Persistent dandruff is one of the most-misdiagnosed scalp conditions. Patients spend years cycling through anti-dandruff shampoos, never asking the more important question: is this actually dandruff? Often it is something else — seborrhoeic dermatitis, scalp psoriasis, or fungal overgrowth — and the wrong treatment makes it persist.
Diagnosis first
- Dandruff (pityriasis capitis): dry, white flakes. No inflammation, mild itch. Responds to ketoconazole/zinc shampoos.
- Seborrhoeic dermatitis: oily, yellowish flakes with redness and itch. May involve eyebrows, sides of nose. Needs anti-fungal + anti-inflammatory therapy.
- Scalp psoriasis: thick, silvery scales with sharp borders, often extending past hairline. Needs psoriasis-specific treatment.
- Tinea capitis (fungal): patchy hair loss + scaling + occasional pus. Needs oral antifungals — topical alone is not enough.
- Contact dermatitis: from hair colour, conditioner, oils. Needs identification and avoidance of trigger.
Treatment by diagnosis
True dandruff: medicated shampoo (ketoconazole 2% twice weekly, alternating with zinc pyrithione or selenium sulfide). Apply to scalp, leave 5 minutes, rinse. Maintenance for life.
Seborrhoeic dermatitis: same shampoos plus topical anti-inflammatory (ciclopirox, low-potency steroid for short bursts). Treat eyebrows and nose folds if affected.
Scalp psoriasis: medicated shampoo + topical steroid lotion + calcipotriol scalp solution. Full psoriasis protocol for severe cases.
Tinea capitis: 6 to 8 weeks oral antifungal (terbinafine or griseofulvin) plus medicated shampoo. Topicals alone do not penetrate hair shafts adequately.
If your dandruff has not cleared with 4 to 6 weeks of anti-dandruff shampoo, you likely have a different condition. Book a consultation for proper diagnosis and the right treatment.
