Doctor’s Note: Your Easy Guide to Dandruff Treatment

As dermatologists, we know that dandruff can be uncomfortable and sometimes embarrassing. We know it’s tough to deal with the flakes, especially when wearing dark clothes. It can be hard to know what helps, but our online content is here to guide you!

Watch the video to the right, or keep reading to learn more!

What Is Dandruff?

Dandruff is a common scalp condition that causes white flakes and itching. It happens because the skin on your scalp sheds too quickly. This leads to mild to moderate itching and noticeable white or yellow flakes with small “holes” where hair grows.

Dandruff isn’t something that can be cured, but it can be managed. It’s a long-term skin condition that can come and go. Even though dandruff isn’t harmful and can’t spread to others, it can make people feel self-conscious.

What Causes Dandruff?

We don’t know the exact cause of dandruff yet, but experts believe it may be linked to a reaction in the immune system. This reaction could be triggered by a type of yeast called Malassezia, which naturally lives on the scalp. For some people, the immune system sees this yeast as a problem and reacts to it, causing flaking and itchiness.

Because of this, many dandruff treatments include antifungal ingredients. These ingredients help control the growth of Malassezia, which is why medicated shampoos with antifungal properties are often recommended for managing dandruff.

Dandruff Lifestyle Changes

Dandruff can be unpredictable. Stress and cold weather can make it worse. Sunlight often helps improve it. Reducing stress, getting a bit of sunlight, and adjusting your hair care routine can help manage dandruff. There may also be a link between dandruff and diet, so eating foods rich in zinc and B vitamins might help.

Here are some tips to manage dandruff:

Reduce Stress: Lower your stress levels to help prevent flare-ups.
Sun Exposure: Get some sunlight on your scalp, but don’t overdo it.
Hair Care Routine:
- If your scalp is oily, shampoo daily.
- If your scalp is dry, shampoo less often.
Limit Styling Products: Avoid using too many products that can cause buildup.
Balanced Diet: Eat foods rich in zinc and B vitamins.

Quick Guide: How to Choose the Right Dandruff Shampoo

The best dandruff shampoo for you depends on your scalp’s needs. Each dandruff shampoo contains an active ingredient designed to target dandruff, but different ingredients work in different ways. Here’s a quick guide to help you find the right one for your scalp:

For mild flakes: Zinc Pyrithione or Tea Tree Oil
For persistent flakes: Ketoconazole or Selenium Sulfide
For oily scalp: Selenium Sulfide or Tea Tree Oil
For thick flakes: Salicylic Acid or Coal Tar
For sensitive skin: Piroctone Olamine or Apple Cider Vinegar

For mild dandruff, a gentle zinc pyrithione shampoo might be all you need. If dandruff is more severe, a ketoconazole or coal tar shampoo may work better. Start with a mild shampoo and see if it helps. If you don’t see improvement, try a stronger formula with antifungal or anti-yeast ingredients. Be patient; dandruff shampoos may take a few washes to show results.

It’s always best to follow the directions on the shampoo bottle and avoid over-washing, as this can dry out the scalp.

Best Shampoo for Mild Dandruff

For mild flakes, look for ingredients that gently reduce flakes and soothe irritation without drying out the scalp. Effective ingredients include zinc pyrithione, tea tree oil, and sulfur.

Head & Shoulders Classic Clean Dandruff Shampoo.jpg

Head and Shoulders Dandruff Shampoo

Main Ingredient: Zinc Pyrithione
Reduces: Flakes, irritation
Notes: Suitable for sensitive scalps; gentle for regular use

Tea Tree Shampoo for Dandruff

Main Ingredient: Tea Tree Oil
Reduces: Flakes, scalp oil
Notes: Provides a cooling, tingling feel; good for mild dandruff

Biolage Dandruff Shampoo

Main Ingredient: Zinc Pyrithione
Reduces: Flakes, irritation
Notes: Suitable for sensitive scalps; gentle for regular use

Dove Dandruff Shampoo

Main Ingredient: Zinc Pyrithione
Reduces: Flakes, irritation
Notes: Suitable for sensitive scalps; gentle for regular use

Best Shampoo for Moderate Dandruff

For persistent flakes or moderate itchiness, opt for shampoos with stronger antifungal ingredients like ketoconazole or selenium sulfide.

Nizoral Anti-Dandruff Shampoo

Main Ingredient: 1% Ketoconazole
Reduces: Severe flakes, fungal growth
Use: 1-2 times weekly
Notes: Stronger prescription option available (2% ketoconazole)

Selsun Blue Medicated Anti-dandruff Shampoo

Selsun Blue Dandruff Shampoo

Main Ingredient: 1% Selenium Sulfide
Reduces: Flakes, scalp oil
Use: 2-3 times weekly
Notes: Effective for oily dandruff

Selsun Blue Moisturizing Antidandruff Shampoo

Selsun Blue Dandruff Shampoo

Main Ingredient: 1% Selenium Sulfide
Reduces: Flakes, scalp oil
Use: 2-3 times weekly
Notes: Effective for oily dandruff + moisturizing

Head & Shoulders Clinical Dandruff Shampoo

Head and Shoulders Dandruff Shampoo

Main Ingredient: 1% Selenium Sulfide
Reduces: Flakes, scalp oil
Use: 2-3 times weekly
Notes: Effective for oily dandruff

Best Shampoo for Dandruff + Oily Scalp

For dandruff combined with excess oil, choose shampoos that balance scalp oil while reducing flakes. Key ingredients include selenium sulfide and tea tree oil.

