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Dandruff affects up to half of the general population. Anyone who has experienced an itchy, flaky scalp—one of the key symptoms of the condition—will agree, it's never fun. No matter the season, your hair type, hair color, gender, or lifestyle—those visible skin flakes can make you self-conscious and even lead to low self-esteem.
Fortunately, there are many ways to treat the pesky, irritating, and often unsightly condition with both at-home remedies and medications. Read on to learn what dandruff is and how you can treat it.
What is dandruff?
Dandruff is a skin condition that occurs on the scalp, causing itchiness and dry skin flakes. More severe cases that have symptoms of inflammation are called seborrheic dermatitis. If you’ve noticed flaking of your scalp, you’re not alone. Estimates say over 50 million people in the U.S. have dandruff, and nearly 50% of adults worldwide experience the condition.
It can affect people of any age, from babies (in the form of cradle cap) to the elderly. “Having dandruff does not reflect on the overall health of the majority of patients," explains said Tsippora Shainhouse, MD, FAAD, a board-certified dermatologist from the Beverly Hills-based practice SkinSafe Dermatology and Skin Care. "Everyone has some yeast living on their skin and scalp, some people are just more sensitive to it and their skin reacts.”
You can treat dandruff at home with natural remedies, like dabbing diluted apple cider vinegar on the scalp or using over-the-counter solutions such as dandruff shampoos one to two times a week. For more severe conditions, prescription medications, often in the form of dandruff shampoo, are also available.
How is dandruff diagnosed?
Dandruff can be caused by a number of factors. Its primary cause is the interaction of excess oil on the scalp with the yeast/fungus called Malassezia. This yeast occurs naturally on everyone's scalp, but its levels rise when your scalp produces too much oil. This combination can lead to skin cell buildup and clumping, resulting in visible flakes.
Because of the clear physical symptoms, your healthcare provider should be able to diagnose dandruff with a simple physical examination of your scalp. To determine the specific cause and appropriate treatment, your physician may ask questions such as:
- When did the symptoms start?
- Did you change anything in your hair care routine when the symptoms began?
- How often do you shampoo your hair?
- What foods do you eat? Tell me about your diet.
Dandruff treatment options
Once you’ve been diagnosed with dandruff, you’ll want to alleviate and treat the uncomfortable symptoms right away. It’s likely your doctor will first recommend trying some over-the-counter anti-dandruff shampoos, like Head & Shoulders, which will contain ingredients like zinc pyrithione, selenium, or ketoconazole. There are many options available. Your pharmacist can point you in the right direction if you need help finding the best product for your condition.
Your doctor may also suggest washing your hair more regularly and exfoliating your scalp with a gentle scrub to remove buildup. You may also try some natural, at-home remedies. These can include applying diluted apple cider vinegar, diluted tea tree oil, coconut oil, or lemon juice onto the scalp for a few minutes followed by rinsing. Not all doctors agree on the effectiveness of these natural techniques, so you should always speak with your healthcare provider before trying them.
If your dandruff is severe and these treatments do not work, your healthcare provider may prescribe a corticosteroid like fluocinolone, or calcineurin inhibitors to help suppress the immune response. Prescriptions for dandruff often come in the form of shampoos, gels, or topical creams.
There is no cure for dandruff, but you can treat the symptoms. Once you find what works for you and maintain a treatment plan, you can look forward to a healthy, irritation-free scalp.
Dandruff medications
There are a number of different dandruff medication that you may use. Most medicines tackle the fungus that triggers dandruff or reduces excess oil. Here are details about each:
Pyrithione zinc shampoos
- Head & Shoulders
- DermaZinc
- Aveeno Nourish + Dandruff Control
The most popular shampoos for dandruff contain the antibacterial and antifungal agent zinc pyrithione. They are available over-the-counter. Side effects are very rare, but can include mild skin irritation.
Ketoconazole shampoos
- Nizoral A-D
- Xtina
- Xolegel
These shampoos are available over-the-counter and in stronger prescription formulations. Like pyrithione zinc shampoos, these work by killing the fungi that cause dandruff. Side effects include mild itching, dry scalp, or thinning hair.
