Adult Dandruff Treatment (Seborrheic Dermatitis)
Fast MD-only dandruff and scalp care by secure online video visit, $49 flat-fee, no insurance required.
Persistent scalp flaking, itching, and redness are usually caused by seborrheic dermatitis, a chronic inflammatory reaction to skin yeast and oil, not "poor hygiene." Our board-certified MDs use guideline-based criteria to confirm dandruff, rule out red-flag conditions, and tailor evidence-based treatment you can start quickly at home.
- $49 flat-fee adult visit
- MD-only care (no mid-levels)
- No insurance required
- Secure video visits in 25+ states
MD-Only Virtual Dandruff Care
- Online video visit with a board-certified MD
- Assessment of scalp flaking, itching, and redness
- Guideline-based treatment plan and prescriptions when appropriate
- Clear guidance on when in-person dermatology is needed
Adult patients only (18+). No controlled substances are prescribed through TeleDirectMD.
What Is Dandruff (Seborrheic Dermatitis)?
Dandruff in adults is most often a mild form of seborrheic dermatitis affecting the scalp. It occurs when the skin's oil (sebum), normal skin yeast, and the immune system interact to cause inflammation, leading to flaking, itching, and sometimes redness or greasy scales. It is not contagious and is not caused by poor hygiene, though infrequent washing can make flaking more noticeable.
Seborrheic dermatitis can also affect other oil-rich areas such as the eyebrows, sides of the nose, beard, ears, or chest. In most adults, it can be safely evaluated and treated by telehealth using a detailed history and video exam, as long as red-flag features are not present.
Symptoms and Red Flags in Adult Dandruff
Common dandruff symptoms can often be treated through a telehealth visit, but certain features suggest a more serious skin or systemic condition that requires in-person or urgent evaluation.
| Symptom | What it suggests | Telehealth appropriate? | Red flag requiring urgent in-person care |
|---|---|---|---|
| Dry or greasy white flakes on the scalp | Typical dandruff / seborrheic dermatitis | Yes, if no other concerning features | Not a red flag by itself |
| Mild to moderate scalp itching | Common in seborrheic dermatitis or irritant scalp | Yes, if no open sores or infection | Severe pain, burning, or sleep-disrupting itch |
| Scalp redness with flaky or greasy scales | Inflamed seborrheic dermatitis or psoriasis overlap | Usually, if skin is intact and no systemic symptoms | Rapidly spreading redness, warmth, or swelling suggesting infection |
| Yellow, thick, adherent crusts or oozing areas | Possible secondary bacterial infection or impetigo | Sometimes, but often needs close in-person inspection | Honey-colored crusting, pus, or signs of spreading skin infection |
| Patchy hair loss in areas of scaling | Possible tinea capitis, scarring alopecia, or autoimmune disease | May start with telehealth, but often needs in-person derm exam | Rapid hair loss, broken hairs, scalp tenderness, or swollen lymph nodes |
| Rash extending beyond scalp (face, chest, groin) | More extensive seborrheic dermatitis, psoriasis, or other dermatoses | Telehealth may be appropriate if skin intact and patient stable | Extensive, painful, blistering, or rapidly spreading rash |
| Fever, chills, feeling very ill along with scalp changes | Possible systemic infection or inflammatory condition | No | Requires urgent in-person or emergency evaluation |
| New scalp lesions in an immunocompromised patient | Higher risk of atypical infection or severe dermatitis | Telehealth may help triage, but low threshold for in-person care | Rapid progression, ulceration, or systemic symptoms in immunocompromised host |
Differential Diagnosis: Dandruff vs Other Scalp Conditions
Dandruff is common, but not every flaky scalp is simple seborrheic dermatitis. During your TeleDirectMD visit, the MD will consider other diagnoses based on your history, appearance on video, and distribution of symptoms.
Dandruff (Seborrheic Dermatitis)
- Fine or greasy white or yellow flakes on scalp
- Mild to moderate itching, often chronic or relapsing
- May also affect eyebrows, sides of nose, ears, or beard
- Improves with medicated shampoos and anti-inflammatory topicals
Other Causes of Scalp Flaking
- Dry scalp / irritant dermatitis: Tight, dry, sometimes burning sensation, often from harsh hair products or over-washing.
- Psoriasis: Thicker, silver-scale plaques that may extend beyond hairline; often coexists with psoriasis on elbows, knees, or trunk.
