Treatment Methods for Scalp Dandruff

dermatologist's treatment tips for scalp dandruff

Treatment tips for scalp dandruff can help control stubborn scalp flaking and itching. Often confused with "dry scalp," scalp dandruff can be irritating and even embarrassing. You don't have to live with this. Over the years, I have treated many patients with dandruff. Follow my tips below to treat scalp dandruff.

Check Out My Dermatologist's Instructions for Treating Scalp Dandruff

The main treatment for scalp dandruff is the use of medicated dandruff shampoos. It is important to understand that the scale and itch may look like dry skin, but it's not! It is a rash and that rash can get worse when you don’t shampoo. Shampoo delivers medicated ingredients, washes off oil, and removes the dead skin cells that seem to help the Pityrosporum yeast flourish in seborrhea. The bottom line is that washing your hair will help you to better control this scalp problem. Try to shampoo as often as possible. Initially, you may want to shampoo every day until your scalp is controlled. Remember, shampooing delivers medicine to the scalp skin and it also helps to remove the oils, scale, and yeast that contribute to dandruff.

Instructions for Using Medicated Shampoos to Fight Dandruff

You may think you know the best way to shampoo your hair. However, there are 5 tips specific to treating dandruff, which are outlined here.

5 Tips to Control Dandruff with Shampoo

  1. Lather and rinse your hair twice each time you wash.
  2. Each lather needs to reach down to the skin of your scalp, where dandruff starts.
  3. best scalp scrubber to heal dandruff
    Evenly cover the skin with suds and rub or scrub them into the scalp using your finger tips or a scalp scrubber. I love scalp scrubbers and searched the globe for the best one. Click here to order this great scalp scrubber.  
  4. Use your favorite non-medicated shampoo for your first lather. This lather will remove oil, dirt, dead cells, and hair care product from your scalp and hair. Rinse well until you feel no suds or slippery shampoo residue, especially on the scalp skin.
  5. For your second lather, use your medicated shampoo. Be certain that the shampoo is evenly distributed across your entire scalp. Scrub it in with your fingertips or the scalp scrubber. Allow the shampoo to stay on your scalp for about five minutes before rinsing. To achieve this, it is best to wash your hair first then do all the other things you do in the shower. Once done with those tasks about five minutes have passed and you can rinse your scalp and proceed with hair conditioner if needed. After rinsing off your medicated shampoo, be certain to remove all shampoo residue. Then, you can follow up with conditioners or the other hair care products that you like to use.

What Is the Best Medicated Shampoo to Treat Dandruff?

dermatologist recommended best dandruff shampoo

My favorite dandruff shampoo ingredient is pyrithione zinc at a concentration of 2%. This is the maximum allowed. This ingredient treats the Pityrosporum yeast which plays a yet mysterious role in dandruff. It is also an ingredient that I find to be the least harsh on fine or color-treated hair. Know that all dandruff shampoos can be harsh on hair, which is why you really only need to focus on applying them to your scalp skin. My Foaming Zinc Cleanser is the ideal shampoo and the product that I use for my own dandruff control on my fine and color treated hair. 

If one ingredient, such as pyrithione zinc, is not sufficient to control stubborn dandruff, then rotate active ingredients until your dandruff "pays attention" to your treatment. To do this, use a different type of medicated ingredient each time that you shampoo for that second medicated lather.

Know that your scalp may quit responding to one ingredient and by rotating through at least three different ones you will have more power over this vexing rash. The phenomenon is called tachyphylaxis, which is when a medical condition gets used to a medicine. Seborrhea is a condition prone to tachyphylaxis.

Continue using your medicated shampoos until at least one month after your scalp is controlled. If you stop too soon, the dandruff may come back faster than if you really chase it away with persistent treatment.

Many medicated shampoos are harsh to your actual hair shafts. If you have fine or fragile hair, then take care to only apply the shampoo to your scalp skin. There’s no need to lather up the full length of your hair shafts because you cleaned them with your first, non-medicated shampoo product. As the medicated shampoo rinses over the hair shafts it will be in a dilute concentration and so less harsh than if you applied a full lather to each shaft.

What Are the Active Medicated Ingredients in Dandruff Shampoos?

treatment tips for scalp dandruff

There may seem like there are many dandruff shampoos to choose from, but over-the-counter medicated shampoos basically only have five different ingredients. When you're staring at the shelf of dandruff products in your drug store, realize that all these brands really form only five choices of ingredients, but at varied strengths. Pick the ones with the highest concentration of active ingredients (noted below in parentheses). You should pick at least three different active ingredients and rotate the products.  The product ingredients are:

1) Zinc Pyrithione 

My favorite ingredient, zinc pyrithione seems to be gentler on fine hair than the other dandruff medicines. My Foaming Zinc Cleanser is made with the maximum strength (2%) of zinc pyrithione. It is an excellent shampoo and is also a great body wash for seborrhea on the back, chest, and even skin folds. Click here to order Foaming Zinc, my favorite dandruff shampoo. Another option is DHS Zinc Shampoo. DHS Zinc is also made with 2% pyrithione zinc but it has a fairly strong fragrance. Additional options with lower concentrations of zinc pyrithione include:

  • Many Head and Shoulders products (1%)
  • Zincon (1%)
  • Herbal Essences No Flakin’ Way Pyrithione Zinc Anti-Dandruff Shampoo (1%)
  • Neutrogena T-Gel Daily Control Dandruff Shampoo (1%)
best soap for seborrhea
New products enter the market daily. The trick is to turn the bottle over and read the active ingredient and concentration on the back label. My full 2% pyrithione Zinc Bar Soap can lather on the scalp if there is not an abundance of hair. It is my favorite soap for facial seborrhea.


2) Salicylic Acid with or without Sulfur

These medicines are also fairly gentle on fine or treated hair. Products include:

  • Denorex Extra Strength (3% salicylic acid)
  • Selsun Blue Naturals (3% salicylic acid)
  • DHS Sal Shampoo (3% salicylic acid)
  • Neutrogena T/Sal Therapeutic Shampoo (3% salicylic acid)
  • P&S Shampoo (2% salicylic acid)
  • Sebulex (2% sulfur, 2% salicylic acid)

3) Ketoconazole

This is an antifungal product that used to be a prescription but is now available in half-strength over the counter. It’s reasonably gentle on fine hair. The brand name product is Nizoril (1% ketoconazole).

4) Selenium Sulfide

This very effective ingredient has been around for years. It’s a little harsh on fine and color-treated hair. Products include Selsun Blue (1%) and Head and Shoulders Intensive Treatment (1%).

5) Tar

This is an ingredient that works really well, but will yellow light-colored hair. It also smells like tar and no amount of perfume can mask that smell in your hair. The tar concentration can be described with different terms. The coal tar concentration is listed in parentheses. (Tar is my favorite ingredient for scalp psoriasis, which can look like seborrhea but is much more severe.) Products include:

  • Denorex (2.5%)
  • T/Gel Therapeutic Shampoo (0.5%)
  • T/Gel Extra Strength (1%)
  • DHS Tar (0.5%)
  • MG 217 Medicated Tar Shampoo (3%)
  • Tarsum Shampoo/Gel (2%)

What Can You Do To Treat Dandruff If It Is Not Controlled By Using a Medicated Shampoo? 

Sometimes medicated shampoos alone aren’t enough to clear stubborn scalp dandruff. If your scalp doesn’t clear after you’ve diligently rotated through the medicated shampoos, then it’s time for more intensive scalp treatments and medicated leave-on products.

Topical Leave-on Medicated Products for Scalp Dandruff

For stubborn dandruff and for faster relief than using medicated shampoos alone, you can apply leave on-products to the affected areas.

Non-prescription medicated scalp treatment options for dandruff include hydrocortisone and salicylic acid liquids. - Dr. Bailey

Typically, these products will instruct you to use the product twice a day until your scalp clears.  Remember to follow the directions on the product labels.  Product options include:

  • Scalpicin Maximum Strength with 1% Hydrocortisone
  • Scalpicin with 3% Salicylic Acid
Your doctor can prescribe stronger cortisone products if your scalp seborrhea won’t clear with these non-prescription options.

Intensive Scalp Treatments to Remove Thick Scale and Stubborn Dandruff

If you have stubborn plaques of really thick scale, you can loosen them with oil treatments or P&S liquid.

Oil Treatment

Slightly warm mineral oil or coconut oil in the microwave (of course be careful not to heat it to the point that it burns your skin!) I prefer extra virgin coconut oil because it has natural antimicrobial properties and it seems more effective. Apply the warmed oil to the scalp plaques for 30 minutes under a towel. Comb the plaque to loosen the scale then shampoo your scalp to remove the oil. Use your medicated shampoo as your last lather as directed above.

P&S Liquid

Apply the liquid to the scalp plaques and cover with a shower cap for 8 hours. Then shampoo your scalp as described above. Repeat your scalp treatment daily until your seborrhea is controlled. You can apply one of the leave-on treatments above after shampooing for maximal therapy.

Please remember that if your scalp does not improve, you should see your doctor to be certain that you don’t have some other more unusual reason for an itchy and scaly scalp. There are a number of conditions that can cause scalp scale including psoriasis, which often appears like really stubborn scalp dandruff.

Find the type of dandruff that you have and click below to see the routine I recommend:

Treatment for scaly, itchy, "dry scalp" from dandruff (this article)

Treatment for crusty ears from dandruff (seborrheic dermatitis)

Treatment for "dry" redness and scale in the eyebrows, on the nose, and on the face from seborrhea

Treatment for eyelash line redness and scale from seborrhea (seborrheic blepharitis)

Treatment for seborrheic dermatitis of the back, chest and skin folds