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Indian Journal of Dermatology

Wolters Kluwer -- Medknow Publications

Shampoo and Conditioners:

What a Dermatologist Should
Know?
Paschal D'Souza and Sanjay K Rathi

Additional article information

Abstract
Dermatologists many a times encounter
questions from patients and even colleagues
asking about how to keep their hair looking
clean, healthy and beautiful. Therefore,
familiarity and a basic knowledge of the
available hair care products will help them
to guide their patients properly. A shampoo
not only provides the cleaning of the scalp
skin and hair as its primary function, but in
addition also serves to condition and
beautify hair and acts as an adjunct in the
management of various scalp disorders. To
achieve this, various ingredients in the
correct proportion are mixed to provide a
shampoo which is suitable for individuals
having different hair types and hair need.
Among the ingredients that go into the
making of a shampoo are detergents,
conditioners, thickeners, sequestering
agents, pH adjusters, preservatives and
specialty additives. Hair conditioners are
designed to improve hair manageability,
decrease hair static electricity and add luster.
They are used in several ways depending
upon the state of hair and requirement of the
individual. This article attempts to put
forward the basic and practical aspects
regarding use of these products.

Keywords: Conditioner, hair, shampoo

What was known?

Hair shampoo is a hair care

product comprising among other
things of synthetic detergents
designed to remove sebum and
environmental dirt.

Hair conditioners aid to improve

hair manageability.

Introduction
Having good looking hair and skin is the
need of the hour, both being a part and
parcel of our personality. The value of the
treasure sitting on our heads is appreciated
deeply by those who start losing it due to
various causes of hair loss. Maintenance and
grooming of hair is a daily routine for most
of the people and it is not uncommon to see
people investing a huge amount of time and
money on hair care, which has created a
huge industry selling lots of hair care
products to fulfill the demand. India too is
undergoing a hair revolution with markets
flooded with products promising instant
beautification of hair.

What makes for a healthy hair?

Healthy hair looks clean, soft to feel, shiny,
untangled, has no frizz and is bouncy when
shaking the head. To have this, you require
not only a good overall health and freedom
from disease but a daily chore of
maintenance and grooming of hair. For a
smooth, wet and dry feel, friction between
hair and skin should be minimized in wet
and dry environment, respectively, and if
you desire a good feel with respect to
bouncing and shaking of the hair during
walking and running, friction low between
hair fibers.[1] Shampoos and conditioners of
today target some of the factors responsible
for helping the hair look healthy through
their various ingredients.

Why a dermatologist need to know

about hair cleansing products?
Dermatologists many a times encounter
patients with or without hair disorders
asking many questions about how to keep
hair looking clean and beautiful. Which
shampoo or conditioner must I use for my
kind of hair? is the most common query of
most patients. Familiarity with available hair
care products along with a basic knowledge
of the different types of hair seen in
individuals will help doctors to offer expert
advice and prevent awkward moments in
clinical practice. This article in brief would
be discussing the basic and practical aspects
regarding cosmetic shampoo and
conditioners relevant to a dermatologist.
Therefore, therapeutic shampoo will not be
discussed here.

Shampoo
Shampoo in simple terms is a hair care
product designed to clean the scalp skin
along with its hairs. Incidentally, the term
shampoo entered the English language
through India where the Hindi word
“champoo” was used meaning to press or
massage; it was used to denote cleaning
through massage of the hair and skin.[2]
Cleaning the hair has always been a tough
task especially for women. An average
western woman has 4-8 square meters of
hair.[3] This will probably be more for the
average Indian women due to culture of
keeping long hair. Traditional soaps which
were used earlier for both skin and scalp are
not recommended anymore for hair cleaning
as they don’t have good lathering capability
and leave behind “soap scum” when mixed
with hard water which is difficult to rinse
off. Modern shampoo as it is known today
was first introduced in the 1930s with
Drene, the first shampoo using synthetic
surfactants instead of soap. Used initially for
laundry and for cleaning carpets and cars,
they later evolved as hair shampoo.[4]

What shampoos do?

Shampoos are used primarily to clean the
scalp of dirt and other environmental
pollutants, sebum, sweat, desquamated
corneocytes (scales), and other greasy
residues including previously applied hair
care products such as oils, lotions and
sprays.[5] It is easy to formulate a shampoo
which will remove all of the sebum and dirt
from the hair and scalp, but this will leave
the hair, frizzy, dry, unmanageable and
unattractive. Shampoo now is also supposed
to have a secondary function which serves to
condition and beautify hair and to soothe the
irritated scalp skin in conditions like
seborrheic dermatitis.[6,7] The challenge is
to remove just enough sebum to allow the
hair to appear clean and leave behind
enough conditioning agents to leave the hair
soft, shiny and manageable.[8] This
balancing act between good cleaning and
beautifying the hair is an art achieved by
mixing various ingredients in the correct
proportion in the shampoo preparation. The
modern advances in chemistry and
technology have made it possible to replace
the soap bases with complex formulation
which contain cleansing agents, conditioning
agents along with functional additives,
preservative, aesthetic additives and
sometimes even medically active
ingredients.[1]

What shampoos contain?

