Manage dandruff with first-line OTC medicated shampoos such as pyrithione zinc (1%, used 2–3 times weekly) or ketoconazole (1%, used twice weekly) to address the underlying Malassezia yeast. For persistent symptoms, second-line options like selenium sulfide or coal tar shampoos may help. Severe cases may require prescription corticosteroids or stronger antifungal treatments like 2% ketoconazole shampoo.
January 10, 2025

Dandruff: Proven Methods for Relief

Evidence-Based Over-the-Counter Guide

William Shen

William Shen

Co-founder & CPO

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Dandruff, pityriasis, and seborrheic dermatitis may be considered to be the same condition. Most people have some degree of dandruff, but more severe cases may require specialized shampoos.

Dandruff has been linked to a skin fungus called Malassezia, so medicated antifungal shampoos are the first-line treatment for mild dandruff.

First-line recommendations:

  • Pyrithione Zinc: An antifungal and anti-inflammatory agent. Use 1% shampoo 2–3 times weekly. Pyrithione zinc 1% shampoo.

  • Ketoconazole: An antifungal effective against Malassezia yeast, which is associated with dandruff. Use 1% shampoo twice weekly. Ketoconazole 1% shampoo.

Second-line recommendations:

Prescription medications:

For severe cases, corticosteroid lotions or stronger antifungal shampoos (e.g., 2% ketoconazole) may be prescribed.

Citation:

Grimalt, R. (2007). A practical guide to scalp disorders. Journal of Investigative Dermatology Symposium Proceedings, 12(2), 10-14.


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Levels of evidence considered:

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