Selsun Blue Dandruff Shampoo

Main Ingredient: 1% Selenium Sulfide
Reduces: Flakes, scalp oil
Use: 2-3 times weekly
Notes: Effective for oily dandruff

Tea Tree Shampoo for Dandruff

Main Ingredient: Tea Tree Oil
What It Does: Reduces flakes and excess oil on the scalp.
Notes: Natural option for mild dandruff and oily scalp.

Selsun Blue Dandruff Shampoo

Main Ingredient: 1% Selenium Sulfide
Reduces: Flakes, scalp oil
Use: 2-3 times weekly
Notes: Effective for oily dandruff

Tea Tree Shampoo for Dandruff

Main Ingredient: Tea Tree Oil
Reduces: Flakes, scalp oil
Notes: Provides a cooling, tingling feel; good for mild dandruff

Best Shampoo for Dandruff + Thick Flakes

If you have thick, scaly flakes, look for shampoos that exfoliate the scalp and break down build-up. Effective ingredients include salicylic acid, sulfur, and coal tar.

Neutrogena T/Sal Shampoo

Main Ingredient: Salicylic Acid
Reduces: Thick flakes, scalp build-up
Notes: Best for heavy build-up and thick scales

Ouai Dandruff Shampoo

Main Ingredient: Salicylic Acid
Reduces: Thick flakes, scalp build-up
Notes: Best for heavy build-up and thick scales

Neutrogena T/Gel Therapeutic Shampoo

Main Ingredient: 0.5% Coal Tar
Reduces: Flakes, skin cell growth
Notes: Strong smell; can be messy

Denorex Therapeutic Dandruff Shampoo

Main Ingredient: 0.5% Coal Tar
Reduces: Flakes, skin cell growth
Notes: Strong smell; can be messy

Best Shampoo For Dandruff + Sensitive Scalp

If you experience dandruff with redness or sensitivity, look for ingredients that reduce flakes while calming irritation. Key ingredients include tea tree oil and apple cider vinegar.

Avalon Organics Scalp Treatment Tea Tree Shampoo

Tea Tree Shampoo for Dandruff

Main Ingredient: Tea Tree Oil
Reduces: Flakes, scalp oil
Notes: Provides a cooling, tingling feel; good for mild dandruff

Tea Tree Shampoo for Dandruff

Main Ingredient: Tea Tree Oil
Reduces: Flakes, scalp redness
Notes: Cooling sensation; gentle for sensitive skin

Wow Apple Cider Vinegar Shampoo

Main Ingredient: Apple Cider Vinegar
Reduces: Flakes, scalp irritation
Notes: Balances scalp pH; good for mild dandruff

Tea Tree Shampoo for Dandruff

Main Ingredient: Tea Tree Oil
Reduces: Flakes, scalp oil
Notes: Provides a cooling, tingling feel; good for mild dandruff

Prescription Dandruff Shampoo

If the above over-the-counter dandruff shampoos aren’t working, it’s time to see a dermatologist. Persistent dandruff may actually be severe dandruff, seborrheic dermatitis, or scalp psoriasis. Dermatologists can prescribe stronger treatments, such as:

2% Ketoconazole Shampoo: Antifungal, used for flare-ups 2-3 times weekly. The over-the-counter version is Nizoral (1%).

2% Ciclopirox Shampoo: Prescription-only antifungal. Used for flare-ups 2-3 times weekly.

Clobetasol Lotion: Prescription-only anti-inflammatory, used for itching. Strong steroid. Works well, though prolonged use can lead to skin thinning. Use only as directed.

If these products aren’t helping your scalp, it might not be dandruff. Here are some other common scalp issues to consider:

Dandruff vs Dry Scalp

It’s important to know the difference between dandruff and a dry scalp. A dry scalp is usually caused by a lack of moisture and can lead to small, white flakes. On the other hand, dandruff flakes are larger, often white to yellow, and might have “hair holes.”

Dandruff

Cause: Yeast
Itch: Mild to moderate
Flakes: Large, white to yellow, with “hair holes”
Context Clues: Look for flakes with “hair holes,” which dry scalp flakes don’t have.
Treatment: Antifungal shampoo.

Dry Scalp

Cause: Lack of moisture
Itch: Mild
Flakes: Small, white
Context Clues: Cold weather, dry air, harsh shampoos, eczema
Treatment: Scalp moisturizers, gentle shampoo, avoid harsh chemicals.

Lice vs Dandruff

It’s important to know the difference between dandruff and lice. Dandruff flakes are larger, often white to yellow, and can sometimes have “hair holes.” Lice, on the other hand, are tiny insects. Their eggs, called nits, look like small white or brown dots that stick to the hair and don’t flake off easily like dandruff does.

