Dandruff affects millions of people and can be frustrating to manage, but it’s usually caused by a combination of factors like scalp yeast, oil imbalance, and environmental stressors. Understanding the root causes and choosing the right treatment can help restore a healthy, flake-free scalp. Dr. Alexandra Bowles dives deeper into this topic in HuffPost’s article.

What are some of the main causes of dandruff?

Dandruff is incredibly common, and it often stems from a combination of factors rather than one single cause. One of the biggest contributors is an overgrowth of Malassezia, a yeast that naturally lives on the scalp but can become irritating when it multiplies. This irritation leads to flaking, itching, and inflammation. Dry skin, especially in colder months, can also make dandruff worse, as can excess oil production, which creates an environment where yeast thrives. Some hair products may trigger sensitivity or buildup, leading to even more irritation. Stress and changes in hormones can also play a role, which is why dandruff can flare during busy or stressful periods. Overall, dandruff is rarely about “poor hygiene.” It’s usually about how your scalp responds to oils, yeast, and environmental factors.

Are there key ingredients that people should look for when trying to treat their dandruff?

Yes. Several ingredients do a wonderful job at calming dandruff and restoring balance to the scalp. Pyrithione zinc and selenium sulfide help reduce scalp yeast, which is often the root cause of flaking and itching. Ketoconazole is another powerful antifungal option, especially for more stubborn cases. If inflammation is a big issue, salicylic acid can gently exfoliate flakes while helping other active ingredients penetrate better. And for people with sensitive skin, formulas containing tea tree oil can offer natural antimicrobial and soothing benefits. The key is choosing a shampoo that directly addresses your type of dandruff and using it consistently to keep symptoms under control.

What are some dandruff shampoos that you recommend?

Nizoral A-D (1% ketoconazole): This is one of my top recommendations for more persistent dandruff because ketoconazole is a strong antifungal ingredient that helps control yeast on the scalp. You have to let it sit on the scalp for it to work!

Head & Shoulders Clinical Strength (selenium sulfide): A great option for moderate to severe flaking, and it also helps calm itching and redness while restoring moisture balance.

Neutrogena T/Sal (salicylic acid): Perfect for people with thicker scale or buildup because the salicylic acid breaks up flakes without being too harsh.

Selsun Blue (selenium sulfide): Another reliable choice that reduces inflammation and helps regulate oil production, which is especially helpful for oily or irritated scalps.

Is there anything else people should be doing to address their dandruff?

Consistency is key when treating dandruff. Most people see the best results when they use their medicated shampoo several times a week and allow it to sit on the scalp for five minutes before rinsing. Avoiding heavy styling products can also help, since buildup can worsen flaking and irritation. If your scalp feels dry, pairing your dandruff shampoo with a gentle, hydrating conditioner on the ends of your hair, not the scalp, can keep hair soft without disrupting treatment. Managing stress, getting adequate sleep, and maintaining a healthy diet can also support overall scalp health. And if your flaking doesn’t improve after a few weeks, or if you notice redness, pain, or hair shedding, it’s a good idea to see a dermatologist to rule out another condition. My biggest message is that dandruff is very treatable. You just need the right approach and a little patience.

Hair changes can be confusing, especially when you’re noticing more strands in your brush or a gradual thinning over time. While many people use the terms interchangeably, hair shedding and hair loss are actually two different conditions with different causes and treatment approaches. Understanding the difference is the first step toward finding the right solution, and Dr. Alexandra Bowles helps to explain how to in NBC Select’s article.

What are the main differences between hair loss and hair shedding?

Hair shedding and hair loss are often confused, but they’re not the same thing. Shedding refers to increased hair fall from the scalp, usually as part of a temporary disruption in the hair growth cycle. Hair loss, on the other hand, occurs when hair follicles stop producing new hairs or gradually shrink over time. With shedding, the follicle is still healthy and capable of regrowth, whereas hair loss may involve follicle damage or miniaturization. Shedding typically feels sudden and diffuse, while hair loss often appears more gradual and patterned. Understanding this distinction is important because the causes, treatments, and long-term outlook can be very different.

What causes hair loss versus shedding?

Hair shedding is most commonly triggered by stressors such as illness, surgery, childbirth, hormonal shifts, nutritional deficiencies, or significant emotional stress. These events push more hairs than usual into the shedding phase, leading to noticeable shedding weeks to months later. Hair loss is often driven by genetics, hormonal changes, autoimmune conditions, or chronic inflammatory scalp disorders. Androgenetic alopecia, for example, is influenced by genetics and hormones and tends to progress slowly over time. Certain medications and medical conditions can contribute to both shedding and hair loss. Identifying the underlying cause is key to determining the most effective treatment approach.