Keratoplastics or tar-based shampoos
- Neutrogena T/Gel
- DHS Tar Shampoo
These shampoos slow down the growth of skin cells, preventing them from building up into flakes and itchiness. Tar shampoos often have a strong scent and can stain hair, so are generally not recommended for those with light-colored hair. On rare occasions, you may experience skin irritation or inflammation.
Shampoos containing salicylic acid
- Neutrogena T/Sal
- Meted
Unlike other shampoos, these treat the excess oil production rather than the yeast. These products are available over-the-counter without a prescription. Side effects are rare, however, seek immediate medical advice if you develop a severe skin reaction or signs of an allergic response like swelling of the lips and tongue.
Selenium sulfide shampoos
- Dandrex
- Head & Shoulders Intensive
- Selsun Blue
- Selseb
These antifungal treatments are available over-the-counter. Side effects are rare, however, if you show signs of an allergic reaction such as hives, difficulty breathing, or swelling, seek medical attention immediately.
What is the best medication for dandruff?
What works for one person may not be the best solution for another. The only way to find out which medication for dandruff is best for you is to speak with your healthcare provider. Your physician will advise you based on your medical condition, medical history, any medications you may already be taking that could interact with dandruff treatment. Then, your healthcare provider can monitor your response to treatment and adjust accordingly.
This table gives a comparison of the most commonly prescribed dandruff medications.
| Best medication for dandruff | ||||
|---|---|---|---|---|
| Drug name | Drug class | Administration route | Standard dosage | Common side effects |
| SelRx (selenium sulfide) | Anti-infective agent | Shampoo | 180 mL at 1% and 2.25% Apply a small amount to wet hair, work into a lather, leave on scalp for two minutes, then rinse thoroughly | Hair loss, skin irritation, dry scalp, change in hair color |
| Selsun Blue (selenium sulfide) | Anti-infective agent | Shampoo | 325 mL of 1% Apply one ounce or less to wet hair, work into a lather, leave on scalp for five minutes, then rinse thoroughly | Temporary hair loss, dry scalp, skin irritation |
| Sebuderm | Antibacterial agent | Topical gel | Rub gently into the scalp, leave for two minutes, then wash out | No known side effects as it is naturally produced by the body |
| Capex | Steroid | Topical cream (shampoo) | 120 mL of 0.01% Apply one ounce or less to wet hair, work into a lather, leave on scalp for five minutes, then rinse thoroughly. | Swollen hair follicles, blistering or pimples, mild itching or burning |
| Ovace Wash (sodium sulfacetamide wash) | Sulfa antibiotics | Topical liquid | 480 mL of 10% Wet skin well and apply a generous amount to the affected area, work into a lather, then rinse thoroughly. | Redness, stinging or burning skin |
Note: Dosage is determined by your doctor based on your medical condition, response to treatment, age, and weight. Other possible side effects exist. This is not a complete list.
What are common side effects of dandruff medication?
It's rare to experience any side effects from dandruff medication. The most common side effects are mild irritation of the scalp or inflammation.
However, there is always the risk of an allergic reaction when taking medication. If you experience signs of an adverse reaction, such as vomiting, hives, swelling of the lips, throat, or tongue, seek medical attention immediately.
Please note this is not a complete list of side effects. You should always talk to a healthcare professional for a complete list of potential adverse events and drug interactions.
What are the best dandruff home remedies
Although there is no cure dandruff, there are a number of lifestyle changes and home remedies that can treat and alleviate symptoms.
Shampoo regularly
It's a simple, yet effective solution that will help prevent product, skin cell, and oil buildup. Alternate between an anti-dandruff and a clarifying shampoo for best results. Just be sure not to overdo it. Too much washing will strip your scalp of oils it needs, drying it out and triggering even more oil production. If you shower before bed, make sure to dry your hair properly before going to sleep. Some dandruff-causing fungus and bacteria thrive in damp environments.
Skip conditioner on the roots
“Applying too much conditioner or oily products to the scalp can exacerbate dandruff," explains Yeral Patel, MD, a board-certified physician in anti-aging/regenerative and family medicine. "Use conditioner and styling products on the hair itself and avoid direct application to the scalp.”
Apply aloe vera
Some say that the antibacterial and antifungal properties of aloe vera can help treat dandruff. It can also have a soothing effect that helps with inflammation and itching. Just add some of the gel to your scalp for a few minutes then wash out.
