Calm itchy, flaky skin · 8 weeks
Dandruff & Seborrhoeic Dermatitis (Afro Hair)
8 weeks to calm itch and flakes with a medicated shampoo schedule that fits weekly or fortnightly wash days and protective styles. Includes a scalp psoriasis track for people a doctor has diagnosed.
- Length
- 8 weeks
- For
- Women, Men
- Evidence A
- Strong evidence: guidelines or reviews of trials
- What to expect
- Itch eases: 1–2 weeks. Flakes clear: 2–4 weeks. Without maintenance about half relapse within 6 months. Light patches on brown skin return to normal colour over weeks to months.
The goal: Most people clear or improve by week 4; a once-weekly (or every wash-day) medicated wash keeps it away.
Ketoconazole 2% shampoo: Cochrane review (Grade A); weekly maintenance from a placebo-controlled RCT (Grade B). Trials were in European and US populations; the wash-day and scalp-only adaptations for Afro hair are expert consensus (Grade C).
Start this program
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The plan
Weeks 1–4
Clear
Ketoconazole 2% shampoo twice a week, scalp only; oils off the scalp.
In the RCT, twice-weekly ketoconazole for 2–4 weeks gave an excellent response in 88% of people.
Morning
Oils on ends, not scalp
Put hair oils, greases and pomades on the lengths and ends only; keep the scalp product-free.
Why: Oil build-up on the scalp may feed the Malassezia yeast behind seborrhoeic dermatitis.
Evening
No scratching with combs or pins
For itch, press or tap the scalp; keep nails short.
Why: Scratching breaks the skin and causes dark marks and infection.
Medicated scalp wash
Ketoconazole 2% shampoo — scalp only
Twice a week. Loose hair: section into 4–6; apply a coin-size amount along each parting directly to the scalp; massage with fingertips (not nails) for 1 minute; leave on 3–5 minutes (or as the label says); rinse thoroughly; condition the lengths only. Braids, cornrows or locs: use an applicator-nozzle bottle (shampoo diluted 1:1 with water) along each parting, massage, leave, rinse well, then dry the scalp fully (cool dryer) to stop mildew. Pregnant or breastfeeding: check with your pharmacist first.
Leave on: leave 3–5 min
Why: Cochrane: ketoconazole reduces persisting symptoms compared with placebo, with fewer side effects than steroids. Applying it only to the scalp avoids drying coily lengths (Cutis 2025).
Okokon et al. Topical antifungals for seborrhoeic dermatitis (Cochrane Review, 2015)
Habits
Also on face, ears or eyebrows?
Lather the same shampoo on those areas for 1 minute and rinse, or ask a pharmacist. Pale patches on brown skin usually return to normal colour once the inflammation settles.
Why: Seborrhoeic dermatitis in Black patients often causes temporary lightening at the hairline, ears and face.
Dry under wigs and braids
Dry the scalp fully after washing braids; never sleep in a damp wig cap; wash wig caps and bonnets weekly.
Why: Sweat and damp under wigs and caps in humid heat worsen flares.
Skip harmful remedies
No kerosene, methylated spirit, engine oil, or steroid "dandruff creams" bought without a diagnosis. Generic ketoconazole shampoos are fine — check for a NAFDAC number.
Why: These burn or thin the scalp and can mask ringworm.
Weeks 5–8
Keep it away
One medicated wash a week (or every wash day).
In the RCT, weekly ketoconazole cut 6-month relapse from 47% (placebo) to 19%; every other week, to 31%.
Morning
Oils on ends, not scalp
As before: lengths and ends only.
Why: Keeps yeast food off the scalp.
Evening
Protect for sleep
Loose plaits, twists or a pineapple; satin bonnet or satin pillowcase. Wash the bonnet weekly.
Why: Less friction breakage, which makes thinning look worse.
BAD patient information leaflet: Caring for Afro-textured hair (July 2023)
Wash day + maintenance
Maintenance: ketoconazole 2% once a week (or at every fortnightly wash)
Use it as the first shampoo on wash day, scalp only, leave 3–5 minutes, then your usual conditioner. If you wash every 2 weeks, use it every wash day; if itch returns, add a mid-week scalp-only rinse. If it stops working, alternate with a selenium sulfide or zinc pyrithione shampoo. Pregnant or breastfeeding: check with your pharmacist.
Leave on: leave 3–5 min
Why: RCT: weekly ketoconazole kept 81% clear for 6 months; alternating actives is AAD advice.
Habits
If it comes back
Restart twice-weekly washes for 2 weeks, then return to weekly.
Why: Seborrhoeic dermatitis is long-term and flares; quick restarts keep it controlled.
Thick plaques? Ask about psoriasis
Thick, silvery or sharply edged patches, or patches on elbows, knees or nails, may be psoriasis — see a doctor, then switch to the psoriasis track if diagnosed.
Why: Psoriasis needs prescription treatment.
NICE CG153: Psoriasis — initial topical treatment incl. scalp (information for the public)
Milestones
Your weekly check-in
Ask yourself these once a week. If an answer worries you, stop and see a doctor or pharmacist.
Stop and see a doctor if
- Scaly patches with hair loss or black dots, especially in a child: possible scalp ringworm — see a doctor (shampoo alone will not clear it)
- Pus, a boggy painful lump, or fever
- Crown tenderness or burning with thinning (possible scarring CCCA)
- Rash or swelling after starting the shampoo
- No improvement by week 4: see a doctor
In an emergency, call 112112999911911.
Sources
- Okokon et al. Topical antifungals for seborrhoeic dermatitis (Cochrane Review, 2015)
- Peter & Richarz-Barthauer. Treatment and prophylaxis of scalp seborrhoeic dermatitis and dandruff with 2% ketoconazole shampoo: double-blind placebo-controlled RCT (Br J Dermatol, 1995)
- Robinson, Shah, Ogbonna & McMichael. Treatment of seborrheic dermatitis in Black patients (Cutis, 2025)
- NICE CG153: Psoriasis — initial topical treatment incl. scalp (information for the public)
- AAD: How to treat dandruff
- DermNet: Nail psoriasis
Education, not diagnosis. This plan cannot examine you; pending physician review where marked.
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