- Tinea capitis (fungal infection of scalp): More common in children but can occur in adults; patchy hair loss, broken hairs, tender lymph nodes.
- Contact allergy: New hair dye, shampoo, or styling product causing redness, itching, and sometimes blisters.
Many of these conditions can be triaged and initially managed via telehealth, but some—especially those involving hair loss, scarring, or severe inflammation—may require in-person dermatology evaluation, scalp cultures, or biopsy.
When Is a Video Visit Appropriate for Dandruff?
When a Video Visit Is Appropriate
- Mild to moderate scalp flaking or "snow on shoulders"
- Mild to moderate itching without open sores or drainage
- Chronic, recurring dandruff that has only partially improved with OTC shampoos
- Redness or greasy scaling on scalp, eyebrows, beard, or around the nose
- No fever, chills, or feeling systemically ill
- No rapidly progressive patches of hair loss
- Patient is stable, can participate in video exam, and can safely obtain medications
Red Flags Requiring In-Person or ER Care
- Sudden, rapidly spreading redness, warmth, or swelling of the scalp
- Painful, pus-filled bumps or extensive honey-colored crusts
- Rapid patchy hair loss, broken hairs, or scarring areas
- Fever, chills, or feeling very unwell along with scalp changes
- Blistering, ulceration, or open sores on the scalp
- Severe immunosuppression (e.g., chemotherapy, advanced HIV) with rapidly changing scalp lesions
- Eye involvement, facial swelling, or difficulty swallowing or breathing
If any red-flag symptoms are present, seek in-person or emergency care immediately. TeleDirectMD is not an emergency service.
Treatment Options for Adult Dandruff
Most adults with dandruff can be managed with a combination of medicated shampoos, short courses of anti-inflammatory topicals, and maintenance scalp care. Our approach emphasizes long-term control while minimizing unnecessary medications.
Supportive and Home-Based Care
- Regular shampooing to reduce oil and build-up on the scalp
- Rotation of anti-dandruff shampoos (e.g., ketoconazole, selenium sulfide, zinc pyrithione)
- Gentle massage of shampoo into the scalp and leaving it on for several minutes before rinsing
- Avoiding harsh hair products, fragrances, and aggressive scratching of the scalp
- Managing contributing factors such as stress and cold, dry weather when possible
First-Line Prescription Options (When Appropriate)
- Topical antifungal shampoos (e.g., ketoconazole) for Malassezia yeast overgrowth
- Short courses of low-potency topical corticosteroids for inflammatory flares
- Topical calcineurin inhibitors for certain sensitive areas (e.g., around the face) when clinically appropriate
Antibiotics are not routinely used for dandruff because it is primarily inflammatory and yeast-related, not a simple bacterial infection. Oral medications are reserved for select, severe, or refractory cases and typically require in-person dermatology follow-up.
Common Medications Used for Dandruff (Seborrheic Dermatitis)
The exact regimen will depend on the severity, distribution, and response to prior treatments. Below are example options that an MD may consider. Your individual plan may differ.
| Medication | Dose | Duration | When it is used |
|---|---|---|---|
| Ketoconazole 2% shampoo | Apply to scalp, lather, leave on 5 min, then rinse | 2 times per week for 2–4 weeks, then weekly as needed | First-line antifungal shampoo for seborrheic dermatitis |
| Selenium sulfide 2.5% shampoo | Apply to scalp, leave on 5–10 min, then rinse thoroughly | 2 times per week for 2–4 weeks | Alternative or adjunct to ketoconazole in moderate dandruff |
| Fluocinolone 0.01% scalp oil or solution | Apply thin film to affected scalp areas once daily | Up to 7–14 days, then taper or use intermittently | Short course for inflammatory flares with significant itching |
| Hydrocortisone 1% cream or lotion | Apply a thin layer to inflamed scalp margins or facial areas 1–2 times daily | Up to 7–10 days, then discontinue or use sparingly | Mild steroid option for sensitive or facial areas when appropriate |
| Topical calcineurin inhibitor (e.g., pimecrolimus 1% cream) | Apply thin layer to affected non-scalp areas 2 times daily | As directed, often for recurrent facial involvement | For select patients where steroid-sparing therapy is preferred |
Actual medications, strengths, and durations will be individualized by the MD based on your history, video examination, other health conditions, and prior treatments. TeleDirectMD does not prescribe controlled substances for dandruff.
