Dandruff & Scalp Psoriasis Treatment Options: Finding the Right Treatment
A comparison hub for every treatment we cover — antifungal shampoos, steroid scalp applications, descaling ointments and combination gels — with links to the full guide for each.
Part of our dandruff and scalp health guides. See also scalp psoriasis: symptoms and causes and dandruff and seborrhoeic dermatitis.
Key fact: There is no single best scalp treatment — the right choice depends on the cause. Fungal-driven dandruff needs an antifungal shampoo, inflamed scalps need a corticosteroid, and thick scale needs descaling before anything else can work.
Not Sure Which Treatment You Need?
Access Doctor provides prescription scalp treatments following a GPhC-regulated online consultation. Our pharmacist independent prescribers will recommend the right option for your symptoms.
Start Consultation →Match the treatment to the cause
Flaking, itching and scaling look similar on the surface, but the driver differs: dandruff and seborrhoeic dermatitis are linked to an overgrowth of Malassezia yeast, while scalp psoriasis is an immune-driven condition of accelerated skin cell turnover. Picking the treatment that matches your cause is what matters most — our guide on what causes dandruff and our scalp psoriasis explainer cover the diagnosis side in detail.
The treatments in this guide fall into four main groups:
Antifungal shampoos
Ketoconazole and Nizoral — reduce the Malassezia yeast behind dandruff and seborrhoeic dermatitis.
Steroid scalp applications
Betacap, Betnovate and Etrivex — switch off inflammation, redness and itch.
Descaling ointments
Cocois — coal tar and salicylic acid soften and lift thick, stubborn scale.
Combination gels
Dovobet — a vitamin D analogue plus a potent steroid for plaque psoriasis.
Antifungal shampoos: ketoconazole & Nizoral
For most dandruff and seborrhoeic dermatitis, an antifungal shampoo is the first-line treatment. Ketoconazole 2% reduces the yeast population on the scalp, typically used two to three times a week with a 3–5 minute contact time, then weekly for maintenance.
- Ketoconazole 2% shampoo (generic) — the standard antifungal strength, sold in pharmacies. Learn more in our ketoconazole shampoo guide.
- Nizoral — the best-known ketoconazole brand. Learn more in our Nizoral guide.
Steroid scalp applications: Betacap & Betnovate
When the scalp is red, sore and itchy — not just flaky — the problem is inflammation, and antifungal shampoos alone will not settle it. Betamethasone valerate 0.1%, a potent topical corticosteroid, is the usual first-line prescription choice, formulated as a quick-drying liquid for hair-bearing skin.
- Betacap scalp application — betamethasone valerate 0.1%. Start with our Betacap product guide, or the focused guides on soothing an inflamed scalp, itchy scalp relief and stubborn dandruff.
- Betnovate scalp application — the same potent active in GSK's branded formulation. Learn more in our Betnovate condition guide, and see the step-by-step application guide.
Steroid stewardship: NICE advises reviewing a potent steroid for scalp psoriasis 4 weeks after starting, not using a potent steroid continuously for more than 8 weeks, and aiming for a 4-week break between courses. Steroids settle flares; they aren't long-term daily maintenance. Your prescriber will set the course length.
Stepping up: Etrivex shampoo
If a potent steroid hasn't controlled a scalp psoriasis flare, Etrivex delivers clobetasol propionate 0.05% — a very potent corticosteroid, the strongest topical class — in a short-contact shampoo: apply to the dry scalp, leave for 15 minutes, then rinse. See our full Etrivex guide, or read what to expect from clobetasol shampoo.
Descaling first: Cocois ointment
Thick, compacted scale acts as a physical barrier — steroids and antifungals cannot penetrate it. Cocois (coal tar 12%, salicylic acid 2%, sulphur 4% in a coconut-oil base) is the descaling step: massaged in, left for an hour or overnight, then washed out, lifting softened scale with it. Many treatment plans run Cocois first, then follow with a steroid once the skin is reachable. Learn more in our Cocois guide.
Combination treatment: Dovobet gel
Dovobet combines calcipotriol (a vitamin D analogue that slows skin cell turnover) with betamethasone dipropionate (a potent corticosteroid) in a once-daily gel for plaque psoriasis of the scalp and body — treating both the cell turnover and the inflammation in one product. Learn more in our Dovobet guide.
