What Scalp Treatment Works Best for Dandruff? We Asked Dermatologists

We often forget about our scalp until it starts sending out distress signals like flakes and itchiness. “For an average adult, the surface area of a scalp is roughly 500 to 700 centimeters per square,” says Dr. Andrea Suarez, MD, FAAD. That is a lot of surface area on your body to be ignoring! One day you’re blissfully unaware, and the next, you’re brushing snow-like flakes off your shoulders. It’s not just you—figuring out an effective scalp treatment can feel like wading through endless bottles of products and well-meaning advice. But don’t worry, we’ll break it down to make sense of what’s happening up there.

What Is Dandruff?

Dandruff is the not-so-fun result of your scalp shedding extra skin cells. It’s not just a flaky party—there’s usually something causing this imbalance. “When we’re talking about dandruff, we’re actually talking about a medical condition called seborrheic dermatitis,” says Dr. Mike Varshavski. It might sound scary, but it is just a condition that leaves you with red, scaly, and often oily patches. These love to hang out where oil glands are plenty, like your scalp.

There’s also a yeast-like fungus called Malassezia that lives on the scalp. It’s usually harmless but can sometimes decide to throw a party, leading to more skin shedding than usual. Voilà, flakes everywhere.

While the exact cause of dandruff can be elusive, several factors can kick it up a notch—stress, hormonal shifts, and even your diet can play a part.

Is It Dandruff or Dry Scalp?

So how do you know if you’re dealing with dandruff or just a dry scalp? Both can make you scratch your head (literally) and leave flakes behind, but they’re different beasts. A dry scalp happens when your scalp loses moisture, leading to irritation and flakiness—much like dry skin anywhere else on your body.

The flakes can clue you in: dandruff flakes are usually larger and a bit oily, while dry scalp flakes are smaller and, you guessed it, drier. Your scalp might feel tight and itchy if it’s dry. On the other hand, redness and oily patches point more towards dandruff, especially if things get worse when you skip a shampoo or two.

Finding a Scalp Treatment That Works for You

Dandruff isn’t just about flaking; it’s a condition that needs a targeted approach, mixing the right products and lifestyle tweaks. When I first found out that I had dandruff, my first instinct, like anyone else’s, was to oil my hair. But this might be a terrible idea. “When you’re using any kind of natural oil, whether it’s almond oil, coconut oil or tea tree oil, it’s really important to know that it works well for dry scalp but if you have dandruff caused by too much oil production, and you’re putting more oil on your scalp, that can make the problem worse!” add Varshavski. So, if oil is not an effective scalp treatment, then what is? Well, the secret lies in your shampoo.

Choosing the Right Shampoo

Your first move against dandruff is picking the right shampoo. Not just any bottle labeled “anti-dandruff” will do.

Look for products with active ingredients known to combat dandruff effectively. Zinc pyrithione is a gentle anti-fungal ingredient that helps reduce Malassezia yeast, often linked to dandruff, making it perfect for regular use without irritating your scalp. Selenium sulfide, another key ingredient, slows down skin cell turnover and fights fungus. It’s effective, but if you have light or chemically treated hair, it might alter your hair color, so use it with caution.

For those stubborn dandruff cases, Abraham The Pharmacist recommends ketoconazole. It’s a powerful anti-fungal ingredient available in both over-the-counter and prescription shampoos; your go-to when other treatments don’t cut it. While coal tar might sound intense, it effectively slows skin cell growth and reduces scaling, especially beneficial for seborrheic dermatitis or psoriasis. Just be mindful of its strong smell and potential to stain light hair. Salicylic acid is also an excellent exfoliator for your scalp that can help remove flakes when paired with other anti-fungal ingredients.

Using Your Shampoo the Right Way

Having the right shampoo is only half the battle; how you use it makes a big difference.

Start by wetting your hair and applying a generous amount of shampoo, working it into your scalp thoroughly to cover every inch. “Allow the shampoo to sit on your scalp for at least five minutes, giving the active ingredients time to work their magic,” says Abraham The Pharmacist.

Make sure to rinse thoroughly, as leftover shampoo can lead to build-up and irritation, undoing your hard work. Initially, use your dandruff shampoo daily until symptoms improve, then switch to a maintenance routine, using it two to three times a week.

When One Shampoo Isn’t Enough

If one shampoo doesn’t cut it, you might need to mix things up with a multi-shampoo strategy. Rotating between different shampoos with various active ingredients can target dandruff from multiple angles, preventing your scalp from becoming resistant to a single treatment.

