There are lots of options out there to treat dandruff—so how do you know which one to go for? We’re breaking down the pros and cons of the most common remedies to help you decide what’s the best fit for you.
Why do we get dandruff?
First, it helps to understand what’s actually causing dandruff—because that’s key to knowing how treatments work.
The exact cause isn’t fully understood, but it’s thought to be linked to an overgrowth of a naturally occurring yeast on the scalp called Malassezia. While this yeast is a normal part of your scalp’s microbiome, when it becomes unbalanced it can trigger inflammation and disrupt the skin barrier.
The result? Those familiar dandruff symptoms—visible flakes, itchiness, and irritation.
Shampoos that treat dandruff
There are a few different ways anti-dandruff shampoos work. Here’s a simple breakdown of the most common approaches, the ingredients behind them, and how effective they tend to be.
Keratinolytic agents
Sounds technical, but this just means ingredients that help break down clumps of dead skin—making it easier to wash flakes away. They can also help reduce the environment that allows dandruff to build up.
Common ingredients include salicylic acid, coal tar, sulphur, and sometimes corticosteroids. These shampoos are good at managing visible flakes and improving symptoms, but they mainly treat the surface-level issue rather than the root cause.
Antimicrobial (antifungal) agents
Another approach is tackling dandruff at its source—by rebalancing the scalp and controlling the growth of Malassezia.
Selenium sulfide
Slows down the growth of Malassezia and reduces cell turnover, helping to limit flake formation. It also has mild keratinolytic properties, so it helps clear existing flakes too.
Piroctone olamine
Penetrates and disrupts the fungus, helping reduce inflammation, flakes, and excess oil on the scalp.
Zinc pyrithione
Targets Malassezia while also limiting the production of lipases (the fungus’ food source), helping keep growth under control.
Ketoconazole
A more potent antifungal that works by blocking the fungus’ ability to form cell membranes—effectively stopping it from growing.
So, which shampoo works best?
Shampoos with ingredients like salicylic acid and coal tar can be effective at clearing flakes and relieving symptoms, but they don’t do much to address the underlying cause. Some people also find coal tar shampoos messy or unpleasant to use.
Antifungal shampoos tend to be more effective overall because they target the root of the problem—yeast overgrowth. For milder dandruff, zinc pyrithione is often a gentler starting point.
For more persistent or moderate-to-severe dandruff, ketoconazole 2% is typically the most effective option. It’s also commonly recommended for seborrhoeic dermatitis—a more severe form of dandruff.
In studies comparing treatments, both zinc pyrithione and ketoconazole improved dandruff symptoms. However, ketoconazole came out ahead—more people saw improvement, and recurrence rates were lower.
The key thing most people miss
Dandruff is a recurring condition—it doesn’t just disappear for good.
If you’ve ever stopped using treatment once your flakes cleared, only for them to come back—you’re not alone.
The trick is maintenance. Even after symptoms improve, keep using an anti-dandruff shampoo regularly (around once a week) to stay ahead of it and stop it returning.
All of our blog articles are reviewed by our Medical Director before publication.
