Ashlee Williams, MD: Hair washing routines look very different depending on your scalp, hair, texture, and cultural practices. If you've ever wondered why your hair feels dry, greasy, irritated, or why your wash schedule never seems to match someone else's, we're hair to help. Welcome

to The Healthier You Podcast. I'm Dr. Ashley Williams, and today I'm here talking with Dr. Randa Corey, a board certified dermatologist here at Kaiser Permanente to break down the science behind cleansing your hair and scalp. We'll talk about wash frequency, dry shampoo, sulfates, clarifying shampoos, and how to choose the products that actually work.

For your hair, whether you wash daily or every one to two weeks. Dr. Corey, thank you so much for being here.

Randa Khoury, MD: Thank you for having me, Dr. Williams.

Ashlee Williams, MD: Let's just start with the basics. How often should we be washing our hair?

Randa Khoury, MD: That is a complicated question. How often you should be washing your hair. Really depends on your scalp type, your hair type, and your personal. Daily grooming schedule. If you have a really dry, flaky, irritated scalp, you need to be refreshing your scalp daily to at most every other day.

If you don't, you're going to get buildup of yeast and dead skin cells that usually naturally slough off into the environment, but they kind of get packed down when you have hair, and that can just propagate more of those problems. Dryness, itchiness, flakiness. So for dry scalps. Daily to every other day.

All scalps are normal, but if you have what we would consider an unproblematic scalp, it's neither very dry nor very oily, then generally you can get away with extending your wash schedule up to every two days. But I always like to remind my patients the scalp is not a self-cleaning oven.

Even if you have a normal scalp, you still need to refresh the skin of the scalp regularly, meaning daily to at most, every two days. If you are somebody who has coarse or textured hair. Or you're somebody whose scalp is really sensitive, you may find that your skin feels a little bit better if you don't use shampoo quite that often.

In those cases, you can extend to a maximum of every three to four days for the skin of the scalp itself. But while we're speaking of textured hair like mine, the needs of the end of the hair and the needs of the skin of the scalp are completely different.

When we're talking about washing the hair, we're really talking about washing the scalp. We will get to the needs of the ends of your hair in a little bit.

Ashlee Williams, MD: So what we're hearing is everyone's hair is different and everyone's hair has different needs. Can you talk a little bit about dry shampoo?

Randa Khoury, MD: Yes. Dry shampoo is a total misnomer. Dry shampoo is not shampoo, dry shampoo is baby powder. That is. Market it in a bunch of different ways. Sometimes it's an aerosol spray, sometimes it's a physical powder that you place on the scalp. And the goal of these products is to absorb some of the oil that's naturally produced as we go throughout our day in our life.

This is not cleaning the scalp. This is actually adding additional product that if overused can suffocate and congest your hair follicles and even lead to hair loss. This doesn't mean that dry shampoo can never be used, but it should certainly be used really sparingly and ideally right before a wash day, so you can then cleanse that product out.

Ashlee Williams, MD: Because I'm pretty sure no one really wants hair loss. Well, there's so many different products out there. I mean, there's thousands of different shampoo types. How do you know what is the best shampoo for your hair?

Randa Khoury, MD: Such a great question. Much of the differences among the shampoos that are available is just marketing shampoos are all really similar in their cleansing properties. However, I'd like to highlight a few specific types. One thing we hear about a lot is a sulfate-free shampoo and sulfates are things that I think have been a little bit unfairly demonized in the media.

Sulfates are really important because those are things that are important for effective cleansing. If you are somebody who uses a lot of product on your hair, if you're a dry shampoo lover, or if you have a particularly oily scalp, sulfates are really important. You can think of sulfates like a detergent, so it's the difference between washing your clothes with just water, or the difference between washing your clothes with water and soap.

Those sulfates are able to bind to those oil particles and product particles to effectively remove them from your scalp with your washing cycle. However, if you have really dry sensitized or textured hair, you may find that those sulfates are a little too stripping because that's their job is to remove oils from the scalp.

So if you need your natural oils to remain sulfate-free may be for you. For everyone else, sulfates are your friend.

Ashlee Williams, MD: it is so true. Sulfates have really gotten a bad rap. Can you talk a little bit about clarifying shampoos?

Randa Khoury, MD: So most clarifying shampoos are gonna contain our old friend sulfates. That's kind of how they work. They're going to contain detergent that are going to be. Thought of in some instances as harsh or stripping, but that is because they're taking the oils away, but in other circumstances. So I have a good number of patients who say the ends of my hair feel dry.

They don't feel like they need to be washed. If anything, they feel like they need to be conditioned, but my roots feel so greasy. I feel like I need to wash those regularly. And balancing the two is a challenge. In those patients, clarifying shampoos can be your best friend, but what's super important is that they are not designed for the length of your hair.

That is a skin treatment, not a hair treatment. So you're going to use the clarifying shampoo on the skin of your scalp into your roots, and starting about an inch down from that. Use a regular sulfate-free shampoo, or even skip the shampoo completely and just do a conditioning mask on your end.

Ashlee Williams, MD: Your thoughts on double shampooing.

Randa Khoury, MD: Double shampooing is great in certain circumstances, so if you are somebody who does not wash your hair frequently, or if you are somebody who uses a lot of product. A single shampoo might not be sufficient to remove all of that buildup all at once. So doing a double cleanse may be great.

