How to Get Rid of Dandruff
Treat dandruff with an over-the-counter shampoo picked by its active ingredient, a twice-a-week routine (once a week for curly or coily hair), and a 4-week check that tells you when to see a doctor.
You will end up with a dandruff shampoo picked by its active ingredient, a washing routine that fits your hair type, a weekly habit that keeps the flakes from coming back, and a 4-week checkpoint that tells you when to see a doctor.
Dandruff is common. A 2015 review in the Journal of Clinical and Investigative Dermatology puts it at about half of all adults worldwide. The NHS calls it a common skin condition that is not harmful and that you cannot catch, and it says dandruff is not caused by poor hygiene. The American Academy of Dermatology says that for most people dandruff does not need medical attention and that mild dandruff can usually be treated at home.
The steps are for teenagers and adults. Scaly patches on a baby's scalp are usually cradle cap, and the American Academy of Dermatology says dandruff shampoo is not recommended for children. FAQ 5 below covers what to do instead.
Check that the flakes are dandruff
The American Academy of Dermatology describes dandruff as small pieces of dry skin flaking off the scalp. The flakes show up most on dark hair and dark clothes, and the scalp may itch. The 2015 review describes dandruff flakes as white to yellow, oily or dry, and spread across the scalp and hair without redness. You do not need to work out whether your flakes are oily or dry before you treat them. A Mayo Clinic dermatologist says flaking can come from overactive oil glands, from dryness, or from both, and that dandruff shampoos treat both types. Some conditions look like dandruff and need a doctor. The NHS links scaly, itchy, red patches on the scalp, face, and other parts of the body to seborrheic dermatitis. It links a red or silver rash on the scalp, sometimes with patchy hair loss, to ringworm of the scalp. Red, flaky, crusty, sore patches covered with silvery scales point to psoriasis, and red, irritated skin after hair dye, sprays, gels, or mousses points to contact dermatitis. If one of these fits, go to step 8 first. The flakes start with a yeast called Malassezia, which the review says lives on the skin of most healthy adults. It breaks down the oil on your scalp into fatty acids such as oleic acid. On the scalps of people prone to dandruff, those fatty acids disturb the outer layer of skin, and that layer comes off as flakes. In tests the review describes, oleic acid caused flaking on the scalps of people with dandruff and no visible change on people without it.
Pick a shampoo by its active ingredient
For mild dandruff, start by washing your hair more often with a gentle shampoo. Mayo Clinic says this clears away extra oil and dead skin from the scalp. If the flakes stay, move to a medicated dandruff shampoo. Dandruff shampoos are sold over the counter, and the American Academy of Dermatology recommends looking for one of six active ingredients: zinc pyrithione, salicylic acid, sulfur, selenium sulfide, ketoconazole, and coal tar. The active ingredient and its strength are printed at the top of the Drug Facts label. Mayo Clinic sorts them by what they do. Ketoconazole, zinc pyrithione, and selenium sulfide help kill or slow the fungus linked to dandruff. Salicylic acid and coal tar help with itching, scaling, and flaking. Start with an antifungal, either ketoconazole 1% or zinc pyrithione. The 2015 review says antifungal activity is the one mechanism shared by the many treatments that work on dandruff. Read the label before you buy. Nizoral's ketoconazole 1% shampoo is for adults and children 12 years and over, says to ask a doctor first if you are pregnant or breastfeeding, and says not to use it on a scalp that is broken or inflamed. Know the side effects of two others before you pick them. Coal tar can discolor light-colored, bleached, or tinted hair, the American Academy of Dermatology warns, and the FDA requires coal tar labels to say that it may increase your tendency to sunburn for up to 24 hours and should not be used for long periods without consulting a doctor. If you use one, wear a wide-brimmed hat outdoors and put a broad-spectrum sunscreen of SPF 30 or higher on any exposed scalp, as the academy advises. Selenium sulfide shampoo can leave an orange-brown discoloration on the scalp, which the 2015 review lists among its side effects.
Good to know: The FDA sets the strengths an over-the-counter dandruff product may contain: coal tar 0.5 to 5%, zinc pyrithione 0.3 to 2% in a shampoo you rinse out, salicylic acid 1.8 to 3%, selenium sulfide 1% (0.6% if micronized), and sulfur 2 to 5%. Nizoral's over-the-counter ketoconazole shampoo is 1%.
