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Does Dandruff Cause Hair Loss? Dermatologists Weigh In + Share 4 Tricks To Stop Flaking

Find out how noshing on avocado toast keeps your scalp healthy

If you’ve been dealing with an uptick in dandruff lately, all the flakes and uncomfortable itching can make you question its impact on your hair. In particular, you’re probably wondering does dandruff cause hair loss? To find out, we asked experts to explain what dandruff actually is, how ketoconazole shampoo may help, plus more ways to find relief.

Dandruff is a symptom of a common skin condition

Dandruff is a symptom of seborrheic dermatitis, says Heather Woolery-Lloyd, MD, a board-certified dermatologist in Miami, FL, and Director of the Skin of Color Division for the University of Miami Department of Dermatology. “Seborrheic dermatitis is an inflammatory skin condition that causes scales, flakes, itching [and] redness on the scalp,” she says. And it’s incredibly common. “It’s the type of thing that a typical dermatologist would see several times a day in their practice.”

Seborrheic dermatitis is chronic and intermittent, meaning it won’t go away completely and you can experience periodic flare-ups. It can also show up in places like the eyebrows, around the nose, on the chin and behind the ears, Dr. Woolerly-Lloyd says. While it’s not curable, it is controllable.

Experts suspect the condition may be a reaction to malassezia, a type of yeast found on the skin, says Rosanne Paul, DO, a board-certified dermatologist at University Hospitals in Ohio and an assistant professor at Case Western Reserve University. “It’s not that a patient that may be affected by this has too much of it, they just tend to react to it,” she explains.

Dr. Woolery-Lloyd stresses that it isn’t an infection. “I happen to have seborrheic dermatitis, so I always say to my patients: ‘you and I mount this inflammatory response to the normal yeast on our skin,’” she says.

See also: Dandruff vs Dry Scalp: Find Out Which One is Making You Itch — And How To Cure It

Dandruff can occur year-round

As Dr. Woolery-Lloyd notes, there’s no “classic” seborrheic dermatitis patient. You can develop the condition and experience flare-ups throughout your life. “You could have never had it and out of the blue start to get it in your 30s, 40s or 50s,” she says.

And while people may think dandruff spikes in cold weather, it can happen at any time. “It’s definitely year-round,” confirms Dr. Woolery-Lloyd. That said, you may notice an uptick in the winter when the air is drier.

Though seborrheic dermatitis isn’t caused by stress, it can get worse with stress, Dr. Woolerly-Lloyd explains. “Sometimes people will see it flare during stressful times,” she says, noting that she had her worst case while in medical school.

Does dandruff cause hair loss?

Generally, no. “It would be very unlikely to cause hair loss,” says Dr. Paul. That said, the full picture is a bit more complicated.

As Dr. Woolery-Lloyd explains, “if you have severe — let’s say the worst case of seborrheic dermatitis ever — and you’re scratching your scalp like crazy, obviously that’s going to cause breakage and can cause hair loss, especially on the frontal hairline.”

Stress can also have an impact. “If [dandruff] was causing a lot of emotional distress because [the patient] was itching so much or so uncomfortable from the condition itself, it could cause a type of hair loss called telogen effluvium,” Dr Paul says. “This is shedding that typically occurs two to three months after a psychologic or an emotional stress.”

Whether the underlying cause of your spare strands is severe dandruff or high levels of stress, the good news is that this type of hair loss is not permanent.

Using ketoconazole shampoo for dandruff

mature woman using ketoconazole shampoo to prevent dandruff and hair loss
Liudmila Chernetska/Getty

When it comes to treating dandruff, an anti-fungal medication known as ketoconazole can help. It typically comes as a shampoo, though it can also be found in a cream or foam form. It works to control yeast production, which helps keep seborrheic dermatitis (and dandruff) in check, says Dr. Paul. “I would say that [ketoconazole] would be the most commonly prescribed topical form management of dandruff,” she adds.

Ketoconazole is available by prescription or over the counter (under the brand name Nizoral). The Rx has a higher strength at 2% ketoconazole compared to the OTC at 1%.

A few things to keep in mind:  

  • Ketoconazole shampoo doesn’t have a lather and it can be very drying. “I warn every single patient that it’s drying, because it’s [the] number one complaint,” says Dr. Woolerly-Lloyd.
  • You shouldn’t rinse it out immediately. Leave it on for at least 5 minutes, says Dr. Paul.
  • Be sure to use it regularly, typically around two to three times a week. Not shampooing that often? “I will say once a week, if they can do it twice a week, great,” says Dr. Woolery-Lloyd.

