Treatment

The itching and flaking of dandruff can almost always be controlled. For mild dandruff, first try regular cleansing with a gentle shampoo to reduce oil and skin cell buildup. If that doesn't help, try a medicated dandruff shampoo. Some people can tolerate using a medicated shampoo two to three times a week, with regular shampooing on other days if needed. People with drier hair would benefit from less frequent shampooing and a moisturizing conditioner for the hair or scalp.

Hair and scalp products, both medicated and nonmedicated, are available as solutions, foams, gels, sprays, ointments and oils. You may need to try more than one product to find the routine that works for you. And you'll likely need repeated or long-term treatment.

If you develop itching or stinging 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. Some are available in stronger formulations by prescription.

• Pyrithione zinc shampoos (DermaZinc, Head & Shoulders, others). These contain the antibacterial and antifungal agent zinc pyrithione.
• Tar-based shampoos (Neutrogena T/Gel, Scalp 18 Coal Tar Shampoo, others). Coal tar slows how quickly skin cells on your scalp die and flake off. If you have light-colored hair, this type of shampoo may cause discoloration. It can also make the scalp more sensitive to sunlight.
• Shampoos containing salicylic acid (Jason Dandruff Relief Treatment Shampoo, Baker P&S, others). These products help eliminate scaling.
• Selenium sulfide shampoos (Head & Shoulders Intensive, Selsun Blue, others). These contain an antifungal agent. Use these products as directed and rinse well after shampooing, as they can discolor the hair and scalp.
• Ketoconazole shampoos (Nizoral Anti-Dandruff). This shampoo is intended to kill dandruff-causing fungi that live on your scalp.
• Fluocinolone shampoos (Capex, Derma-Smoothe/FS, others). These products contain a corticosteroid to help control itching, flaking and irritation.

If one type of shampoo works for a time and then seems to lose its effectiveness, try alternating between two types of dandruff shampoos. Once your dandruff is under control, try using the medicated shampoo less frequently for maintenance and prevention.

Read and follow the directions on each bottle of shampoo you try. Some products need to be left on for a few minutes, while others need to be rinsed off quickly.

If you've used medicated shampoo regularly for several weeks and still have dandruff, talk to your doctor or dermatologist. You may need a prescription-strength shampoo or a steroid lotion.