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Like many things in life, the causes of an itchy scalp and dandruff — and how to get rid of them — are more complicated than I realized.
It’s winter, I thought. The rest of my skin is dry and chapped. It needs better hydration than it would in the summer. Shouldn’t that apply to my scalp as well?
Turns out the answer is no.
“Dry scalp is not akin to dry skin,” said Dr. Julia Tzu, founder and director of Wall Street Dermatology. “It's a completely different condition. It has nothing to do with how dry the weather is. It’s more to do with the amount of yeast burden in the scalp, and it also has to do with the amount of stress that someone is undergoing.”
Tzu said that when we talk about dry scalp, we often mean dandruff (the medical term is seborrheic dermatitis), which can be brought on by a variety of factors.
Dandruff is yet another way one’s body may respond to stress, and the scalp’s yeast load also tends to be higher for those with oilier skin, people with more abundant hair, and people who wash their hair less frequently.
That last part may seem counterintuitive, since hair seems to get dryer the more you wash it, and dryness causes flakes on other parts of the body.
However, the scalp is a whole different beast, according to Tzu. What happens there is not necessarily reflected in the feel or texture of our hair.
How to get rid of dandruff
Since oil and yeast in the scalp can be dandruff triggers, Tzu recommends washing your hair more frequently if you’re experiencing flaking. You may feel compelled to wash it less if the scalp feels dry or irritated, but a buildup of oil could actually be perpetuating the condition.
Anti-dandruff shampoos are a great over-the-counter option for treating dandruff. You can rotate these into your washing routine as often as your doctor or the instructions recommend. Tzu advises looking for yeast-controlling active ingredients like zinc pyrithione, selenium sulfide, or ketoconazole.
But there are different types of skin conditions that can affect the scalp, and the ingredients you need may depend on your particular skin.
If you have tiny flakes scattered in your hair, that’s most likely the result of seborrheic dermatitis or dandruff. A medicated shampoo with one of those yeast-controlling ingredients is the way to go.
Psoriasis, an immune system–related skin condition that causes itchy, scaly patches on the body, is another possible cause of flakes on the scalp. For scalp psoriasis where there are thick, crusted plaques covering the surface of the scalp, Tzu said, you should consider products with coal tar or potentially something exfoliating to help detach the dead skin.
If your scalp simply feels a bit dry without any flakes or signs of psoriasis, some sort of hydrating scalp serum may be all you need. Tzu described a therapeutic ladder of sorts: The treatment depends on the severity of your symptoms, and it’s always best to consult a dermatologist in case a prescription treatment is your best option.
With any medicated shampoo and general increase in washing to treat the scalp, it’s not uncommon for your hair to feel drier. Tzu’s advice for that is to massage the shampoo directly onto the root of the hair and the scalp and to avoid lathering the ends as much as possible. You can continue to use your regular conditioners or conditioning treatments on the lengths and ends to keep your hair smooth and shiny.
Even if you’ve never had a single flake of dandruff in your life, you’ve heard of Head & Shoulders. And for good reason, apparently, since it was the first anti-dandruff shampoo that Tzu recommended to try if you’re experiencing seborrheic dermatitis. It promises to soothe dry and itchy scalps thanks to the inclusion of zinc pyrithione. Since the 1960s, Head & Shoulders shampoos have had zinc pyrithione as the main active ingredient; they now also have some clinical-strength variations with selenium sulfide that you can try if the original doesn’t do the trick.
Promising review: “Have been using this shampoo since 1965. Had a dandruff problem then, none since. I'll stick with a winner!” —Amazon Customer
You can buy Head & Shoulders Classic Clean Shampoo from Amazon for around $31.
The other classic brand Tzu mentioned for dandruff control is Selsun Blue. Most of their shampoos contain selenium sulfide 1% for maximum strength over-the-counter treatment. This one promises to relieve dandruff symptoms by preventing and eliminating itchy scalp and visible flakes.
Promising review: “One of the first shampoos in a while that have actually gotten rid of my dandruff.” —Vanesa
You can buy Selsun Blue Medicated Anti-Dandruff Shampoo from Amazon for around $7.