How can you tell which one you’re experiencing?

One helpful clue is how the hair loss looks and feels. Shedding often presents as large amounts of hair coming out in the shower, on pillows, or in brushes, but without obvious bald patches. Hair loss tends to show up as thinning in specific areas, widening of the part, recession at the temples, or visible scalp over time. Another indicator is timing. Shedding usually starts a few months after a triggering event and often improves within several months. Hair loss is typically more gradual and persistent. If the pattern or timeline feels unclear, a dermatologist can help clarify what’s happening.

Is hair shedding the same as thinning hair?

Hair shedding and thinning are related, but they’re not identical. Shedding refers to hair falling out, while thinning describes a visible decrease in hair density. Temporary shedding can sometimes make hair appear thinner, but the hair often regrows once the trigger resolves. Thinning hair is more commonly associated with ongoing hair loss conditions, such as androgenetic alopecia, where regrowth may be slower or incomplete. In thinning hair, individual strands may also become finer over time. The key difference is whether new, healthy hairs are growing back at the same rate they’re being lost.

Do both require medical care? 

Not all cases of hair shedding require medical treatment, especially if the cause is temporary and identifiable. Many shedding episodes resolve on their own with time, stress reduction, and proper nutrition. Hair loss, however, often benefits from medical evaluation because early treatment can help slow progression and preserve existing hair. Certain types of shedding may also need medical attention if they’re severe, prolonged, or associated with other symptoms. A dermatologist can help determine whether reassurance, monitoring, or treatment is appropriate. Getting the correct diagnosis helps prevent unnecessary treatments and anxiety.

When should you see a doctor?

You should consider seeing a dermatologist if hair shedding lasts longer than six months, worsens over time, or occurs without an obvious trigger. It’s also important to seek care if you notice patchy hair loss, scalp redness, pain, or itching. Sudden hair loss involving the eyebrows, eyelashes, or body hair should always be evaluated. If hair changes are accompanied by fatigue, weight changes, or hormonal symptoms, further workup may be needed. Early evaluation allows for more treatment options and often better outcomes. Most importantly, if hair changes are causing distress, it’s absolutely appropriate to seek professional guidance.

What are the best treatments for hair loss versus shedding? 

Treatment depends heavily on whether someone is dealing with true hair loss or temporary shedding. Hair loss conditions, such as androgenetic alopecia or alopecia areata, often benefit from targeted therapies like topical minoxidil, prescription medications, or in-office treatments that address follicle health and inflammation. Hair shedding is usually managed by identifying and correcting the underlying trigger, such as stress, illness, hormonal changes, or nutritional deficiencies. There is some overlap, as treatments that support scalp health and follicle function can benefit both. However, shedding often improves with time and supportive care, whereas hair loss typically requires ongoing treatment to slow progression. This is why an accurate diagnosis is so important before starting any regimen.

What should you consider when shopping for a treatment for hair loss?

When choosing a treatment for hair loss, it’s important to look for products with clinical evidence supporting their effectiveness. Ingredients like minoxidil have strong data behind them and remain a cornerstone of treatment for many types of hair loss. Patients should also consider consistency and long-term use, since most hair loss treatments require ongoing application to maintain results. Scalp tolerance is another key factor, especially for those with sensitive skin or underlying scalp conditions. It’s also wise to be cautious of products that promise rapid or dramatic regrowth, as these claims are often unrealistic. Consulting a dermatologist can help tailor treatment choices to the specific type of hair loss.

What should you consider when shopping for a treatment for hair shedding?

With hair shedding, the focus should be on gentle, supportive products rather than aggressive growth stimulants. Look for formulations that promote scalp health, reduce inflammation, and support the hair growth cycle, such as those containing soothing botanicals or peptides. Since shedding is often temporary, the goal is to create an environment that allows hair to regrow naturally. Avoid harsh treatments or excessive product layering, which can further irritate the scalp. It’s also important to consider lifestyle factors, like nutrition and stress, alongside topical treatments. In many cases, patience and consistency are just as important as the product itself.

Are there any specific products recommended for hair loss or shedding?

For hair loss, topical minoxidil remains one of the most effective and accessible treatments, with decades of research supporting its use. Products like Rogaine 5% Minoxidil Foam or Keeps 5% Minoxidil Foam are well-studied options that can help slow progression and support regrowth when used consistently over several months. For hair shedding, the focus should be on calming and supporting the scalp rather than aggressively stimulating it. Gentle options such as PURA D’OR Original Gold Label Anti-Hair Thinning Shampoo or Nizoral A-D Shampoo can help address inflammation or scalp imbalance that may contribute to shedding. A lightweight topical like The Ordinary Multi-Peptide Serum for Hair Density can also support scalp health without adding buildup. Ultimately, choosing the right product depends on the underlying cause, scalp sensitivity, and individual lifestyle, which is why a proper diagnosis is so important.

