Dandruff can almost always be controlled, but dandruff treatment may take patience and persistence. In general, daily cleansing with a gentle shampoo to reduce oiliness and skin cell buildup can often help mild dandruff.
When regular shampoos fail, dandruff shampoos you can buy at a drugstore may succeed. But dandruff shampoos aren't all alike, and you may need to experiment until you find one that works for you. If you develop itching, stinging, redness or burning from any product, stop using it. If you develop an allergic reaction, such as a rash, hives or difficulty breathing, seek immediate medical attention.
Dandruff shampoos are classified according to the medication they contain:
Zinc pyrithione shampoos (such as Head & Shoulders, Jason Dandruff Relief 2 in 1, others). These contain the antibacterial and antifungal agent zinc pyrithione, which can reduce the fungus on your scalp that can cause dandruff and seborrheic dermatitis.
Tar-based shampoos (such as Neutrogena T/Gel). Coal tar, a byproduct of the coal manufacturing process, helps conditions such as dandruff, seborrheic dermatitis and psoriasis by slowing how quickly skin cells on your scalp die and flake off.
Shampoos containing salicylic acid (such as Neutrogena T/Sal). These "scalp scrubs" help eliminate scale, but they may leave your scalp dry, leading to more flaking. Using a conditioner after shampooing can help relieve dryness.
Selenium sulfide shampoos (such as Selsun Blue). These shampoos slow your skin cells from dying and may also reduce malassezia. Because they can discolor blond, gray or chemically colored hair, be sure to use them only as directed, and rinse well after shampooing.
Ketoconazole shampoos (such as Nizoral). Ketoconazole is a broad-spectrum antifungal agent that may work when other shampoos fail. It's available over-the-counter as well as by prescription.
Try using one of these shampoos daily or every other day until your dandruff is controlled; then cut back to two or three times a week, as needed. If one type of shampoo works for a time and then seems to lose its effectiveness, try alternating between two types of dandruff shampoos. Be sure to massage the shampoo into the scalp well and then leave the shampoo on for at least five minutes — this gives the ingredients time to work.
If you've shampooed faithfully for several weeks and there's still a dusting of dandruff on your shoulders, talk to your doctor or dermatologist. You may need a prescription-strength shampoo or treatment with a steroid lotion.