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Dr Roger Henderson
Reviewed by Roger HendersonReviewed on 29.04.2024 | 5 minutes read

Dandruff is caused by dead skin cells falling off your scalp which can be seen as white-grey flakes on your scalp, in your hair and sometimes on your clothes. It can also cause symptoms of an itchy scalp. It is very common and not linked to hair cleanliness although more flakes may build up with the less you wash your hair. Dandruff is a type of seborrhoeic dermatitis that also causes a red, greasy, flakey rash over the nose and cheeks.

In the majority of cases, dandruff can be treated at home. Extreme weather conditions, such as when hot, cold or dry may cause dandruff, and stress can worsen the condition in some people. Dandruff is not contagious.

Doctor’s advice

What to start with if you have dandruff.

If you are suffering from dandruff, we would recommend using an anti-dandruff shampoo regularly for one month. Your local pharmacist can advise you on which one to choose and how to use it.

Here are some commonly available anti-dandruff shampoos and their key ingredients:

  1. Head & Shoulders Classic Clean Anti-Dandruff Shampoo:

    • Pyrithione Zinc
    • Suitable for daily use to control dandruff and relieve scalp itchiness.
  2. Nizoral Anti-Dandruff Shampoo:

    • Ketoconazole
    • Used twice weekly to treat dandruff caused by the fungus, which can lead to flaking and itching.
  3. Selsun Shampoo:

    • Selenium Sulfide
    • Effective for treating stubborn dandruff and seborrheic dermatitis, used twice weekly initially, then once weekly for maintenance.
  4. Neutrogena T/Gel Therapeutic Shampoo:

    • Coal Tar
    • Designed to treat scalp conditions such as dandruff, psoriasis, and seborrheic dermatitis, used twice weekly or as directed by a healthcare professional.
  5. Alphosyl 2 in 1 Medicated Shampoo:

    • Coal Tar
    • Helps relieve symptoms of scalp psoriasis, seborrheic dermatitis, and dandruff, used twice weekly or as recommended by a doctor.
  6. E45 Dermatological Dry Scalp Shampoo:

    • Moisturiser
    • Suitable for regular use to cleanse and soothe dry, itchy scalps prone to dandruff.

It is important to know when to use anti-dandruff shampoos:

  • Regular Use - For mild dandruff, using an anti-dandruff shampoo as part of your regular hair care routine can help keep symptoms under control and prevent flares.
  • Treatment Phase - During periods of increased dandruff severity or flare-ups, using an anti-dandruff shampoo with specific active ingredients targeting the underlying cause can provide relief and help manage symptoms effectively.
  • Maintenance - Once dandruff symptoms improve, transitioning to a maintenance regimen with less frequent use of the anti-dandruff shampoo can help prevent recurrence while keeping the scalp healthy and balanced.

Healthwords pharmacists' top tips

As a dry scalp is the start of dandruff, moisturising the scalp is the basis of treatment. There are many dandruff treatment shampoos that can help to improve the hydration of the scalp, whilst gently cleansing and exfoliating the dead flaky skin. They should be used regularly to prevent dandruff.

Some people use oils to help hydrate the scalp alongside a shampoo treatment. Rubbing in olive oil or coconut oil will help to hydrate the scalp, and you'll also get nourished hair roots to improve overall hair health. Try to apply daily if your scalp is particularly dry, or at least around two to three times per week.

Dandruff usually presents as dry white flaky patches or debris on the scalp and hair, and possibly a dry powder on the shoulders of clothes. It doesn't usually cause redness. If your scalp has red or very irritated scaling, particularly around the back of the head or nape of the neck, you may have a different condition such as a fungal infection or psoriasis, so you should see your doctor to confirm diagnosis and suggest the right treatment.

When should I see my doctor?

You should book a routine visit with your doctor if you have used the anti-dandruff shampoo recommended by the pharmacist for one month and seen no improvement or if your scalp is red or sore.

The doctor will ask you about your medical history and examine your scalp in order to look for signs of other skin conditions or skin irritation that might be causing the dandruff symptoms, such as eczema.

Am I fit for work?

You are fit for work if you have dandruff.

Do anti-dandruff shampoos have side effects?

Here are some potential side effects associated with anti-dandruff shampoos:

Scalp Irritation

Some people may experience scalp irritation, redness, or itching after using anti-dandruff shampoos, especially those containing active ingredients such as coal tar, selenium sulfide, or ketoconazole. This irritation is usually mild and temporary but may be more pronounced in individuals with sensitive skin.


Certain anti-dandruff shampoos, particularly those containing active ingredients like coal tar or salicylic acid, may cause dryness or flakiness of the scalp, especially with prolonged or frequent use. Using a moisturising conditioner or reducing the frequency of shampooing can help alleviate dryness.

Hair and scalp discolouration

Coal tar-based shampoos, such as Neutrogena T/Gel Therapeutic Shampoo, may cause temporary discolouration of the hair or scalp, particularly in light-coloured individuals. This effect is usually harmless and reversible but may be undesirable for some people.

Allergic reactions

Although rare, some individuals may experience allergic reactions to the ingredients found in anti-dandruff shampoos. Symptoms of an allergic reaction may include rash, hives, swelling, or difficulty breathing. If you experience any of these symptoms after using an anti-dandruff shampoo, discontinue use immediately and seek medical attention.

Eye irritation

Anti-dandruff shampoos containing certain active ingredients, such as selenium sulfide or ketoconazole, can cause eye irritation if they come into contact with the eyes. It's essential to rinse the eyes thoroughly with water if shampoo accidentally gets into them and to avoid direct contact with the eyes when using these products.

Changes in hair texture

Prolonged or frequent use of some anti-dandruff shampoos may alter the texture or appearance of the hair, particularly if they contain strong active ingredients or harsh detergents. Using a mild shampoo or conditioner in conjunction with the anti-dandruff shampoo can help minimise these effects.

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Dr Roger Henderson
Reviewed by Roger Henderson
Reviewed on 29.04.2024
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