Similar to what we were discussing with the strategy of using different products for your roots and your ends. This also may be a situation where you wanna use a clarifying or sulfate containing shampoo. First to remove the bulk of the debris and then use a more gentler or softening shampoo.

Second to kind of put back a little bit of that moisture that the clarifying shampoo stripped away.

Ashlee Williams, MD: Okay. You shampooed your hair. Everyone knows you should. With a conditioner, does the conditioner go on the scalp or not?

Randa Khoury, MD: It does not. much like shampoos are really designed for the skin of the scalp and then. In certain extents for the lengths of the hair on a different schedule. Conditioners are for the hair shaft, for the cuticle of the hair. If you are putting conditioner on your scalp, in addition to kind of wasting some of your money, you are also adding some of those oils to an environment that's already going to make its own.

So starting about an inch down from your roots gives you the best bang for your buck and the best outcome for your hair.

Ashlee Williams, MD: I love that you added about wasting your money. I know you're very cost conscious. Um, okay, so conditioners, shampoos, but there's other things that people are putting in their hair, like rosemary oil. There's a trend that this helps with hair growth. Can you speak about that?

Randa Khoury, MD: Yeah, I think that's really interesting. There is a lot of interest in using these quote unquote natural products to stimulate hair growth. Things like rosemary oil, castor oil, tea tree oil, have long been part of the lore of hair growth. And more recently have had a resurgence, in interest and.

While I understand that the science really doesn't support in any robust way that they're gonna do a whole lot of anything, and in keeping with our previous discussion about putting things that are thick or heavy or greasy on the scalp, it can actually contribute to scalp. Problems when you're adding oils to an environment that already make their own.

If your primary objective is hair growth, the ingredient minoxidil in the concentration of 5% for everyone. Men and women has the best data behind it. And to your point of cost consciousness, many of these hair growth products and oils are marketed and packaged in a beautiful way. But they're pretty pricey.

Whereas 5% Minoxidil is available in multiple generic forms at a really accessible price point, and it has fabulous data behind it. So if our goal is hair growth, I would stick with that.

Ashlee Williams, MD: And with the mono, it's one of those things that we. Once you start it, you kind of have to continue it right.

Randa Khoury, MD: Absolutely. It's like brushing your teeth or watering a plant or diet and exercise. If you quit on it, it quits on you. So I know that sounds so daunting for some patients that, oh my gosh, I'm gonna have to do this forever. Yeah, just like you have to eat your vegetables and get your steps in, you have to do it forever as a maintenance.

aspect of your kind of hair health journey, all of us men, women, everyone. Your hair is gonna be peak fabulous at age 13, and then after puberty, mother nature starts to do her thing and we're gonna lose 10 to 25% of our hair density. Every decade of life moving forward.

And if you are somebody who is blessed with tons of full, thick, gorgeous hair and your family scooch is more towards the 10% side, you might cosmetically not notice that until you're in your forties or even beyond. But there is not a 40-year-old alive who will tell you that their hair is the same at 40.

As it was at 13, and that is a progressive process. We don't talk a lot about the way the hair ages, but that's really what happens. Minoxidil is the strongest general in the army against the fight for keeping your natural hairline. 5% Minoxidil, just once a day is fine.

I know a lot of studies quote twice. Once is great. If you can get it on your scalp once a day in either the foam or the serum. You'll continue to have fabulous hair well into your fifties and sixties.

Ashlee Williams, MD: Agree. We should be talking more about it, which is why we're having this podcast. I love it. Can you talk about your scalp to produce less oil? does washing less help that?

Randa Khoury, MD: I would love to talk about training your scalp because it is not a thing, and I would love to find the person who invented this fake news. you cannot train your scalp. Your scalp has already been trained from birth to do exactly what it needs to do, which is turn over.

Its. Skin cells in a programmed and regulated way. All that happens when you don't wash your hair for a long period of time is it gets really gross. And then when you wash it, you're like, Hey, that feels great. So many people think that they can go a longer duration, but it's really just because you habituated yourself to your scalp feeling.

A little bit put upon. What naturally happens is the scalp turns over, and again, this is assuming a healthy or normal scalp without issues such as dandruff for breaks or folliculitis. Your scalp is gonna turn over in a normal, controlled way, and your scalp is alive. It has normal, healthy yeast and bacteria that live on there that are supposed to live on there.

They're part of our normal skin flora. But if you don't wash regularly as those dead skin cells build up. Those bacteria and yeast numbers start to multiply, they're gonna grow out of proportion to what a healthy scalp expects. If we're not cleansing those regularly, that's when we start to get into problems.

You can't train your scalp not to be what it is. It's always gonna behave in the way that it's programmed to do.

Ashlee Williams, MD: Also, yes, another great takeaway that everyone is different and has different hair types and the wash schedule may be different. Thanks for all this helpful information Dr. Corey. Here are the top takeaways. One, there is no universal wash schedule. Your routine should honor your scalp type hair, texture, and cultural practices.

Two. Dry shampoo is a temporary tool, not a cleanser. Three shampoo choice starts with your scalp, then your hair. Four. Sulfates and clarifiers are useful when matched to the right hair. Type N five. Conditioner belongs on the hair and not the scalp and your scalp. Health, comfort, cleanliness, and how it behaves between washes tells you more than any rule on the internet.

For more information from our experts, visit kp.org/doctor and listen to more episodes of Healthier You wherever you get your podcast. If you enjoyed this episode, be sure to subscribe and share it with others who may find it helpful. Thank you, and from all of us at Kaiser Permanente, be well.