What should you know about severe dandruff?

Dandruff is shedding from the scalp that can appear as white or yellow flakes on the hair or clothing. Severe symptoms may include frequent visible scale, itching, greasy areas, or redness. Seborrheic dermatitis can cause a more inflamed version. Scalp psoriasis, contact irritation, and other conditions can resemble dandruff, so thick plaques, soreness, or changes beyond the scalp deserve a closer look.

Use a medicated shampoo according to its label or a clinician’s directions, allowing it to contact the scalp for the recommended time before rinsing. Apply it to the scalp rather than only the hair, and be consistent even when flakes improve. Avoid scratching, harsh fragranced products, and very hot water. If one approach irritates the scalp or does not control symptoms, a clinician may choose another medicated shampoo or topical antifungal treatment.

Book a dermatology review for painful redness, thick plaques, crusting, pus, bleeding, patchy hair loss, or symptoms affecting the ears, face, or body. Seek prompt care for fever, rapidly spreading redness, or severe tenderness. Assessment is also appropriate when carefully used medicated shampoo has not helped, because the diagnosis may be seborrheic dermatitis, psoriasis, infection, or contact dermatitis.

Ask which diagnosis fits the scale, how long to use the shampoo, whether another active ingredient is appropriate, and how to protect irritated skin around the hairline.