Can scalp massages help?

Scalp massages can be a helpful, supportive practice, but they are not a standalone treatment for hair loss. A gentle massage may improve blood flow to the scalp and reduce tension, supporting overall scalp health. This can be particularly beneficial for people experiencing stress-related shedding. However, scalp massages alone are unlikely to reverse genetic or autoimmune hair loss. It’s also important not to massage too aggressively, as excessive traction can worsen shedding. When used appropriately, scalp massage can be a useful complement to other treatments, but it should not replace evidence-based therapies.

What else can you do to avoid hair loss or shedding?

Lifestyle factors play a significant role in hair health. Managing stress, maintaining a balanced diet with adequate protein and iron, and addressing underlying medical conditions are all essential. Gentle hair care practices, such as avoiding tight hairstyles and minimizing heat styling, can also help reduce breakage and shedding. Sleep quality and hormonal balance are often overlooked but can significantly impact the hair growth cycle. Regular scalp care and sun protection for thinning areas are also important. Taking a holistic approach often leads to better long-term outcomes.

Hair changes can be emotionally challenging, and it’s important for patients to know they’re not alone. Many cases of shedding are temporary and improve with time and proper care. Early evaluation can make a meaningful difference, especially when it comes to hair loss conditions that benefit from prompt treatment. I encourage patients to be cautious of trends or quick fixes and to focus on consistent, evidence-based approaches. Hair health is closely tied to overall health, so addressing the whole picture matters.

If your atopic dermatitis feels harder to control or is starting to impact your daily life, it may be time to reassess your treatment plan. From frequent flares to newer oral therapies like JAK inhibitors, understanding your options can help you take a more effective, comprehensive approach to care. Learn more about what might be the best treatment plan for you with Dr. Alexandra Bowles in Everyday’s Health article.

How can someone with Atopic Dermatitis know they need to switch treatment? 

One of the clearest signs that it may be time to reassess treatment is when flares are frequent or increasingly difficult to control. Especially if they persist despite consistent use of topical therapies and good skincare habits. If someone is relying heavily on topical steroids and experiencing rebound flares, that can indicate that surface-level treatments alone are no longer enough. Quality-of-life factors also matter. If itching is disrupting sleep, daily activities, or work or school performance, those are important signals that the current approach may not be adequately controlling the disease.

How do you know if systemic treatment may be the right choice?

Systemic treatment is often considered when atopic dermatitis is moderate to severe, widespread, or significantly affecting a patient’s physical and emotional well-being. If eczema involves multiple body areas, is associated with intense itch, or continues despite optimized topical therapy and trigger management, systemic options may be appropriate. This is not about “giving up” on topicals. It’s about recognizing that atopic dermatitis is an inflammatory condition driven by immune pathways that sometimes need to be addressed from the inside out.

What are new oral therapies that might be a good option?

Newer oral therapies known as JAK inhibitors work by targeting specific inflammatory signaling pathways involved in atopic dermatitis. These medications can help reduce inflammation and itch more directly and often quicker than traditional treatments. They may be appropriate for adults with moderate to severe disease who have not responded well to topical therapies or other systemic options. Like any medication, they require careful patient selection and monitoring. They should always be prescribed and managed by a dermatologist familiar with these treatments.

How are these integrated with other aspects of treatment like skincare and dietary considerations?

Systemic therapies don’t replace good skincare. They work alongside it. Even when someone starts an oral medication, maintaining a gentle, consistent skincare routine remains essential. It’s still important to support the skin barrier and reduce irritation. That includes regular moisturizing, avoiding harsh cleansers, and minimizing known triggers. Dietary considerations can be helpful, especially if specific food triggers have been identified. But, diet alone rarely controls moderate to severe disease. The most effective approach is a layered one that addresses both internal inflammation and external barrier support.

What are the potential side effects of new oral therapies?

JAK inhibitors and other systemic therapies can have potential side effects. These vary depending on the specific medication and the individual patient. These may include increased risk of infections, changes in laboratory values, or other systemic effects. This makes ongoing monitoring very important. A dermatologist will review a patient’s medical history, risk factors, and lifestyle before starting treatment.They will continue to monitor labs and symptoms over time. For many patients, the benefits in symptom control and quality of life can outweigh the risks.