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Best Tips to Control Dandruff

Dandruff … just the word is enough to make you check your shoulders for telltale white flakes! You might feel an urge to itch your scalp, even if you don’t have dandruff. If you do struggle with dandruff and its embarrassing effects, understanding what’s happening and knowing what you can do to control the problem will greatly improve your confidence.

What is Dandruff

Dandruff is a skin disorder also known as seborrheic dermatitis. It’s triggered by overproduction and buildup of skin cells of the scalp, which, once dead, shed either as clumps or individual flakes. Dandruff is sometimes accompanied by an itchy scalp, but not always.

Many studies have identified a type of fungus, generally known as Malassezia, as the primary cause of the problem. This fungus lives naturally on the scalp of many people, but is especially abundant on the scalps of those who struggle with dandruff.

Despite the conclusions of the research that identify Malassezia as the culprit, treatment options for dandruff have not changed much over the years. In fact, the same ingredients in anti-dandruff products that have been used for years are still effective for reducing the amount of fungus present, thus controlling the symptoms.

Is it Dandruff or Something Else?

Now for the tricky part: not all cases of flaky scalp are dandruff. Flaky scalp can be the result of seasonal dry scalp, a buildup of hairstyling products, or a side effect of topical medications like Rogaine (minoxidil), all of which can cause flaking that is easily mistaken for dandruff.

Fortunately, it’s simple to determine whether it’s dandruff or not. If the flakes stop when the season changes again, or when you stop using heavy styling products, or when you stop applying minoxidil, you know it’s not dandruff. True dandruff is a persistent problem that is rarely affected by the climate or by the products you use.

What Works to Treat Dandruff?

For a flaky scalp that is indeed due to dandruff, we describe some of the best, research-supported ingredients and products to consider below. Keep in mind that dandruff products do NOT have to be expensive; don’t waste your money believing that expensive haircare means better results—it’s just not true.

  • Zinc Pyrithione (ZPT) shampoos and conditioners: ZPT is the oldest and the most often used anti-dandruff ingredient. It’s found in many antifungal shampoos and conditioners, including Head & Shoulders, Dove Dandruff Care, DHS Zinc Shampoo, and Zincon Medicated Dandruff products. If you have stubborn dandruff, check the label to make sure you’re using higher concentrations (2%). While these rinse-out products do help, leave-on products with ZPT often provide better results.
  • Zinc Pyrithione leave-on products: As mentioned above, shampoos with ZPT can be very effective, but leave-on products with ZPT can provide even better results. Like many ingredients, ZPT works best if left on the surface of skin so it remains there long enough to have a greater effect.

The only leave-on options with ZPT we’re aware of are Head and Shoulders Clinical Solutions Leave-On Dandruff Treatment and DermaZinc Cream. You’re instructed to massage the product into your scalp once or twice daily. You apply it at night and leave it in; in the morning, after shampooing your hair, you reapply it and leave it in all day.

Note: You can leave a shampoo or conditioner with ZPT on your scalp for a while before rinsing, but that still doesn’t give you the same results as a leave-on product.

