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Health condition · Clinically reviewed

Dandruff, flakes, itch and the shampoos that actually work.

Not just cosmetic, and not just dry scalp. Dandruff is a mild yeast-driven scalp condition that responds well to a small set of medicated shampoos, used properly.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE, BAD and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK guidance including antifungal shampoos, topical steroids and calcineurin inhibitors.

Key facts

Dandruff at a glance.

The essentials, in plain English - what it is, why it happens, and how it’s treated in the UK today.

  • What it is

    Pityriasis simplex capitis - a mild, non-inflammatory scaling of the scalp that sheds small white or grey flakes.

  • How common

    Affects roughly half of all adults at some point - peaks in young adulthood and is slightly more common in men.

  • What drives it

    Overgrowth of Malassezia yeast on the scalp, sebum production and an individual irritant response to yeast metabolites.

  • Spectrum

    Sits at the mild end of the seborrhoeic dermatitis spectrum - the same process, without significant redness.

  • Foundation therapy

    Medicated shampoos - ketoconazole, selenium sulfide, zinc pyrithione or coal tar - used regularly for four to eight weeks.

  • Maintenance

    Once controlled, an antifungal shampoo once or twice a week keeps flakes and itch away long term.

Why this guide matters

A stepped plan, not a supermarket experiment.

Dandruff is very common and almost always controllable. The three points below shape everything else on this page.

  • Medicated shampoos are foundational

    Ketoconazole, selenium sulfide, zinc pyrithione and coal tar - used regularly and left on for a few minutes - do most of the work.

  • Steroids are short-course tools

    Topical steroid lotions help settle itch and inflammation for a few weeks, alongside a shampoo, not instead of it.

  • Maintenance is what keeps it away

    Dandruff comes back if you stop. An antifungal shampoo once or twice a week is the difference between clear and flaring.

How the diagnosis is made

From first flakes to a clear plan.

The steps a UK GP or dermatologist will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    Scalp exam and pattern

    A structured look at the scale, distribution across the scalp and whether the hair-line, ears or face are involved.

  2. 02

    Assessing

    Rule out seborrhoeic dermatitis

    Look for redness, greasy yellow scale on the face, brows, ears and chest - features that push the diagnosis along the spectrum.

  3. 03

    Assessing

    Rule out scalp psoriasis

    Thicker silvery plaques, well-demarcated edges, involvement of the hair-line and Auspitz sign point to psoriasis rather than dandruff.

  4. 04

    Confirming

    Consider tinea capitis

    Patchy hair loss, broken hairs and scale in children or immunocompromise warrant scalp brushings for fungal culture.

  5. 05

    Confirming

    Look for triggers

    Cold weather, stress, hormones, immunosuppression, Parkinson’s and HIV can all worsen scalp Malassezia activity.

  6. 06

    Treating

    Trial of medicated shampoo

    A four to eight week trial of an antifungal shampoo is both diagnostic and therapeutic in typical cases.

  7. 07

    Treating

    Dermatology referral if atypical

    Refractory, severe or diagnostically uncertain cases benefit from a specialist opinion and, occasionally, oral antifungals.

Typical timeline: a first visit to a settled plan in weeks, not months.

Symptoms

What dandruff actually looks like.

Fine flakes, mild itch and minimal redness - and the features that push the diagnosis towards seborrhoeic dermatitis, psoriasis or tinea instead.

  • Fine white or grey flakes

    Small dry-looking flakes shed from the scalp onto the shoulders - the hallmark feature.

  • Itchy scalp

    A persistent low-grade itch, often worse when the scalp is oily or after wearing hats.

  • Oily or dry scale

    Some people have a greasy, waxy scale; others have a dry, powdery one - both are dandruff.

  • Minimal redness

    The skin underneath is largely normal - visible redness pushes the diagnosis towards seborrhoeic dermatitis.

  • Diffuse scalp involvement

    Flakes are usually spread across the whole scalp rather than in well-defined patches.

  • Flares with cold weather and stress

    Winter, sleep deprivation, illness and stress reliably worsen scale and itch.

  • Adult form of cradle cap

    The same Malassezia-driven process that produces cradle cap in infants - just later in life.

  • Red flag - severe or refractory disease

    Rapid worsening, ulceration, hair loss or failure of standard therapy needs a specialist opinion.

Treatment

How dandruff is treated in the UK.

Medicated shampoos first, topical steroids and calcineurin inhibitors for itch and inflammation, and oral antifungals reserved for refractory disease.

  • Ketoconazole 2% shampoo

    An evidence-based antifungal shampoo - two to three times a week for four weeks, left on for five to ten minutes before rinsing.

  • Selenium sulfide 2.5% shampoo

    A well-established antifungal and antiproliferative option - useful when ketoconazole is not tolerated.

  • Zinc pyrithione shampoo

    The active ingredient in many over-the-counter brands - gentle, effective and suitable for regular maintenance use.

  • Coal tar shampoo

    Slows scalp cell turnover and reduces scale - useful when there is overlap with psoriasis or seborrhoeic dermatitis.

