Key takeaways
- Dandruff is very common. Close to half of adults have it at some point, and it is not a sign of poor hygiene.
- It is linked to a yeast called Malassezia that lives on everyone's scalp, together with scalp oils and how sensitive your skin is.
- Scratching an itchy, inflamed scalp can break hairs and increase shedding, but this shedding usually reverses.
- If hair fall continues after the dandruff is controlled, look for another cause, such as pattern hair loss, low iron or thyroid problems.
- Medicated shampoos work only if you leave them on the scalp for five to ten minutes before rinsing.
What is dandruff, and how is it different from seborrhoeic dermatitis?
I think of it as one spectrum. Dandruff is the mild end: white or greyish flakes, maybe some itch, not much redness. Seborrhoeic dermatitis is the more active form: greasy, yellowish scales, red patches, and often flaking at the eyebrows, the sides of the nose, behind the ears or on the chest.
A StatPearls review puts the prevalence of seborrhoeic dermatitis at about 5% worldwide, while dandruff is closer to 50%. Both are linked to how Malassezia yeast, the oils on your scalp, and your own skin interact. The amount of oil or yeast alone does not explain who gets it. That is why two brothers with the same washing habits can have completely different scalps.
In Mumbai, the heat, the humidity, the sweat through a long monsoon, and hours under a helmet on a two-wheeler can all make an oily scalp feel worse. Stress and late nights tend to bring flares too.
So does dandruff cause hair fall?
People come in with a handful of hair and a shoulder full of flakes, and they have already decided the dandruff did it. Maybe. See, what happens is, there are three separate things that get mixed up.
- Shedding from scratching. An itchy scalp gets scratched, often at night. Nails break hairs and irritate follicles. Cleveland Clinic notes that seborrhoeic dermatitis can cause hair shedding from scratching in the affected areas. Once the itch is controlled, this usually settles.
- Inflammation around the follicle. A scalp that stays inflamed is not a healthy place for hair. That is a fair concern, but the effect is usually modest and reversible.
- Two conditions at once. Dandruff and pattern hair loss are both common in young adults. Many people blame the flakes for a thinning crown or receding temples that is actually genetic. Treating dandruff will not stop pattern hair loss.
Dandruff does not cause scarring or bald patches. If you have round bald spots, a scaly patch with broken hairs (especially in a child), thick silvery plaques, or pain and pus, that is not simple dandruff. A doctor needs to see it.
How do you tell which one is causing your hair fall?
| Feature | Mostly dandruff-related shedding | Likely another cause |
|---|---|---|
| Itch and flakes | Prominent | May be mild or absent |
| Where hair is thinning | Diffuse, no clear pattern | Temples, crown or widening parting |
| Hair fall after scalp is treated | Settles in a few weeks | Continues |
| Family history of thinning | Not relevant | Often present |
| Recent illness, crash diet or delivery | Not relevant | Suggests telogen effluvium |
Here is the simple test I give people. Treat the scalp properly for four to six weeks. If the flakes clear but the hair fall carries on, the dandruff was not the main cause. My guide on sudden hair shedding and the one on blood tests for hair fall explain what to check next.
What actually treats dandruff?
Medicated shampoos are the first step. Read the ingredient list, not the brand on the front. Ingredients with evidence behind them:
- Ketoconazole (1 to 2%), an antifungal
- Zinc pyrithione (around 1%)
- Selenium sulphide
- Ciclopirox (1%), an antifungal
- Salicylic acid or coal tar, which help lift scale
How you use them matters more than which one you buy:
- Massage it onto the scalp, not just the lengths of the hair.
- Leave it on for five to ten minutes before rinsing. Most people rinse in thirty seconds, and then they tell me the shampoo failed. It did not get a chance.
- Use it two or three times a week at first. Oily, straight hair may need washing more often. Curly or coarse hair may do fine with the medicated shampoo once a week on the scalp and conditioner on the lengths.
- Give one shampoo about four weeks. If it stops working, alternate with one that has a different active ingredient.
