Medical Treatment

Once a health care practitioner has confirmed an individual has dandruff (seborrheic dermatitis), the main treatment includes antifungal shampoos, antibacterial cleansers, and anti-inflammatory creams and lotions. More importantly, often the most effective dermatologic treatments are combination treatments using several different medicated ingredients used at the same time.

Prescription-strength shampoos and steroid cream medications are the usual treatments. More frequent shampooing and cleansing is usually recommended.

For severe cases not responding to a combination of ultra high-potency steroid creams, foams, sprays, or lotions, alternate treatments may be tried. A dermatologist may be very helpful for resistant cases that have not cleared with standard prescriptions.

Rare severe cases may require short-term treatment with oral steroids such as prednisone (Deltasone, Orasone, Prednicen-M, Liquid Pred) and/or oral antifungal pills. Oral pills are not the mainstay of dandruff treatment and should not be routinely used.

Sample escalating (step-up) treatment of adult dandruff by a dermatologist:

Skin care routine for mild dandruff:

• Wash scalp with ketoconazole (Nizoral) or ciclopirox (Loprox) shampoo daily or every other day



• May use hair conditioner on hair as needed (avoid applying to scalp)



• Need more frequent daily shampooing when symptoms are more severe

Skin care routine for moderate dandruff:

• Wash scalp with ketoconazole (Nizoral) or ciclopirox (Loprox) shampoo daily



• May use hair conditioner on hair as needed (avoid applying to scalp)



• Need more frequent daily shampooing when symptoms are more severe



• Rub in fluocinonide or clobetasol (Olux) solution one to two times a day into scalp for itchy skin

Skin care routine for severe dandruff:

• First, wash scalp with a tar shampoo such as Neutrogena T/Gel or DHS Tar



• Rinse scalp



• Second, wash scalp with salicylic acid shampoo such as DHS Sal or Neutrogena T/Sal



• Rinse scalp



• Third, wash scalp with ketoconazole (Nizoral) or ciclopirox (Loprox) shampoo daily and leave in for two to five minutes



• Rinse scalp



• May use hair conditioner on hair as needed (avoid applying to scalp)



• Rub in clobetasol (Olux) foam or solution one to two times into scalp for itchy, inflamed skin areas



• Use weekly or biweekly special nourishing bedtime treatment with Dermasmoothe under shower cap. Rinse off in the morning.



• As dandruff improves, step back to every other day treatments or rescale to the moderate or mild dandruff recipe above