How to get rid of dandruff

Dandruff is one of the most common scalp conditions, affecting around half the worldwide population (1). While it isn’t harmful, it can be itchy, frustrating, and even embarrassing.

The good news is that with the proper knowledge and products, dandruff is entirely manageable. In this guide, we’ll explore the causes of dandruff, what might trigger flare-ups, and how you can effectively tackle the problem of a flaky, itchy scalp.

What is dandruff?

Dandruff is a condition where the scalp sheds excessive amounts of skin cells, resulting in visible white flakes, often more obvious in dark hair. It’s usually accompanied by dryness and itching (2).

Shedding of the skin is normal; your skin constantly produces new cells and sheds the old ones to stay healthy. However, people with dandruff usually shed skin more quickly, causing larger patches of skin to flake off. While not harmful, it is somewhat embarrassing, and many people want to know how to get rid of dandruff. To do that, we need to understand what causes dandruff in the first place.

What causes dandruff?

Most people assume that dandruff is caused by dry skin, but this isn’t entirely accurate. While a dry scalp can flake and itch, the root cause of dandruff is usually a type of yeast-like fungus called Malassezia that exists naturally on our scalps.

Malassezia is a healthy part of the skin’s microbiome (3)—not only for humans but for many animals (4)—but too much of it can cause an itchy, flaky scalp. Malassezia thrives in oily environments. The excess sebum combines with dead skin cells, creating a perfect food source for the microbe that can cause it to grow in excess. Therefore, it’s often an oily scalp, rather than a dry scalp, that is responsible for dandruff.

What causes dandruff flare-ups?

Some people have permanent dandruff, but many of us will experience flare-ups caused by changes to our environments or psychological states (5). Here are some potential triggers that could contribute to having a flaky scalp:

• Weather changes: Dandruff can worsen in colder months, particularly among people with light skin (6). One reason for this is that people often wear hats to keep warm, which trap moisture and heat. This creates the perfect warm, moist, dark environment that the Malassezia microbe loves.
• Emotional stress: Stress impacts the entire body, affecting our hormonal systems and immune responses. By disrupting these systems, stress worsens many skin conditions, including rosacea, eczema, itching, and – you guessed it – dandruff. Chronic stress or one-off highly stressful experiences could cause a flare-up (7).
• Hair care habits: Leaving the scalp damp for too long can create the ideal environment for yeast to thrive. Heavy, oil-based hair products have the same effect. Unfortunately, based on the myth that dandruff is caused by dry skin, many people use an oil-based, dry scalp treatment to improve dandruff. Little do they realise they’re likely making it worse!

Importantly, dandruff is not caused by poor hygiene—washing your hair more won’t stop the fungus from growing excessively. However, some dead skin flakes will be washed out with every shampoo, so your dandruff might look more noticeable if you don’t wash your hair regularly.

How can I get rid of dandruff?

The best way to tackle dandruff is by addressing the root cause: controlling yeast overgrowth. And the most effective way to do this is by using an anti-dandruff shampoo.

Some of the best anti-dandruff shampoos are products like Nizoral, an anti-fungal shampoo that contains an ingredient called ketoconazole. Ketoconazole reduces the amount of Malassezia on the scalp, bringing balance and eliminating flakes.

How to use Nizoral anti-dandruff shampoo

Using Nizoral is the same as using a regular shampoo—apply it to wet hair and massage it gently into your scalp—so you can easily integrate it into your routine. However, you should leave the shampoo on your scalp for 5 minutes before rinsing thoroughly to allow the ketoconazole to work.

You should aim to use the shampoo twice weekly and start seeing improvements after a couple of weeks. We recommend you continue shampooing for a few more weeks to ensure the yeast is under control. If you regularly suffer from an itchy scalp, you might want to keep using Nizoral anti-dandruff shampoo as an ongoing, once-a-week treatment, as it can stop dandruff from returning (8).

Otherwise, you could switch to a milder anti-dandruff shampoo like Head & Shoulders, which is gentler on the skin. Regular shampoo is also fine, but steer clear of products designed for dry hair. These are overly moisturising and will recreate the moist environment that Malassezia loves.

Dryness and ketoconazole shampoos

Anti-fungal shampoos containing ketoconazole are excellent dandruff treatments, but they are powerful cleansers and can leave your hair and skin feeling dry (9). To counteract this, you can:

• Use a conditioner or hair oil, but only apply it from the mid-lengths to the ends of your hair (you don’t want to re-introduce moisture to the scalp).
• Try using less shampoo or rinsing it off quicker.

Remember, you only need to use ketoconazole shampoo for a few weeks to see improvements, after which you can switch to a gentler anti-dandruff or regular shampoo. If dry hair is your only negative of using the treatment, it might be worth persisting—it’s a few weeks of dryness for a flake-free scalp. However, stop using the product if your scalp is very itchy or irritated or your dandruff worsens.

What other anti-dandruff shampoos are there?

Anti-fungal shampoos like Nizoral are generally considered the best anti-dandruff shampoo, especially for severe cases. These products directly reduce the Malassezia microbes responsible for causing an itchy, dry scalp. But they aren’t your only option.