  • Ketoconazole (KET): KET is another ingredient that can control proliferation of the fungus known to cause dandruff. Using a product with KET is a great option, especially if ZPT hasn’t worked for you. Nizoral is an example of a shampoo that contains KET. Products with 2% KET have been shown to be better for stubborn dandruff than other anti-dandruff ingredients.
  • Ketoconazole (KET) leave-on products: The same reason to use a leave-on product containing ZPT also applies to KET. Consult your physician for leave-on options medicated with KET, as such products are not available over-the-counter.
  • Combination of Ketoconazole and Zinc Pyrithione: If you don’t get the results you want from either a ZPT or KET product, it might be worth trying a product that contains both of these anti-fungal ingredients. This is something to discuss with your physician.
  • Coal tar: A by-product of coal after it’s processed has been shown to be very effective for dandruff and other forms of seborrheic dermatitis. The most well-known coal-tar shampoo is Neutrogena T-Gel (but there are others). Coal tar fights dandruff by slowing the rate at which the skin cells on your scalp die and flake off. It’s not the most elegant ingredient—it looks and smells bad—but it works. You’re likely to find information on the internet asserting that coal tar is a carcinogen, but the research is at best mixed, and many studies have shown it to be safe and effective.
  • Selenium sulfide: This works similarly to coal tar in that it slows the rate of skin cell death and thus the accumulation of dead skin cells. A bonus: Selenium sulfide doesn’t have the odor or aesthetic issues of coal tar. You can find selenium sulfide in Selsun Blue shampoo and Head & Shoulders Clinical Strength Dandruff and Seborrheic Dermatitis Shampoo, among others.
  • Salicylic acid: Also known as BHA, salicylic acid is an exfoliating superstar that helps slough off excess skin cells anywhere they accumulate on skin, including on the scalp. It can be very effective for dandruff and presents less risk of irritation than other options for treating this concern. BHA also has anti-inflammatory and antimicrobial properties, making it an option for addressing itchy, flaky scalp and reducing the Malassezia fungus. Popular shampoos with salicylic acid are Denorex and Neutrogena T/Sal Therapeutic Shampoo.
  • Tea Tree Oil (Melaleuca): When it comes to any skin condition, the desire for a natural solution is, well, a natural inclination. Tea tree oil is one of the only natural options for dandruff that has any research behind it, although that isn’t saying much because the research is very limited; also, the research is often performed by the company doing the study, and so it might be biased. However, tea tree oil does have anti-fungal properties that might be helpful for mild forms of dandruff. Several shampoos and conditioners contain tea tree oil, including Paul Mitchell Tea Tree Special Shampoo and Kiehl’s Tea Tree Oil Shampoo. Going the “natural” route will cost you more, but the results won’t necessarily be any better.

Inherently, the anti-fungal properties of all these anti-dandruff products present a risk of irritation, which often can be mitigated by changing how often you use them.

Tips for Getting the Best Results

When shampooing, use gentle circular motions to massage the scalp. This encourages dead skin cells to lift off the surface.

Don’t scratch! Scratching damages the scalp, increasing the fungus and scaling that causes dandruff.

The active ingredients in medicated dandruff shampoos can be drying and irritating (even when the label claims they’re not), another reason not to scratch because scratching allows those ingredients to penetrate beyond the skin’s barrier.

Consider alternating your medicated shampoo with your un-medicated shampoo. Use the medicated version only enough to keep the dandruff under control.

On the days you use a medicated shampoo, try leaving it on your scalp for 2–3 minutes to give the medicine time to work. But be sure to rinse well because leaving traces of the shampoo ingredients on the scalp can be irritating, which can increase itching and flaking.

If trying over-the-counter treatments for several weeks doesn’t produce noticeable results, you should see a dermatologist. The dermatologist will be able to better pinpoint the cause of your flakiness and can prescribe a stronger treatment that might finally be able to get it under control.

If you have a flaky scalp, don’t use heavy conditioners or oils. Excess oil, whether it’s produced naturally by your scalp or is from the products you use, can increase the presence of the fungus that causes dandruff. These products also hold skin cells down, increasing the flaky buildup you want gone.

Flakiness also can result from highly fragranced haircare products or products that contain irritating ingredients (such as mint, citrus, or eucalyptus). Fragrance (including from the essential oils found in many haircare products) and other irritants also can lead to an itchy scalp, which only encourages flaking.

You may get the best results by alternating the different active ingredients in over-the-counter anti-dandruff shampoos. Try alternating two or three different medicated shampoos, switching every few days.

References for this information:

BMC Dermatology, May 2017, page 5
Australasian Journal of Dermatology, May 2017, pages 80–85
Journal of Drugs in Dermatology, February 2016, pages 140–144
Applied Microbiology and Biotechnology, October 2016, pages 8865–8875
International Journal of Dermatology, May 2016, pages 494–504; August 2015, pages 868–879, and July 2013, pages 784–790
Journal of Clinical Investigative Dermatology, December 2015, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4852869/
Urologic Oncology, January 2015, pages 19–20
Seminars in Cutaneous Medicine and Surgery, September 2013, pages 140–146
International Journal of Cosmetic Science, August 2012, pages 298–306
Journal of Investigative Dermatology, April 2010, pages 953–961
International Journal of Trichology, January 2010, page 68
International Journal of Toxicology, 2008, Supplemental, pages 1–24
Skin Pharmacology and Applied Skin Physiology, November-December 2002, pages 434–441
Dermatology, February 2001, pages 171–176
National Center for Complementary and Integrative Health, https://nccih.nih.gov/health/tea/treeoil.htm