  • Salicylic acid preparations

    A keratolytic that lifts thicker scale - often combined with an antifungal shampoo when scale is heavy.

  • Topical corticosteroid lotion

    Short courses of betamethasone valerate or clobetasol scalp application settle itch and inflammation in stubborn cases.

  • Topical calcineurin inhibitor

    Tacrolimus or pimecrolimus - steroid-sparing options for the face, ears and hair-line when steroids are not suitable long term.

  • Oral antifungal for refractory disease

    Itraconazole - typically 200 mg for seven days then intermittent - reserved for severe or refractory cases under specialist care.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or dermatologist knows your scalp and history and can tell you which parts apply to you. If in doubt, get seen.

  • NICE Clinical Knowledge Summary. Seborrhoeic dermatitis.

  • British Association of Dermatologists (BAD). Patient information leaflet on seborrhoeic dermatitis and dandruff.

  • BMJ Best Practice. Seborrhoeic dermatitis - assessment and management.

  • European Dermatology Forum. Guideline on the treatment of seborrhoeic dermatitis.

Red flags

When a flaky scalp needs a specialist.

Most dandruff is easily managed in primary care. These are the situations that aren’t - and where a dermatology opinion is worth it.

  • Hair loss or broken hairs

    Patchy shedding or broken hairs is not dandruff - think tinea capitis or another scarring alopecia and refer.

  • Thick silvery plaques

    Well-demarcated silvery scale at the hair-line suggests scalp psoriasis rather than dandruff and needs a different plan.

  • Severe redness and weeping

    Marked redness, crust or weeping points to seborrhoeic dermatitis or a superimposed infection and warrants review.

  • Rapid worsening in immunocompromise

    Severe or sudden seborrhoeic scalp disease in HIV, transplant or chemotherapy patients needs urgent specialist input.

  • Refractory to standard shampoos

    Failure of a full eight-week trial of the right medicated shampoo is a reason to escalate rather than repeat.

  • Neurological features

    New scalp scale with Parkinson’s features, facial weakness or tremor deserves a broader neurological assessment.

  • Suspected contact allergy

    Sudden flare after a new dye, shampoo or styling product needs a review and, sometimes, patch testing.

  • Scalp folliculitis or pustules

    Pustules and painful follicles suggest a bacterial or yeast folliculitis rather than uncomplicated dandruff.

  • Diagnostic uncertainty

    When the picture is atypical or overlapping, a dermatology opinion prevents months of the wrong treatment.

Living with it

A treatable condition, with a simple routine.

Four things that make the biggest difference day to day - regular washing, patience with actives, rotating shampoos and staying on maintenance.

A quiet reminder

Consistency beats intensity, every time.

Small, steady habits - kept up for months - do more than a heroic week that doesn’t last.

  1. 01 Routine

    Wash regularly, gently

    Two to three medicated washes a week, left on for a few minutes, beats aggressive daily scrubbing.

  2. 02 Patience

    Give it four to eight weeks

    Antifungal shampoos need time - judge success at a month, not after a single wash.

  3. 03 Rotate

    Rotate actives to keep it working

    Alternating ketoconazole, selenium sulfide and zinc pyrithione prevents tolerance and keeps flakes down.

  4. 04 Maintain

    Don’t stop when it clears

    A once or twice weekly antifungal wash keeps dandruff away - stopping completely is the commonest reason it comes back.

Frequently asked

Everything we get asked about dandruff.

Quick answers on shampoos, steroids, seborrhoeic dermatitis and when to see a dermatologist.

  • What is dandruff?

    Dandruff, or pityriasis simplex capitis, is a very common, mild, non-inflammatory scaling of the scalp. It sits at the mild end of the seborrhoeic dermatitis spectrum and is driven by Malassezia yeast, sebum and an individual irritant response.

  • Is dandruff the same as seborrhoeic dermatitis?

    They are part of the same spectrum. Dandruff is the milder, mainly scaly form without significant redness. Seborrhoeic dermatitis is the more inflammatory form, often affecting the face, ears and chest as well as the scalp.

  • Which shampoo works best?

    Ketoconazole 2%, selenium sulfide 2.5%, zinc pyrithione and coal tar shampoos all have good evidence. Use two to three times a week for four to eight weeks, leave on for five to ten minutes before rinsing, and rotate actives if one stops working.

  • Can I use a topical steroid on my scalp?

    Yes, short courses of a mild to potent steroid lotion such as betamethasone valerate 0.1% or clobetasol propionate 0.05% can settle itch and inflammation. They are not a long-term solution - use alongside a medicated shampoo and taper when calmer.

  • Does diet or stress matter?

    Stress, poor sleep and cold weather reliably worsen dandruff. Adequate zinc, omega-3 and probiotics may help some people, but no single diet cures dandruff - consistent scalp care matters more.

  • When should I see a dermatologist?

    If your scalp is severely inflamed, painful, losing hair or has not settled after eight weeks of the right medicated shampoo, ask for a dermatology referral. Immunocompromise, suspected psoriasis or tinea capitis also warrant specialist input.

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