Home Care, Expectations, and Return to Work
Most patients notice improvement in flaking and itching within 1–3 weeks of consistent use of medicated shampoos and topical therapies. Because seborrheic dermatitis is chronic and tends to flare, maintenance therapy is often needed.
- Use prescribed or recommended medicated shampoos exactly as directed.
- When symptoms improve, you may be advised to transition to a less frequent maintenance schedule.
- Avoid picking or scratching the scalp, which can worsen inflammation and increase infection risk.
- Monitor for any new symptoms such as hair loss, severe pain, or spreading rash and seek care if they occur.
- Most people can continue normal work and social activities, as dandruff is not contagious.
If you are given a work note, it will typically confirm evaluation and treatment but does not usually require time off unless symptoms are severe or there are complications.
TeleDirectMD Telehealth Disclaimer
TeleDirectMD provides MD-only virtual urgent care for adults, using secure video visits to evaluate common conditions like dandruff and seborrheic dermatitis. Visits are $49 flat-fee with no insurance required and are available in 25+ states. Our physicians follow evidence-based guidelines, explain what can be safely managed by telehealth, and clearly outline when in-person or emergency evaluation is needed. TeleDirectMD is not a replacement for in-person primary care or emergency services.
Adult Dandruff Treatment FAQs
In most adults, dandruff is a mild form of seborrheic dermatitis of the scalp. It is an inflammatory reaction to skin yeast and oil that causes flaking, itching, and sometimes redness. It is chronic and tends to flare but can usually be controlled with the right regimen of medicated shampoos and topicals.
Yes. For typical dandruff and mild to moderate seborrheic dermatitis, an MD can usually evaluate the pattern, severity, and distribution via video, rule out many red flags, and recommend an evidence-based treatment plan. If anything concerning is seen, we will guide you to in-person dermatology or urgent care instead.
Many people notice less flaking and itching within 1–3 weeks of consistent use of medicated shampoos and topical therapies. Because seborrheic dermatitis is chronic, some level of ongoing maintenance (for example, once-weekly medicated shampoo) is often needed to keep symptoms controlled.
Treatment often includes ketoconazole or selenium sulfide shampoos, sometimes combined with short courses of low-potency topical steroids or other anti-inflammatory creams for inflamed areas. We also give detailed instructions on how to apply and rotate shampoos to get the most benefit while minimizing side effects.
No. Dandruff is not contagious and is not caused by being "dirty." It results from how your immune system and skin respond to normal yeast and oil on the scalp. Infrequent washing can make flakes more obvious, but the underlying problem is inflammatory, not infectious in a way that spreads from person to person.
Mild cases may respond well to over-the-counter anti-dandruff shampoos if used correctly and consistently. When symptoms are persistent, more severe, or extend beyond the scalp, prescription-strength medicated shampoos and topicals prescribed by an MD often provide better control and help prevent repeated flares.
Red flags include rapid patchy hair loss, thick painful plaques, pus, extensive crusting, fever, or feeling very unwell. These can indicate psoriasis, fungal infection of the scalp, bacterial skin infection, or other conditions that require in-person evaluation. Our MDs screen for these during your telehealth visit and will redirect you if needed.
In many cases, daily or near-daily washing with a gentle shampoo is fine, and sometimes helpful, as long as medicated shampoos are used as directed and left on the scalp long enough to work. Your MD can recommend a specific wash schedule tailored to your hair type, symptoms, and medications.
You should see an in-person dermatologist if you have rapidly progressive hair loss, scarring areas, severe or painful rashes, frequent treatment failures despite proper use, or if our MD identifies features that need hands-on examination, lab testing, or biopsy. Telehealth is excellent for triage, ongoing management, and medication adjustments but does not replace in-person specialty care when indicated.
Dandruff and seborrheic dermatitis are usually chronic but controllable rather than permanently "curable." Most adults do well with a long-term plan that includes medicated shampoo during flares, maintenance use as needed, and attention to triggers such as stress, weather changes, or harsh hair products.
TeleDirectMD offers MD-only, guideline-based care by secure video, with transparent $49 flat-fee pricing and no insurance required. We focus on clear expectations, conservative and effective treatment plans, and explicit guidance on when in-person or urgent care is safer for you.