Apply it to the scalp and follow the label's timing
Keep the shampoo out of your eyes. The FDA's required wording for dandruff shampoo labels, and both labels we read, say to avoid contact with the eyes and to rinse them thoroughly with water if it gets in. Stop using a shampoo that causes itching, burning, or stinging, as Mayo Clinic advises, and get medical help right away for a rash, hives, or trouble breathing. Wet your hair, apply the shampoo directly to your scalp, and gently massage it in with your fingertips. Leave it on for as long as the label says before you rinse. The American Academy of Dermatology notes that some dandruff shampoos need to sit on the scalp for up to 5 to 10 minutes, and Mayo Clinic says most need several minutes or more. Labels differ, and Nizoral's gives no wait time at all. Keep the shampoo on your scalp and off the lengths of your hair. The academy warns that dandruff-treating ingredients can dry the hair, which matters most on curly or coily hair. Then rinse thoroughly. The academy says cleanser left on skin with seborrheic dermatitis can irritate it and lead to a flare-up. If your hair feels dry afterward, use your normal conditioner. The academy says you can shampoo and condition with your regular products after the dandruff shampoo.
Use it twice a week, or once a week on curly or coily hair
If you have fine or straight hair or an oily scalp, the American Academy of Dermatology says to wash your hair often, which may mean shampooing daily, and to use the dandruff shampoo twice a week. Use your regular shampoo on the other days. Twice a week also matches the labels. The Selsun Blue label, in the wording the FDA requires, says "For best results, use at least twice a week or as directed by a doctor," and the Nizoral label says every 3 to 4 days. If you have coarse, curly, or coily hair, the academy says to wash your hair when needed and to use the dandruff shampoo about once a week, if your hair tolerates it. Apply it only to your scalp and follow with your conditioner. Do not skip washes to give your scalp a rest. The NHS says dandruff is not caused by poor hygiene but may be more obvious if you do not wash your hair regularly.
Give each shampoo 4 weeks, then rotate and maintain
Give each shampoo 4 weeks of use as directed. The NHS says to use an anti-dandruff shampoo for up to 4 weeks to see if your dandruff gets better, and the Nizoral label says to ask a doctor if the condition worsens or does not improve in 2 to 4 weeks. If you see no improvement at 4 weeks, go to step 8. A shampoo that worked can stop working as well as it did. The American Academy of Dermatology says some people find this, and that rotating dandruff shampoos may help. A Mayo Clinic dermatologist recommends rotating among up to three shampoos with different active ingredients, and Mayo Clinic's dandruff page says to switch between them each time you wash your hair. For example, alternate a ketoconazole shampoo with a zinc pyrithione shampoo, and add selenium sulfide as a third. Once the flakes are under control, keep one medicated wash a week. Mayo Clinic says to keep using a dandruff shampoo at least once a week to help keep dandruff from coming back, and the American Academy of Dermatology says patients with seborrheic dermatitis often continue once a week to prevent flare-ups.
Cut the everyday triggers
Stress is a common trigger. For seborrheic dermatitis, the condition behind stubborn dandruff, the American Academy of Dermatology notes that flare-ups tend to be more common when stress increases. The NHS also lists stress and cold weather as things that may make dandruff worse. Our guide on how to reduce stress has a 1-week trigger log, a 5-minute breathing exercise, and other steps for everyday stress. Use styling products sparingly. Mayo Clinic says hair gels, sprays, and other products can build up on the scalp, make it oily, and cause more dandruff, and the academy tells people with seborrheic dermatitis to apply hair spray, gel, or pomade sparingly. Wash them out completely each time. Choose alcohol-free hair products and skip very hot showers. The academy says products that contain alcohol can cause a flare-up, and it lists hot showers and baths, especially in cold, dry weather, among the common triggers. Write down each flare and what you did before it. The academy suggests this journal because what triggers seborrheic dermatitis in one person may not trigger it in someone else.
Add a 5% tea tree oil shampoo only as an extra
The 2015 review cites one dandruff trial of tea tree oil. In that 2002 trial in the Journal of the American Academy of Dermatology, 126 people aged 14 and older with mild to moderate dandruff used either a 5% tea tree oil shampoo or a placebo shampoo daily for 4 weeks. The tea tree group improved by 41% on the trial's area-and-severity score, against 11% for placebo, and no side effects were reported. It was a single-blind trial, and Mayo Clinic says there is no strong evidence that tea tree oil helps with dandruff and that it may cause allergic reactions in some people. If you want to try it, use it as your regular shampoo on the days between medicated washes, and buy a shampoo labeled 5% tea tree oil, the strength the trial tested. Do not add drops of pure oil to your shampoo, because you cannot tell what strength you end up with. Stop if your scalp turns red or irritated. The National Center for Complementary and Integrative Health (NCCIH) says some people get that reaction and that it may be more likely with a product that is old or has been exposed to heat, light, or air.
