Help for Dandruff: What Really Works

Flakes in your hair (and on your clothes!) are an embarrassing issue most people encounter at some point in their lives. Find out if the flaking is dandruff or something else – and learn what you can do to get it under control!

In This Article:

Dandruff. Just the word is enough to provoke embarrassment in those who struggle with it. But what is dandruff? Simply put, it’s an overproduction and buildup of sticky skin cells of the scalp which shed either as clumps or as individual flakes. Sometimes dandruff is associated with itching and crusting on the scalp. Over the past several years, many studies have identified a fungus—Malassezia—as the cause of the problem. This fungus lives naturally on the scalps of many people, but it is overly abundant on those who have dandruff.[1]

Here’s the tricky part: Not all flakes on the scalp are dandruff! Dry scalp, a buildup of styling products (like hairsprays and gels), and medications like Rogaine (minoxidil) all can cause flaking, which you might mistake for dandruff. To treat the problem, you need to know what you’re dealing with.

Is It Dandruff, or Something Else?

Here’s how to tell the difference between a flaky, itchy scalp caused by dandruff and a flaky scalp caused by dry skin on the scalp, a buildup of styling products, or the use of minoxidil:

  • The flakes caused by dandruff are white, and tend to have a thick, heavy texture. Itching, if it occurs, tends to be all over the scalp, not just in localized areas. Flakes are noticeable on the scalp as well as in the hair.
  • Flakes caused by a buildup of styling products tend not to be white (they’re more translucent), and will appear on the hair and usually not the scalp. Itching can occur all over the scalp, especially if the styling products you use are highly fragranced.
  • Flakes caused by using minoxidil occur in scaly sheets of off-color skin in the areas where the medication is applied. Itching, if present, is confined to areas minoxidil was applied.

What Works to Treat Dandruff?

If your flaky scalp is due to dandruff, here are some of the best, research-supported products and ingredients for treating it:

  • Antifungal agents: As mentioned above, fungus is the common culprit when it comes to dandruff, so attacking the problem with a broad-spectrum antifungal ingredient (such as ketoconazole) can be helpful.[2] Nizoral is an example of a shampoo that contains ketoconazole.
  • Zinc pyrithione: This is another antifungal topical medication, which does double duty by also discouraging bacteria.[3] Selsun Salon and Head & Shoulders rely on this ingredient for their dandruff-busting effects.
  • Coal tar: The most well-known coal-tar shampoo (and one that works) is Neutrogena T-Gel. 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—OK, it really does look and smell bad—but it’s absolutely worth considering if you want to control stubborn dandruff.
  • Selenium sulfide: This works in a fashion similar to coal tar in that it slows the rate of skin cell death and thus the accumulation of dead skin cells, but it doesn’t have the odor or aesthetic issues of coal tar. You can find selenium sulfide in Selsun Blue shampoo, among others.
  • Salicylic acid: This exfoliating superstar (also known as beta hydroxy acid [BHA]) aids in sloughing off the excess skin cells that, if they accumulate on the scalp, result in dandruff. It also has anti-inflammatory and antimicrobial properties, making it a great option for addressing flaky scalp from multiple causes. Paula’s Choice Skincare offers a wide range of BHA exfoliants so you can choose an option that works best for you.

Note: Some dandruff sufferers find that they get the best results by alternating the use of different over-the-counter antidandruff shampoos. For whatever reason, they can keep their dandruff at bay if they use two or three medicated shampoos (alternating every few days), but not if they stick with just one type of medicated shampoo. Strange, but worth a try to see if it works for you!

When shampooing, use gentle circular motions to massage the scalp and encourage dead skin cells to lift off the surface. Don’t scratch! That damages the scalp, and increases the fungus that causes dandruff.

Because medicated dandruff shampoos are drying (even when the label claims they’re not, the active ingredients can be drying), you might alternate, using your medicated shampoo on one day and your un-medicated one the next. 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 two to three minutes to give the medicine time to work. But be sure to rinse well because leaving traces of the ingredients in dandruff shampoos on the scalp can be irritating, which can increase itching and flaking.

If after trying over-the-counter treatments for several weeks you still see no 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 the use of highly fragranced hair-care products or products that contain irritating ingredients (such as mint, citrus, or eucalyptus). Fragrance (including from essential oils found in many hair-care products) and other irritants also can lead to an itchy scalp, which only encourages flaking.

Solutions to Other Causes of Flaking

  • Dry scalp: To find out if the white flakes on your scalp are caused by a dry scalp, and thus are not dandruff, consider doing the following. The night before you’re going to wash your hair, apply a light moisturizing lotion to the dry areas and gently massage that into the scalp. When you shampoo in the morning, be sure to rinse well and apply a conditioner. If the problem is merely dry skin, this procedure should resolve it!
  • Flaking caused from buildup of styling products: Washing your hair more frequently and more thoroughly is a simple solution that will remove buildup immediately. You also may be using products that are more prone to buildup, such as gels and hairspray, so choose your styling products carefully and use less, not more.
  • Flaking caused by a reaction to minoxidil: Using minoxidil can cause irritation that leads to skin flaking. In addition, the ingredients in minoxidil that help it stick to the scalp can become flaky once they dry. Washing your hair daily is an easy solution for reducing irritation because it rinses the previous night’s minoxidil off and cleans off the other ingredients as well.

Now that you know what to do, it’s time to pull your dark clothes out of the closet, and playfully toss your hair like the women in the hair-product commercials do—no more flakes!

References Cited

  1. Manuel, F. Is Dandruff a Disease? Int J Trichology. 2010; 2(1): 68.
  2. Piérard-Franchimont C, Piérard GE, Arrese JE, De Doncker P.Effect of ketoconazole 1% and 2% shampoos on severe dandruff and seborrhoeic dermatitis: clinical, squamometric and mycological assessments.Dermatology. 2001;202(2):171-6.
  3. Marks R, Pearse AD, Walker AP.The effects of a shampoo containing zinc pyrithione on the control of dandruff.Br J Dermatol. 1985;112(4):415-22.
  4. Nowicki R.[Modern management of dandruff].Pol Merkur Lekarski. 2006;20(115):121-4.
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