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Generally, dandruff can be self-diagnosed and does not require medical treatment. However, if symptoms are severe and the dandruff flakes are accompanied by redness and inflammation of the scalp, it may be a related condition such as seborrheic dermatitis. In such cases, a patient should seek the care of a physician (usually a dermatologist).

Sometimes dandruff diminishes on its own but it improves more rapidly with proper treatment. The main therapy for dandruff is diligent and consistent shampooing of the scalp and hair. Washing of the head is important to remove the loose scales so the underlying skin can be treated. 

Typically, patients require an over-the-counter dandruff shampoo to treat dandruff. These shampoos usually contain one of five active ingredients that counteract the buildup of skin cells. These ingredients include:

• Zinc pyrithione. An antibacterial and antifungal agent that has been shown to reduce the yeast associated with dandruff and seborrheic dermatitis.
  
  
• Coal tar. A byproduct obtained from coal manufacturing that has been proven to help conditions including dandruff, seborrheic dermatitis and psoriasis by slowing skin cell turnover. However, coal tar can give blond or light hair an orange tint and may cause photosensitivity.
  
  
• Salicylic acid. This drying agent may help eliminate scales and hair oiliness, but it may leave an excessively dry scalp, which can lead to more flaking. To counter the dryness, the use of a conditioner after shampooing is recommended.
  
  
• Selenium sulfide. This agent helps prevent skin cell turnover and may also reduce the number of yeast cells. However, shampoos with selenium sulfide can discolor blond, gray or chemically colored hair. Patients should only use them as directed and should rinse thoroughly after shampooing.
  
  
• Ketoconazole. A broad spectrum antifungal agent. Ketoconazole shampoos are available over-the-counter as well as by prescription (in higher dosages).

Hair should be washed daily with dandruff shampoo until the scalp condition is controlled. The shampoo should then be used two or three times a week to prevent recurrence. Alternating between two types of dandruff shampoos may work when flare-ups occur. Patients should massage the shampoo into the scalp while using their fingers to loosen scales. The shampoo should be left on the scalp for at least five minutes to allow the ingredients to work. Patients should then thoroughly rinse the shampoo out of their hair. Some experts suggest lathering twice for best results. Individuals may have to experiment with different types of dandruff shampoo in order to find the most effective type.

If over-the-counter dandruff shampoos fail to improve the dandruff after two weeks of use, a patient should contact their dermatologist. The dermatologist may prescribe a prescription-strength dandruff shampoo or a steroid lotion for more aggressive treatment of the scalp condition.