How to Stop Dandruff Coming Back: Causes and Proven Treatments

Dandruff is incredibly common, but that doesn’t make it any less annoying (or embarrassing). If you’re sick of dealing with dandruff - don’t worry. It’s easy to fix with the right shampoo, the correct anti-dandruff ingredients, and a routine which stops the symptoms creeping back.

In this guide, we’ll walk you through the root causes of dandruff, which treatments genuinely work, and how to keep your scalp flake-free for the long run.

What causes dandruff?

Some people assume that dandruff is caused by poor hygiene, but that’s actually not the case. It’s a condition that is thought to affect up to 50% of the world’s adult population, but despite how common it is, scientists aren’t 100% sure what exactly causes it.

It's thought to be caused by a few different factors:

• An overgrowth of the fungus Malassezia can irritate the scalp and speed up skin‑cell turnover; these excess cells then clump together and fall off as visible flakes.
• Oily scalp is sometimes linked to dandruff, but it comes down more to the type of oil your scalp secretes. Some oils are more favourable to Malassezia >and can contribute to overgrowth
• Dry scalp caused by cold weather, using hot water or heat styling tools, or hair products which are drying
• Not shampooing enough, or too often
• Nutrition, stress and genetics may also play a role

How to fix dandruff

It's recommended to use a medicated shampoo containing one of the following ingredients to manage or treat dandruff. Make sure to read and follow the specific instructions of whichever shampoo you buy. 

Here are the most effective ingredients to keep an eye out for on the shelves:

• Zinc pyrithione has antimicrobial, antifungal and antibacterial properties help control yeast and other microbes on the scalp
• Selenium sulphide helps slow down overactive skin cell growth so there are fewer flakes, and has mild antifungal properties
• Ketoconazole fights a wide variety of fungi (including Malassezia), making it an effective treatment for dandruff and it’s more aggressive counterpart: seborrheic dermatitis.

Shampoos including the below ingredients can help manage the symptoms of dandruff, aka get rid of flakes of dead skin, but don’t really address the underlying cause of dandruff.

• Salicylic acid: exfoliates the scalp and breaks down clumps of dead skin cells which helps to remove flakes
• Coal tar: helps slow down rapid skin cell growth (which may help reduce Malassezia levels) and helps loosen and remove flakes of dead skin.

Which is the best treatment?

You can be spoilt for choice with dandruff treatments with different ingredients, so which is actually most effective?

A randomised controlled trial compared shampoos with two common active ingredients for treating Malassezia: zinc pyrithione 1% shampoo with ketoconazole 2% shampoo. Participants were divided into two groups - one group used ketoconazole shampoo twice a week for four weeks, while the other used zinc pyrithione shampoo at least twice a week over the same period. After treatment stopped, both groups were monitored for a further four weeks.

By week four of treatment, ketoconazole showed better results: 73% of users saw an improvement compared with 67% in the zinc pyrithione group. Not only did more people see an improvement in their dandruff, but ketoconazole was also more effective at preventing dandruff from coming back during the follow-up phase.

How to stop dandruff coming back

Dandruff is a chronic condition, which means it has a habit of coming back if you stop treating it. There isn’t a one‑time “cure” for it, aka you can’t wash it away once and expect it to stay gone forever. To keep flakes under control for good, you need to use an anti‑dandruff shampoo regularly.

A lot of people stop using their dandruff shampoo as soon as their symptoms disappear, but studies show the scalp can start slipping back into its old ways in as little as three days after switching to a normal shampoo. The levels of Malassezia begin to rise again, and the markers of inflammation and irritation creep back up. Within about three weeks, the telltale signs of dandruff like itchiness and flakes usually return.

To avoid getting stuck in this frustrating cycle: treat, feel better, then see the flakes come right back - it’s best to keep using an antidandruff shampoo at least once every one to two weeks, even after things look clear. For example, you might use a ketoconazole shampoo for up to four weeks until your symptoms settle, then keep it in your routine once every week or two to stop dandruff from sneaking back.

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All of our blog articles are reviewed by our Medical Director before publication.