Basic formulation of ingredients and their
functions for all standard shampoos is listed
in Figure 1.[9] It is important to realize that
the only ingredients that are important for
the cleansing and the manageability of the
hairs are the synthetic detergents and the
conditioners while the rest aid in the
stability, presentability and marketability of
the product. A brief discussion of the
ingredients is as follows.

Figure 1
Basic ingredients present in a
shampoo

Detergents[7,9,10,11,12,13] Shampoos usually

contain synthetic detergents (syndets) or
surfactants as primary cleansers. A detergent
or surfactant is amphiphilic, meaning the
detergent molecules contains both lipophilic
(oil-attracting) and hydrophilic (water-
attracting) sites. The lipophilic sites help to
bind sebum and oily dirt while hydrophilic
end binds to water; allowing removal of the
sebum while washing with water. The most
commonly selected shampoo detergents are
listed in Table 1.

Table 1
Shampoo detergents

There are five categories of shampoo

detergents: Anionics, cationics, non-ionics,
amphoterics and natural. Each of this group
possesses different hair cleansing and
conditioning qualities. For a shampoo that is
intended for oily hair, detergents with strong
sebum removal qualities are selected, but if
it is intended for permanently waved or dyed
hair, mild detergents are selected to reduce
sebum removal. Modern shampoos contain a
mixture of surfactants (usually between two
and four) for providing optimum cleaning
levels according to hair type and
requirement—normal, oily, dyed, permed,
colored or damaged hair. The detergent
listed first denotes the primary cleanser
which is in highest concentration and the
detergent listed second is the secondary
cleanser designed to offset the short comings
of the primary detergent.

Anionic detergents[13]

Among the most popular surfactants, they

are named for their negatively charged
hydrophilic polar group. Derived from fatty
alcohols, they are very good at removing
sebum from the scalp and hair. However, the
excessively cleaned hair is harsh, rough, dull
with frizz and prone to tangling. Among
them, different classes of detergents are
available with certain selective properties.

Lauryl sulfates: Popular primary

cleansers, they work well in both hard
and soft water, produce rich foam, and
are easily rinsed. They are excellent
cleansers, commonly used in shampoos
for oily hair. As the hair becomes harsh
and rough, careful selection of a
secondary detergent and possible use of
a conditioning agent is always required
as part of the shampoo formulation.
Examples of this class include: Sodium
lauryl sulfate, triethanolamine lauryl
sulfate, and ammonium lauryl sulfate

Laureth sulfates: These are another

class of excellent detergents with good
cleansing ability and foaming property
which are useful for normal-to-dry hair.
Examples of this chemical class are:
Sodium laureth sulfate, triethanolamine
laureth sulfate, and ammonium laureth
sulfate

Sarcosines: They are generally

secondary detergents, as they do not
remove sebum well from the hair to
justify as primary cleansers. They are
listed as the second or third on
ingredient list of detergents. Excellent
conditioners are used in conditioning
shampoos and dry hair shampoos.
Examples are: Lauryl sarcosine and
sodium lauryl sarcosinate

Sulfosuccinates: These are strong

detergents commonly used as a
secondary surfactant in oily hair
shampoos. Examples are disodium
oleaminesulfosuccinate and sodium
dioctylsulfosuccinate.

Cationic detergents[13,14]

In contrast to anionic detergents they have a

positively charged polar group. They are
poor cleansers and do not lather well and are
not compatible with anionic detergents,
limiting their utility. However, they are
excellent at imparting softness and
manageability to chemically damaged hair
and so are primarily used as daily shampoo
for damaged hair such as in case of
permanently dyed or chemically bleached
hair. Examples are: Long-chain amino
esters, ammonioesters,
cetyltrimethylammonium chloride.

Nonionic detergents[13,15]

They have no polar group and are among the

mildest of all cleansers and aid to improve
the antistatic qualities of a shampoo. They
can be combined with ionic detergent as a
secondary cleanser. Examples are:
Polyoxyethylene fatty alcohols,
polyoxyethylene sorbitol esters and
alkanolamides.