Heads up: Never swallow tea tree oil, and keep bottles of pure oil away from children. NCCIH says taking it by mouth can cause serious symptoms such as confusion, unsteadiness, inability to walk, and coma.
See a doctor after 4 weeks without improvement
See a doctor or a board-certified dermatologist if your dandruff has not improved after 4 weeks of a medicated shampoo used as directed. The NHS sets the same point, and the FDA requires dandruff shampoo labels to tell you to consult a doctor if the condition worsens or does not improve after regular use. What looks like dandruff may be seborrheic dermatitis, psoriasis, eczema, or a fungal infection of the scalp, and the American Academy of Dermatology says a dermatologist can tell which. Go sooner if your dandruff is severe or your scalp is very itchy, if your scalp is red or swollen, or if flaky, itchy patches appear on your face or other parts of your body. Those are the NHS's reasons to see a doctor. MedlinePlus adds patches that drain fluid or pus, form crusts, or become very red or painful, and the NHS links a scalp rash with patchy hair loss to ringworm, which needs treatment. Dermatologists have treatments you cannot buy over the counter. For seborrheic dermatitis, the American Academy of Dermatology lists a prescription shampoo (ciclopirox), antifungal creams, gels, and foams such as ketoconazole, corticosteroids for inflammation, and roflumilast foam, which the FDA has approved for people 9 years and older. For widespread seborrheic dermatitis, or when other treatment fails, the plan may include an oral antifungal such as itraconazole or terbinafine, or UVB light therapy.
Once the flakes clear, keep one medicated wash a week (step 5) and keep writing down what came before any flare (step 6). If the flakes come back every winter, return to the step 4 routine as soon as they start (FAQ 3 below covers winter flares). The American Academy of Dermatology says treating a flare-up as soon as it starts helps keep it from getting worse. If the flaking spreads to your eyebrows, the sides of your nose, behind your ears, or your chest, that is the pattern of seborrheic dermatitis, which the academy says often appears on those oily areas, so follow step 8. The 2015 review links flares to sleep deprivation as well as stress, and our guide on how to sleep better covers the sleep side.
Questions we get asked about this
Answers from experience, not a textbook.
No. The NHS says you cannot catch dandruff. The yeast linked to it, Malassezia, already lives on the skin of most healthy adults, according to the 2015 review, and dandruff comes from how a person's own scalp reacts to it, so sharing a comb, hat, or pillow does not pass it on. One condition that can look like dandruff is contagious. Ringworm of the scalp causes a scaly rash with patchy hair loss, and the review calls it highly contagious and common in children. See a doctor if that is what you see.
We could not find a source that links ordinary dandruff to hair loss. The 2015 review says seborrheic dermatitis is not associated with hair loss, although its own table notes that thick crusts on an adult's scalp can lead to it. Scaly patches with patchy hair loss are a reason to see a doctor, because the NHS links them to ringworm of the scalp, which needs treatment.
It can. The 2015 review says seborrheic dermatitis has a seasonal pattern, showing up more often in winter and usually improving in summer, and the NHS says cold weather may make dandruff worse. The American Academy of Dermatology's advice for winter flares is to dress for the weather, including a hat outdoors, and to avoid hot showers and baths, which dry the skin and scalp. If your flakes return every winter, go back to the step 4 routine with the medicated shampoo as soon as they start.
Only in one narrow case that we could find. The 2015 review says deficiencies of pyridoxine (vitamin B6), zinc, niacin, and riboflavin can cause a rash that looks like seborrheic dermatitis. A doctor diagnoses a deficiency, so do not start supplements on your own to treat flakes. We could not find a trial showing that eating more or less of any food clears dandruff in people without a deficiency, so the shampoo routine in steps 2 to 5 does the work.
Not on a baby. Scaly, greasy patches on a baby's scalp are usually cradle cap, a type of seborrheic dermatitis, and the American Academy of Dermatology says dandruff shampoo is not recommended for children. It says cradle cap clears on its own in a few weeks to months and can be treated at home with baby shampoo and by gently removing the loosened scales. For an older child, read the label. Nizoral's ketoconazole 1% shampoo is for adults and children 12 years and over and says to ask a doctor for children under 12. Both dandruff shampoo labels we read say to keep the bottle out of the reach of children and to contact Poison Control (1-800-222-1222 in the US) if it is swallowed.
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