Some dermatologists recommend switching between a zinc pyrithione and a selenium sulfide shampoo. If frequent washing dries out your hair, consider applying a moisturizing conditioner to the ends.

Give Your Scalp Some TLC with Lifestyle Changes

Your lifestyle significantly impacts your scalp health, so a few adjustments can make a big difference.

A balanced diet rich in zinc, omega-3 fatty acids, and vitamins B and D supports skin health, potentially reducing dandruff symptoms, while staying hydrated helps maintain skin moisture.

Stress management is crucial since stress can trigger dandruff flare-ups. Incorporate stress-reducing activities like yoga or meditation into your routine to help keep flare-ups at bay.  “What does fungus like? Well, it likes dark, moist and warm environments so sunlight is our friend,” says Abraham The Pharmacist. Moderate sunlight exposure can help kill the fungus that causes dandruff. Plus the UV light’s anti-inflammatory properties are good for your scalp but don’t forget to use sunscreen!

Common Mistakes People Make When Treating Dandruff

I know many of you are following all the tips out there, but things just don’t seem to get better. Here are some common mistakes people make when dealing with dandruff and how you can start making changes today.

Mistake #1: Not Washing Your Hair Enough

It might seem like washing your hair less often would help reduce dandruff, but the opposite is true. When you skip washes, oil and dead skin build up, creating a breeding ground for dandruff. Regular washing helps clear away this buildup and keeps your scalp healthy. Just be sure to use a gentle shampoo that matches your scalp type to avoid over-drying.

Mistake #2: Overusing Dry Shampoo

Dry shampoo is a convenient fix for oily hair, but using it too often can cause problems. It leaves behind tiny particles that can clog hair follicles, leading to more dandruff and irritation. If you have a normal or dry scalp, you might be okay using it occasionally. But if dandruff is an issue, it’s best to cut back and wash your hair more regularly to avoid buildup.

Mistake #3: Applying Hair Oils Incorrectly

Adding more oil to your scalp when it’s already oily can make dandruff worse. While some hair oils can be beneficial, they can also feed the yeast responsible for dandruff, leading to more flakes. Instead of applying oils directly to your scalp, focus on conditioning the ends of your hair to avoid aggravating the scalp.

Mistake #4: Using the Wrong Shampoo

Not all shampoos are equal, and the wrong one can worsen dandruff. Medicated shampoos can help, but if used incorrectly, they can dry out your scalp. Look for shampoos with zinc pyrithione or ketoconazole to target dandruff effectively. Make sure to leave the shampoo on your scalp for a few minutes before rinsing to allow it to work.

Mistake #5: Combing the Scales Away

We all want to get rid of those flakes, but aggressively combing your scalp can do more harm than good. If you have inflamed skin on your scalp, combing can irritate it further and cause more dandruff. Instead, try to gently brush your hair without touching the scalp. Focus on maintaining a healthy scalp environment with regular, gentle cleansing.

Mistake #6: Ignoring Your Scalp Type

Understanding your scalp type is crucial for choosing the right products. Using a scalp treatment meant for oily scalps on a dry scalp can exacerbate dryness and flaking. Similarly, using products for dry scalps on oily scalps can increase oil production and lead to more dandruff. Identify your scalp type and select products that cater to its specific needs.

Mistake #7: Using Natural Remedies Incorrectly

Natural remedies like tea tree oil can be helpful, but they must be used properly. Adding tea tree oil to your shampoo can create an environment unfavorable to dandruff-causing fungi. But beware of harsh remedies like tar soap, which can irritate the scalp further and increase dandruff. Stick to gentle, natural ingredients and avoid applying anything too aggressive.

When to See a Professional

If you’ve tried over-the-counter treatments and lifestyle changes without success, it might be time to consult a dermatologist. Persistent dandruff could signal an underlying issue that needs medical attention. If you’re noticing patchy hair loss, it could indicate a condition beyond dandruff, such as scalp psoriasis or another dermatological issue.

Prescription shampoos with higher concentrations of active ingredients offer more potent effects, while topical steroids help reduce inflammation and redness in more severe cases. Though rarely used, oral antifungals are an option for particularly severe cases when topicals don’t work.

Managing dandruff requires patience and persistence. By understanding the causes and choosing the right treatments, you can tackle those flakes. Everyone’s scalp is unique, so it might take some trial and error to find what works best for you. With the right approach, you can enjoy a healthier, flake-free scalp.