Also smart: When it comes to additional prescription options, steroids are sometimes used. And Dr. Woolery-Lloyd also points to a new anti-inflammatory medication for seborrheic dermatitis called Zoryve, which was FDA approved in December 2023. The steroid-free foam is applied once a day and doesn’t have to be washed out. “A product that can be used daily and doesn’t have to be washed out is very helpful for people because it doesn’t matter how frequently you wash your hair, you can put this on every day,” she explains.

Related: Dermatologist-Recommended Shampoos for Hair Loss — Discover What’s Right for You

Ketoconazole shampoo and hair loss

In addition to treating dandruff, ketoconazole shampoo can help with hair loss even when the cause is not seborrheic dermatitis. In fact, dermatologists may prescribe ketoconazole for hair loss later in life, says Dr. Woolery-Lloyd. That’s typically studies suggest that people using ketoconazole shampoo are less likely to have hair thinning, she explains.

One reason could be that ketoconazole is thought to have an anti-androgen effect. And androgens are male sex hormones associated with typical female- or male-pattern baldness. (See how spironolactone can help with hair loss, too.)

More ways to get rid of dandruff

Aside from ketoconazole shampoo, there are other non-prescription ways to treat dandruff and help keep flare-ups at bay. That includes:

1. Try medicated OTC shampoos

Along with Nizoral, there are different OTC shampoos that you can find at the drugstore. For example, Selsun Blue Max Strength contains 1% selenium sulfide, which is an anti-fungal, says Dr. Paul.

Head & Shoulders has 1% zinc pyrithione, another type of anti-fungal, in its shampoos. And Dr. Woolery-Lloyd points to the brand’s Bare line — which is great for those sensitive to common chemicals, she says — and the Royal Oils line. Royal Oils is “extremely hydrating” and works well for people with dry or textured hair, she notes.

You should also leave these on for at least 5 minutes before rinsing, says Dr. Paul. “If you’re not responding to the over-the-counter treatments after about six weeks, or had progression after four to six weeks, that’s when I would recommend seeing a dermatologist,” she adds.

2. Scale back on dry shampoo

Dry shampoo tends to leave residue on your scalp, says Dr. Paul. And while the residue itself doesn’t cause any harm, if you’re “having more itching or symptoms, leave-on products may potentially irritate the skin, disrupt the barrier and then cause more symptoms of itching,” she explains. The American Academy of Dermatology also suggests using products like hair gel, hair spray and pomade “sparingly”, as these could prompt a flare-up.

3. Take a stress-busting break

mature woman meditating outdoors to reduce stress and prevent dandruff
The Good Brigade/Getty

“So when it comes to inflammatory skin disease, and with seborrheic dermatitis being one of them, I do talk a lot about lifestyle,” says Dr. Woolery-Lloyd, who is also board-certified in lifestyle medicine. Since stress may be related to dandruff flare-ups, managing it can be helpful. And it can be as easy as enjoying a relaxing walk outside while focusing on the positive things in life, something which Dr. Woolery-Lloyd calls a “moving meditation to calm the brain.”  

Also smart: Dr. Woolery-Lloyd says she often tells her patients to download a meditation app or check out free meditations online. Even just five minutes a day can help lower stress levels, she says. One free option to try: InsightTimer.

4. Enjoy avocado toast

To keep dandruff at bay, fill up on anti-inflammatory foods like avocado, fruit and oily fish such as salmon. Dr. Paul says an anti-inflammatory diet, which means eating foods with a lower glycemic index, or the Mediterranean diet, which is more anti-inflammatory, may be helpful. “I will commonly recommend that to patients who are looking for some dietary change, but there’s nothing that’s proven,” she notes.

That said, research in Cureus found that eating a Western diet (think: white bread, red meat and fried food) showed an increased risk of seborrheic dermatitis. Those who ate a diet rich in anti-inflammatory citrus fruits, leafy greens and other veggies had a lower risk of the condition.

For more ways to halt — and even reverse — hair loss:

Treating Scalp Inflammation Can Reverse Hair Loss — Experts Share the Easy + Soothing Remedies

Itchy Scalp and Hair Loss? Dermatologists Reveal the Surprising Cause + How to Speed Regrowth

Does Spironolactone for Hair Loss Work? Yes — And MDs Say These 4 Tips Boost Results

This content is not a substitute for professional medical advice or diagnosis. Always consult your physician before pursuing any treatment plan.

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