Use apple cider vinegar (ACV)
ACV is often heralded for its health benefits. Although studies are limited, many people swear it's effective in treating dandruff. It’s believed to stop the growth of dandruff-causing bacteria and fungus. Always dilute a few tablespoons of apple cider vinegar either in shampoo or water before applying it to your scalp for a few minutes.
Apply coconut oil
Coconut oil is a soothing, hydrating treatment for your scalp, and can also be an effective at-home remedy for dandruff thanks to its antimicrobial properties.
Use garlic as a pre-wash treatment
“Garlic is a well-known anti-fungal and by simply crushing a clove or two and mixing with water and applying to the scalp, it helps kill off fungus,” explains Dr. Patel. “If the garlic's smell is unpleasant for you, add a drop of essential oil to make it less pungent,” she says.
Tea tree oil
Used for centuries for medicinal purposes, multiple studies show that tea tree oil can be effective in treating dandruff because it can kill fungus and reduce inflammation. The oil is very potent, so it's best practice to dilute a few drops in a carrier oil—like coconut oil—before massaging it gently into the scalp. This is especially important if you have sensitive skin.
Use baking soda
Try applying baking soda directly onto a wet scalp, gently massaging it through for a few minutes, and then follow up with your regular shampoo and conditioner routine. The baking soda has a beneficial exfoliating effect, meaning it clears away dead skin cells. It’s also been shown to be highly effective at stopping the growth of fungus.
Eat fatty fish
Increasing your intake of omega-3 fatty acids may help treat dandruff. It can manage oil production and also reduce inflammation, all of which is beneficial to your scalp. You can find omega-3’s in fatty fish like salmon, mackerel, and trout. Other great sources include flaxseed and walnuts.
Reduce stress
Some people experience increased symptoms of dandruff in high-stress environments. Some ways you can reduce stress include exercising regularly, meditating, eating a balanced diet, and ensuring you get a good night's sleep.
Frequently asked questions about dandruff
What is the best treatment for severe dandruff?
Your healthcare provider will be able to help you determine the best treatment for severe dandruff or seborrheic dermatitis. Dietary changes or an over-the-counter shampoo could alleviate your symptoms. In some severe cases, your doctor will prescribe stronger shampoos or topical creams.
How can I permanently get rid of dandruff? Can dandruff be cured?
Dandruff cannot be cured. It is considered a chronic condition. However, there are many ways you can manage it so you never experience symptoms. This can include regularly washing your hair with anti-dandruff shampoos.
What causes dandruff?
It’s believed that dandruff is caused by a combination of excess oil and a yeast/fungus called Malassezia. This creates an environment where the yeast overgrows, causing a buildup of skin cells that cause itching and flaking. That said, more research is required to understand the complex causes of dandruff.
What is a natural cure for dandruff?
There are a number of natural remedies to treat dandruff that many people find effective. Applying either tea tree oil or apple cider vinegar, diluted in coconut oil is a popular remedy. Massage it gently into your scalp for a few minutes before washing as usual.
What is the best medication for dandruff? What can a doctor prescribe for dandruff?
There are a number of effective medications available for dandruff, including over the counter shampoos. These often include active ingredients such as ketoconazole, coal tar, salicylic acid, selenium sulfide, or zinc pyrithione. Stronger, prescription-strength creams and shampoos, like ketoconazole and selenium sulfide, are also available.
Is dandruff a fungal infection?
Dandruff is often triggered by an excess of a fungus called Malassezia. This fungus occurs naturally on the scalp but can overgrow in certain circumstances, such as too much oil production.
Can dandruff cause hair loss?
Dandruff does not usually directly lead to hair loss. However, dry skin and itchy scalp can lead to scratching. Too much scratching can damage hair follicles, resulting in hair loss, although full hair loss and baldness is unlikely.
Resources
- Seborrheic Dermatitis and Dandruff: A Comprehensive Review
- Melaleuca Alternifolia (Tea Tree) 0il: A Review of Antimicrobial and Other Medicinal Properties
- Antifungal Activity of Sodium Bicarbonate Against Fungal Agents Causing Superficial Infections
- Dandruff: The Most Commercially Exploited Skin Disease