Dandruff

Cause: Yeast
Itch: Mild to moderate
Flakes: Large, white to yellow, with “hair holes”
Context Clues: Look for flakes with “hair holes,” which dry scalp flakes don’t have.
Treatment: Antifungal shampoo.

Lice

Cause: Tiny insects (lice)
Itch: Intense, especially behind the ears and near the neckline.
Appearance: Small white or brown dots (nits = eggs) attached firmly to hair strands. Difficult to pull off hair strand. Sometimes can see bugs moving.
Context Clues: Close contact with someone who has lice, daycare, school, etc.
Treatment: Special lice-killing shampoo, nit combing, washing bedding and clothing, avoiding sharing personal items.

Dandruff vs Seborrheic Dermatitis

It’s important to know the difference between dandruff and seborrheic dermatitis. Dandruff causes larger, white or yellow flakes that may have “hair holes.” Seborrheic dermatitis, on the other hand, has greasy, yellowish flakes with redness and can affect other areas like your eyebrows and the sides of your nose.

Dandruff

Cause: Yeast
Itch: Mild to moderate
Flakes: Large, white to yellow, with “hair holes”
Context Clues: Look for flakes with “hair holes,” which dry scalp flakes don’t have.
Treatment: Antifungal shampoo.

Seborrheic Dermatitis

Cause: Yeast + excess oil production
Itch: Moderate to intense
Flakes: Large, white to yellow, greasy, often “clinging” to hair and skin. Difficult to pick off.
Context Clues: May also have rash on eyebrows or sides of nose.
Treatment: Antifungal shampoo + prescription topicals.

Dandruff vs Scalp Psoriasis

It’s important to know the difference between dandruff and scalp psoriasis. Dandruff causes white or yellow flakes that are usually loose and don’t cause much redness. Scalp psoriasis, on the other hand, creates thick, silvery-white scales over red, raised patches. It often extends beyond the scalp to areas like the forehead, neck, or behind the ears, which dandruff usually doesn’t do.

Dandruff

Cause: Yeast
Itch: Mild to moderate
Flakes: Large, white to yellow, with “hair holes”
Context Clues: Look for flakes with “hair holes,” which dry scalp flakes don’t have.
Treatment: Antifungal shampoo.

Scalp Psoriasis

Cause: Overactive immune system in scalp.
Itch: Moderate to severe +/- burning or soreness.
Flakes: Thick, silvery-white scales + red, raised skin
Context Clues: Often extends beyond the hairline onto the forehead, back of the neck, or behind the ears.
Treatment: Medicated shampoos, topical steroids, and other prescription treatments.

Dandruff FAQs

Can wearing a hat cause dandruff?

No, wearing a hat does not cause dandruff. Dandruff is caused by a fungus called Malassezia, oily skin, or dryness—not hats.

Does hard water cause dandruff?

Hard water can make your scalp dry and irritated, which might make dandruff worse, but it’s not a direct cause.

Does coconut oil help with dandruff?

Coconut oil can help moisturize the scalp, but it may not treat the root cause of dandruff, which is often fungal.

Does sea salt spray cause dandruff?

Sea salt spray can dry out your scalp, which might lead to flaking, but it doesn’t directly cause dandruff.

Does dandruff cause acne?

Dandruff itself doesn’t cause acne, but oily flakes can clog pores on your face, leading to breakouts.

What percent of Chinese people have dandruff?

A study conducted in the U.S. and China found that 30–42% of Chinese people experience dandruff. This rate is lower compared to other ethnic groups, such as African Americans (81–95%) and Caucasians (66–82%).

Can bald people get dandruff?

Yes, dandruff can still occur on a bald scalp because it’s caused by skin conditions, not hair.

Can sweat cause dandruff?

Sweat doesn’t directly cause dandruff, but it can create a moist environment for the fungus Malassezia to grow, worsening it.

Does glycolic acid help with dandruff?

Glycolic acid can exfoliate dead skin cells on the scalp, which may reduce flakes, but it’s not a primary treatment for dandruff.

Can gel cause dandruff?

Hair gel doesn’t directly cause dandruff, but buildup from products can irritate the scalp and lead to flaking.

Does clarifying shampoo help with dandruff?

Yes, clarifying shampoo can remove product buildup and oil that might worsen dandruff symptoms.

Does minoxidil cause dandruff?

Minoxidil can sometimes cause dryness and flaking, but this isn’t the same as dandruff.

Does castor oil help dandruff?

Castor oil can moisturize the scalp, but it won’t treat the fungal cause of dandruff.

Is dandruff genetic?

Dandruff can have a genetic component, as some people are more prone to it due to their skin type or immune response.

How long does it take dandruff shampoo to work?

Dandruff shampoo can start working after a few uses, but it may take 1–2 weeks for noticeable improvement.

Is dandruff communicable?

No, dandruff is not contagious. It’s caused by skin conditions or fungus already present on your scalp.

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