Shampoos with the following ingredients can also help you manage your symptoms (2):

• Zinc pyrithione: Zinc pyrithione is the active ingredient in Head & Shoulders. It is an antibacterial and antifungal agent, but it’s milder than ketoconazole and doesn’t dry your hair as much. These shampoos are best for mild to moderate dandruff or suitable for use as a maintenance treatment after Nizoral has worked its magic.
• Salicylic acid: Salicylic acid shampoos work by removing flaky skin. It does this by exfoliating the scalp and breaking down clumps of skin skills by weakening the bonds that hold them together. It might be a good choice if you’ve got thick, plaque-like scales or a scabby scalp, but it can make your scalp more itchy than Nizoral.
• Selenium sulphide: Like Nizoral, selenium sulphide 2.5% shampoo is an antifungal treatment that directly reduces Malassezia overgrowth. Several studies have shown it can effectively treat severe dandruff and works best when used 2 to 3 times per week (10). However, it isn’t as well tolerated as ketoconazole (11).  
• Coal tar: Coal tar is the ingredient in shampoos like Neurogena’s T/Gel and works by slowing the overproduction of skin cells on the scalp, reducing flaking and scaling. Although effective, these shampoos have a strong smell that you might find offputting, and they don’t work as well as other dandruff treatments like salicylic acid (12).

Each ingredient targets dandruff in different ways, so choosing the best shampoo for dandruff depends on your specific symptoms, scalp type, and skin sensitivity. We recommend trying Nizoral first and exploring other options if you don’t get along with the product.

Additional tips for dandruff treatment

1. Dry your scalp thoroughly: After washing your hair, ensure your scalp is completely dry. You can leave your hair to dry naturally if you want, but avoid tying it up, as this stops air from reaching the scalp and drying it, creating a moist environment in which fungus thrives.
2. Avoid a sweaty scalp: Keeping your scalp dry after exercise is also key. Things like cycling to work, getting sweaty, and sitting in a warm office where the sweat doesn’t dry can make your scalp the ideal environment for Malassezia to rapidly grow.
3. Avoid overly moisturising hair products: Stick to shampoos designed for oily or normal hair, avoiding those targeted at dry hair or containing oils. If you have dry hair, you can use a more intensive conditioner treatment, but only on the ends of your hair.
4. Maintain good hair hygiene: We’ll say it again: dandruff is not caused by poor hygiene. However, regularly washing your hair can make any white flakes appear less noticeable, and regularly washing your hair with the right products can get rid of your dandruff.
5. Consistency is key: Dandruff tends to recur, so ongoing management is important. Once your dandruff has cleared, we recommend continuing with Nizoral shampoo once every week or two to keep symptoms at bay or switching to a milder and gentler anti-dandruff shampoo.

What is the best seborrheic dermatitis treatment?

Seborrheic dermatitis is a skin condition on the same spectrum as dandruff (13). Like dandruff, it’s caused by excess Malassezia yeast, typically follows a cycle of flare-ups and periods of clearing, and can be triggered by weather or stress (14). But while dandruff affects the scalp, seborrheic dermatitis can cause red, flaky, itchy patches on the eyebrows, forehead, and behind the ears.

Over-the-counter antifungal shampoos like those containing ketoconazole are still the go-to treatment as per NICE guidelines (15). However, the shampoo should be used as a facewash, focusing on the irritated areas. If it dries your skin, follow it with an oil-free, water-based moisturiser.

You can buy Nizoral at Oxford Online Pharmacy and take the first step toward a flake-free scalp. If you’ve already tried antidandruff shampoos and haven’t seen any improvement, speak to your doctor.

How to get rid of dandruff: FAQs

Q: Why is my scalp so itchy?

A: An itchy scalp is often caused by irritation from dandruff. Other causes might include dry skin, allergic reactions to hair products, or conditions like psoriasis or eczema.

Q: How can I cure dandruff permanently?

A: There’s no permanent cure for dandruff, but it can be managed effectively with proper habits. Use of anti-dandruff shampoos, maintaining a dry scalp, and avoiding oil-based products can help.

Q: Does dandruff cause hair loss?

A: Dandruff itself doesn’t directly cause hair loss, but excessive scratching can damage your hair follicles and weaken the hair shaft, leading to breakage and hair thinning.  

Q: Is dandruff a sign of poor hygiene?

A: Not at all! Dandruff is a common condition and has more to do with natural factors like oil production and yeast balance than with cleanliness.

Citations

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10. Gauri Godse, Kiran Godse. Safety, Efficacy and Attributes of 2.5% Selenium Sulfide Shampoo in the Treatment of Dandruff: A Single-Center Study. Curēus [Internet]. 2024 Mar 28.‌
11. Danby FW, Maddin WS, Margesson LJ, Rosenthal D. A randomized, double-blind, placebo-controlled trial of ketoconazole 2% shampoo versus selenium sulfide 2.5% shampoo in the treatment of moderate to severe dandruff. Journal of the American Academy of Dermatology. 1993 Dec;29(6):1008–12.‌
12. Piérard-Franchimont C, Piérard GE, Vroome V, Lin GC, Appa Y. Comparative Anti-Dandruff Efficacy between a Tar and a Non-Tar Shampoo. Dermatology. 2000;200(2):181–4.‌
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