Dandruff (Itchy Scalp)
Why do I have dandruff (dry and itchy scalp)?
Dandruff is very common—it affects up to one-third of teens and adults. It often gets worse in the winter and during times of stress. Some people notice white flakes (dead skin), while others have itchy, red, and scaly spots on the scalp. In babies, it is called cradle cap - see my page on Cradle Cap.
In teens/adults, these red, flaky patches can also show up:
Behind or inside the ears
In the eyebrows
Around the nose
In the beard area (for men)
On the middle of the chest
If you have flakes and irritation in these areas, check out my page on Facial Dandruff.
How do I fix dandruff?
The main treatment for dandruff is a medicated shampoo. Different shampoos work in different ways because they have different active ingredients, so if one doesn’t help, try another.
Remember: More expensive doesn’t mean better results.
For a long time, I used store-brand Head & Shoulders. Recently, I tried CeraVe’s new dandruff shampoo—and it’s the first one I’ve found that’s great for both your hair and your scalp.
Shampoos with Active Ingredients:
Zinc pyrithione:
CeraVe shampoo (1%) and conditioner (0.5%)
Head and Shoulders (1%)
Vanicream (2%, good for sensitive skin)
Amazon brand (1%)
Selenium sulfide: Selsun Blue
Salicylic acid: T/Sal
Coal Tar (0.5%): DHS or Amazon brand
NOTE: Coal tar shampoos often have a strong smell, but they work well for dandruff. To get rid of the odor, use a conditioner after shampooing.
Ketoconazole: Nizoral
How do you use dandruff shampoo correctly?
Most people don’t use dandruff shampoo the right way. Just rubbing it on and rinsing quickly won’t help.
To clear dandruff (Use EVERY DAY for 1 week):
Wet your scalp in the sink or shower.
Massage dandruff shampoo into your scalp, focusing on the skin under the hair.
Wrap a towel around your head and leave the shampoo on for 30 minutes.
Rinse out the dandruff shampoo. You can use regular shampoo or conditioner after for your hair.
To Keep Dandruff Away (Use 1–2 times a week):
Wet your hair at the start of your shower or bath.
Massage dandruff shampoo into your scalp, focusing on your skin.
If you have red or scaly spots on your face, you can use the shampoo there too.
Important Tips:
All dandruff shampoos sting your eyes!
To avoid burning, apply shampoo to your eyebrows like a lotion 10 minutes before your shower, then rinse it off during your shower.
Leave dandruff shampoo on your scalp for 5–10 minutes (longer is better!) so the medicine can work.
Rinse the shampoo out at the end of your shower, then use your favorite regular shampoo or conditioner on your hair.
How long do I have to use dandruff shampoo?
Dandruff and itchy scalp are ongoing problems that usually need long-term use of medicated dandruff shampoo to keep under control.
Some people only need to use it once or twice a week to stay clear.
What do I do for my dandruff if the steps above aren’t working?
If dandruff doesn’t improve with the basic steps, try these extra tips:
A few times a week, wet your scalp and massage in your medicated shampoo. Then wrap your hair in a towel for 60 minutes while you eat breakfast or scroll on your phone. Then rinse off in the shower.
You can mix 3–4 different medicated dandruff shampoos in an empty bottle to use together. But this makes it hard to know which active ingredient is helping your scalp the most.
Another option is to use a different shampoo daily for a week to find which one works best for you.
Sometimes your dandruff shampoo may stop working. If that happens, switch to a different active ingredient for a few weeks. Then, go back to your original shampoo—it will often work again.
Should I buy an expensive dry scalp shampoo?
No! Don’t waste your money on pricey “dry scalp” shampoos.
Always check the active ingredient on the back label. The best dandruff shampoos list proven ingredients like ketoconazole, selenium sulfide, or zinc pyrithione at the top.
Some expensive shampoos with tea tree oil might help, but they haven’t been proven to work as well as medicated options.
What if my dandruff isn’t getting better?
The steps above help most people clear their dandruff. But sometimes, itchy scalp can be caused by other conditions like contact allergies or psoriasis. If over-the-counter shampoos don’t work, prescription topical steroid solutions can help control the problem. If you need extra help, look for a board-certified dermatologist near you. If you are in or near Utah, see one of my excellent colleagues at the University of Utah or me virtually with Honeydew.
DISCLAIMER
The statements expressed and content of this website are not intended to be a substitute for professional medical advice. Readers should seek their own professional counsel for any medical condition or before starting or altering any treatment, exercise, or dietary plan. Please see our full disclaimer here.