- Coal tar can make the scalp more sensitive to sun, so cover your head outdoors.
If flakes and redness still persist, I may prescribe a short course of a mild steroid lotion or another prescription option for flares. Those are prescription decisions after I have examined the scalp.
Does ketoconazole shampoo help hair growth?
I get asked this a lot. A small 1998 study in men with pattern hair loss found that using 2% ketoconazole shampoo was associated with improvements in hair density similar to 2% minoxidil. But the authors themselves said larger controlled studies were needed. So my honest view: ketoconazole is a sensible choice when you have both dandruff and thinning, but I would not treat it as a hair loss treatment on its own.
What about hair oil for dandruff?
In many Indian homes, the first answer to flakes is oil. I understand it. It can make dry flakes less visible for a few hours. But it does not treat the yeast. Malassezia actually uses scalp oils as food, and some people notice that heavy oil left on overnight makes their seborrhoeic dermatitis worse. If you love your oiling, I'm not going to take it away from you. Keep it short and wash it off with a medicated shampoo. My article on hair oiling myths and facts goes into this in more detail.
How we approach this at Dr Tvacha
At a hair diagnosis I look at the scalp under magnification to see whether the flaking is dandruff, seborrhoeic dermatitis, psoriasis or a fungal infection, and whether pattern hair loss is sitting alongside it. Often the first month is simply about getting the scalp calm, because any hair treatment works better on a healthy scalp. If you have both flaking and thinning, the hair plan page explains how the diagnosis works at our Thane, Andheri, Bandra and Dahisar centres.
Frequently asked questions
Can dandruff make you bald?
No. Dandruff does not cause baldness or scarring. Heavy scratching can break hairs and increase shedding for a while, and that usually settles once the scalp is treated. If you are going bald at the temples or crown, the more likely reason is pattern hair loss. It often turns up at the same time as dandruff, and it needs its own treatment.
How often should I use an anti-dandruff shampoo?
Start with two or three times a week, and leave it on the scalp for five to ten minutes each time. Once the flakes are under control, many people keep it to once or twice a week to prevent flares. Fine, oily hair may need more frequent washing, curly or coarse hair less. If the shampoo feels drying, use a regular conditioner on the lengths.
Is dandruff contagious or caused by poor hygiene?
Neither. The yeast linked to dandruff lives on almost everyone's skin, and dandruff depends on how your scalp reacts to it. Washing less often can make flakes more visible, but very clean people get dandruff too. Sharing combs does not spread ordinary dandruff. It can spread fungal scalp infections, which are a different condition and more common in children.
Why does my dandruff get worse in the monsoon?
Heat, humidity and sweat, especially under a helmet or cap, make an oily scalp more likely to flare, and hair stays damp for longer. Wash after heavy sweating, dry the scalp properly, and keep a medicated shampoo in rotation through the season. If the scalp gets red, sore or patchy, see a doctor instead of changing products every week.
When should I see a doctor for dandruff?
Come and see a doctor if flaking continues after about four weeks of a medicated shampoo, if the scalp is very itchy, red or swollen, if you have patches on the face or body, or if you notice bald patches or broken hairs. Also come if the hair fall carries on after the flakes have cleared, because then another cause is likely.
Written by
Dr Amit KarkhanisAesthetic Physician · MBBS, Dip. Dermatology (UK) · Reg. No. 2001/02/1124Founder of Dr Tvacha, practising in Thane since 2005. Leads the weight loss and hair programmes.
Sources
- Seborrheic Dermatitis (StatPearls, NCBI Bookshelf)
- Dandruff (NHS)
- How to treat dandruff (American Academy of Dermatology)
- Seborrheic Dermatitis (Cleveland Clinic)
- Ketoconazole shampoo: effect of long term use in androgenic alopecia (PubMed)
This article is for general education and does not replace a consultation. Medicines and treatments are prescribed only after a doctor's assessment. Last reviewed 25 October 2026.