Amphoteric detergents[13,16,17]

Having both positively and negatively

charged polar group, they behave differently
at lower pH (as cationic detergent) and at
higher pH (as anionic detergent). Subgroups
include the betaines, sultaines, and
imidazolinium derivatives. They are used in
baby shampoo and for those with fine and
damaged hair because they don’t cause
stinging in the eyes in children, foam well
and leave hair in manageable state.
Examples are: Cocamidopropyl betaine and
sodium lauraminopropionate.

Natural detergents[11,13,18]

The fruit pulp of Sapindus, also known as

soapberries or soapnuts contains saponins
which are a natural surfactant and creates a
lather which leaves the hair soft, shiny and
manageable. This was used for hair
cleansing in India in ancient times. After the
advent of synthetic detergents, use of natural
detergents became a memory. Recently
botanically based hair care products have
made resurgence. Natural surfactants come
from plants such as sarsaparilla, soapwort,
soap bark, and ivy agave. Although they
have excellent lathering capabilities,
cleansing of hair is poor and their addition is
only for marketing purposes.

Conditioners (In shampoo formulations)

[10,13,19,20,21,22,23] Hair-conditioning
ingredient functions to impart manageability,
gloss, and antistatic properties to the hair.
This may be included in the shampoo which
then serves dual function of cleaning and
conditioning. Procter and Gamble
introduced “2 in 1” shampoos/conditioners
in 1987 using silicone (dimethicone)
droplets suspended in a surfactant mixture.
These are useful for those wishing to
shampoo daily and for dry, damaged, or
chemically treated hair. Commonly used
conditioning substances include hydrolyzed
silk and animal protein, glycerin,
dimethicone, simethicone,
polyvinylpyrrolidone, propylene glycol, and
stearal -konium chloride. Protein-derived
substances in conditioners can temporarily
mend split ends, known as trichoptilosis.
Protein attracted to the keratin holds the
cortex fragments together until the next
shampooing occurs.

Foaming agents[13,24] They introduce gas

bubbles into the water but have nothing to
do with cleansing, a common myth among
general population that a product which
foams better cleans better. Inclusion of foam
boosters like cocodiethanolamide as
ingredients in shampoo helps to satisfy the
customer psyche which equates good
foaming with good cleansing though it does
help spread the detergent over the hair and
scalp. This helps in the commercial success
of a shampoo formulation. Sebum inhibits
the bubble formulation; therefore, there is
more foam during second shampooing.

Thickeners and opacifiers[13,25,26] These are

added to change the physical and optical
properties of the shampoo. This improves
the cosmetic acceptance. Many shampoos
are pearlescent. This effect is achieved by
addition of tiny flakes of suitable materials,
for example, glycol distearate. Thickeners
like salt (sodium chloride) and PEG-150
distearate are used to increase the product
viscosity. Again these have no effect on hair
cleansing.

Sequestering agents[13,27] Sequestering

agent like polyphosphates and
ethylenediaminetetra-acetic acid are used to
chelate magnesium and calcium ions.
Presence of these ions form insoluble soaps
called “scum” over the scalp and hair, may
cause itching and exacerbate the symptoms
of seborrheic dermatitis while making the
hair dull

pH adjusters[8,13,28,29] As the hair fiber has

a pH of 3.67, a pH closer to 3.67 has less
possibility to increase the negative electric
charge that normally involves the capillary
fiber. To address the treatment of the scalp;
shampoos must not have a pH higher than
5.5, which is also scalp pH. Hair shaft
swelling which occurs due to alkalization of
hair shaft after use of most detergents can be
prevented by “pH balancing” the shampoo
by the addition of an acidic substance, such
as glycolic acid or citric acid to adjust the
pH down to approximately 5.5. Use of
“neutral pH” shampoo helps for chemically
treated hair, from either permanent dyeing or
permanent waving.

Preservatives[1,10,13,30] Preservatives resist

germs and prevent decomposition of the
shampoos. They also prevent various other
health risks that accompany contamination
by germs and bacteria. Typical preservatives
in shampoos are sodium benzoate, parabens,
1,3-dimethylol-5,5-dimethyl (DMDM)
hydantoin, tetrasodium EDTA,
methylisothiazolinone, or MIT and
Quaternium-15.

Specialty additives[1,10,13,31,32] Recently, an

attractive list of ingredients is being added to
shampoos ranging from chemical sun
screens to vitamins like panthenol, pro-
vitamins, botanicals like tea tree oil and even
beer. The contact time of shampoos with
scalp and hair is too brief to expect
significant clinical benefits despite claims to
the contrary. These additives serve mainly to
allow the distinction of one shampoo from
another in terms of marketing claims.

Who should use which shampoo?

A common question of a dermatology
patient especially if he or she comes with a
hair problem is to ask the type of shampoo
he or she should use for their type of hair.
Dermatologists are expected to be familiar
with the basic types of shampoos available