If you have severe seborrheic dermatitis or scalp psoriasis and need to kick things up a notch, Tzu recommended this T/Gel shampoo with coal tar extract. You can use it anywhere from twice a week to every day by massaging it into the scalp, letting it sit for a few minutes, and then rinsing it out. Reviewers swear by it to help with scalp dryness, itching, and flaking.
Promising review: “Excellent...my go to to help with scalp psoriasis.” —Thomas Hayes
You can buy Neutrogena T/Gel Therapeutic Shampoo from Amazon for around $17.
This is another product that Tzu put into the same category as the T/Gel shampoo, in that it’s best for scalp psoriasis and more severe cases of dryness and flaking. The salicylic acid helps to exfoliate and clear those thick, crusted flakes known as plaques caused by psoriasis. It exfoliates to remedy the itching and flaking that go along with many of those stubborn scalp conditions.
Promising review: “I am so glad I found this product. It really does work after one use and after a few, my scalp is clear and feels amazing!” —Erica
You can buy Neutrogena T/Sal Therapeutic Shampoo from Amazon for around $8.
For those interested in a higher-end shampoo that also combats dandruff, this one from Biolage is a great option. It contains zinc pyrithione to control flaking and scalp irritation, along with calming mint leaf. It gets rave reviews for treating mild to moderate dandruff, and its pleasant scent doesn’t hurt either.
Promising review: “This stuff is a miracle! I’ve had a small patch of dandruff frustrating me for months. I’ve tried everything but nothing worked. After 2 washes with this stuff it’s gone and my hair is shiny and soft too.” —Chantalle
You can buy Biolage Scalp Sync Anti-Dandruff Shampoo from Amazon for around $23.
Anyone with sensitive skin is probably familiar with First Aid Beauty. It’s a cult-favorite brand, so it’s no surprise its anti-dandruff shampoo is just as beloved as all of the other products. It’s another 1% zinc pyrithione treatment that’s safe for color-treated hair and sensitive skin, with no artificial fragrances. In addition to the flake-fighting ingredients, there are also silk peptides and vitamin E to nourish and strengthen hair, too.
Promising review: “The BEST shampoo I've ever tried for my terrible scalp. I think I have seborrheic dermatitis because my scalp gets itchy, flakey, red, and irritated extremely easily. This is the best shampoo I've ever tried for managing my symptoms. The formula is a very thick and creamy oat-colored shampoo that lathers nicely and smells good. Doesn't dry my hair out, in fact, it leaves my hair feeling pretty hydrated. If you suffer from any scalp issues I'd highly recommend giving it a go!” —ANGOCTANE via Sephora
You can buy First Aid Beauty Anti-Dandruff Shampoo from Sephora for around $30.
The last active ingredient that Tzu recommends for dandruff treatment is ketoconazole, a powerful antifungal, yeast-fighting medicine. Nizoral shampoo contains 1% ketoconazole to control fungus and combat flaking, scaling, and itching from dandruff. Thousands of reviewers vouch for its effectiveness.
Promising review: “After the third use I didn't see any single flake! This is a must buy!!!” —Eddieakapapi
You can buy Nizoral Anti-Dandruff Shampoo from Amazon for around $15.
There are tons of scalp oils and serums on the market these days, many aimed at helping hair grow or soothing dryness and itching. While some have salicylic acid to exfoliate and remove dead skin, few oils or serums are medicated with active ingredients known to combat dandruff. This scalp serum from Jupiter actually contains zinc pyrithione to fight seborrheic dermatitis, plus green tea and aloe vera to help soothe the scalp. The benefit of a serum is its more targeted application, so you can avoid drying out the lengths of your hair. It’s also helpful if you have one particular area that flares up and needs more direct treatment or if you’re just looking for something extra to use in addition to a medicated shampoo.
Promising review: “Feels wonderful! Calms my psoriasis like autoimmune scalp conditions. Relieves itching and redness.” —Janet Whalen S via Jupiter
You can buy the Restoring Serum from Jupiter for around $26.