandruff shampoo
Uses controls flaking, scaling and itching associated with dandruff
Warnings
For external use only
Do not use

on scalp that is broken or inflamed

if you are allergic to ingredients in this product
When using this product

avoid contact with eyes

if product gets into eyes, rinse thoroughly with water
Stop use and ask a doctor if

rash appears

condition worsens or does not improve in 2-4 weeks
If pregnant or breast-feeding, ask a doctor before use.
Keep out of the reach of children. If swallowed, get medical help or contact a Poison Control Center
right away.
Directions
adults and children
wet hair thoroughly
12 years and over
apply shampoo, generously lather, rinse thoroughly. Repeat

use every 3-4 days for up to 8 weeks or as directed by a doctor.
Then use only as needed to control dandruff
children under 12 years
ask a doctor
NIZORAL® A-D (continued)
Other information

store between 35° and 86°F (2° and 30°C)

protect from light
protect from freezing

see top panel for lot number and expiration date
Inactive ingredients acrylic acid polymer (carbomer 1342), butylated hydroxytoluene, cocamide MEA,
FD&C Blue #1, fragrance, glycol distearate, polyquaternium-7, quaternium-15, sodium chloride, sodium
cocoyl sarcosinate, sodium hydroxide and/or hydrochloric acid, sodium laureth sulfate, tetrasodium
EDTA, water
Questions or comments? call 1-800-962-5357
©McN-PPC, Inc.
Distributed by:
MCNEIL CONSUMER HEALTHCARE
DIVISION OF McNEIL-PPC, INC.
FORT WASHINGTON, PA 19034 USA
Made in Italy
US Patent Nos. 4,335,125; 4,942,162 and 5,456,851





Recommended: Yes