More scalp psoriasis guides
- Scalp psoriasis: symptoms and causes, including early signs and triggers
- Scalp psoriasis vs dandruff, dry scalp and scalp eczema
- Psoriasis shampoo: coal tar, steroid and medicated shampoos
- Steroid scalp lotions compared: Betacap, Betnovate, Elocon and Dermovate
- Home remedies and how to remove scale
- Scalp psoriasis and hair loss
Full comparison table
| Treatment | Active ingredient(s) | Best for | How it is used |
|---|---|---|---|
| Ketoconazole 2% shampoo | Ketoconazole (antifungal) | Dandruff and seborrhoeic dermatitis | 2–3× weekly, 3–5 minute contact, then rinse |
| Nizoral shampoo | Ketoconazole 2% (brand) | Dandruff and seborrhoeic dermatitis | As ketoconazole; branded formulation |
| Betacap scalp application | Betamethasone valerate 0.1% (potent steroid) | Inflamed, itchy scalp; persistent dandruff with inflammation | Once or twice daily; left on |
| Betnovate scalp application | Betamethasone valerate 0.1% (potent steroid) | Scalp psoriasis, seborrhoeic dermatitis, scalp eczema | Once or twice daily; left on |
| Etrivex shampoo | Clobetasol propionate 0.05% (very potent steroid) | Scalp psoriasis flares not controlled by potent steroids | Daily on dry scalp, 15 minutes, then rinse; max 4 weeks |
| Cocois ointment | Coal tar 12% + salicylic acid 2% + sulphur 4% | Thick, stubborn scale (descaling step) | Leave on 1 hour or overnight, wash out; daily for 3–7 days, then weekly |
| Dovobet gel | Calcipotriol + betamethasone dipropionate | Plaque psoriasis of scalp and body | Once daily; left on |
Other options our prescribers may consider include Psoriderm and Dermax medicated shampoos, Elocon scalp lotion and Dermovate scalp application (a very potent clobetasol liquid). See steroid scalp lotions compared and our psoriasis shampoo guide.
Where to start: OTC or prescription?
A sensible escalation path saves time and money — our dandruff treatment guide walks the full ladder. In short:
1
Start with an OTC medicated shampoo
Zinc pyrithione, selenium sulphide or coal tar shampoos, used correctly with 3–5 minutes of contact time, control most mild dandruff.
2
Step up to ketoconazole 2%
If four weeks of regular OTC use has not worked, ketoconazole 2% targets the underlying yeast more effectively.
3
Treat inflammation or scale when present
Red, sore, itchy scalp: a potent steroid application. Thick built-up scale: Cocois first. Psoriasis plaques: steroid, Etrivex or Dovobet per your prescriber.
See a clinician promptly if your scalp develops crusted or weeping patches, you notice significant hair loss, flaking spreads to the face or chest, or you develop ring-like patches (possible scalp ringworm needing oral antifungals). In an emergency, call 999.
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Answer a few clinical questions and our pharmacist independent prescribers will match you to the right treatment — dispensed from our GPhC-registered UK pharmacy with discreet delivery.
Start Consultation →Frequently Asked Questions
What is the best treatment for dandruff?
Most dandruff responds to an antifungal shampoo such as ketoconazole 2%, used two to three times a week. If flaking persists after four weeks, or your scalp is inflamed and itchy, a prescription treatment such as a steroid scalp application may be needed.
What is the best treatment for scalp psoriasis?
Potent topical corticosteroids such as Betnovate or Betacap scalp applications are the usual first-line treatment for scalp psoriasis. Thick scale may need softening with a descaling ointment such as Cocois first, and stubborn cases may step up to Etrivex (a very potent steroid shampoo) or Dovobet gel.
How do I know if I have dandruff or scalp psoriasis?
Dandruff causes fine white or yellowish flakes with little redness. Scalp psoriasis causes well-defined, raised red plaques with silvery scale that may extend beyond the hairline. If you are unsure, get a diagnosis before treating — our prescribers assess this during your consultation.
Do I need a prescription for these treatments?
Coal tar shampoos and ketoconazole 2% shampoo (such as Nizoral) can be bought from a pharmacy without a prescription. Steroid scalp applications, Etrivex and Dovobet are prescription-only and need a prescriber's assessment, which Access Doctor provides through a short online consultation.
What should I do if my dandruff shampoo is not working?
If four weeks of regular use with correct contact time (three to five minutes) has not controlled your symptoms, step up. Options include ketoconazole 2% shampoo, a steroid scalp application to settle inflammation, or a descaling treatment if scale has built up.
Can I combine different scalp treatments?
Yes, many treatment plans combine approaches — for example, Cocois to remove thick scale, followed by a steroid application, with an antifungal shampoo for maintenance. Your prescriber will confirm the right combination and sequence.
Every treatment above is available through Access Doctor following a short online consultation reviewed by our GPhC-registered pharmacist independent prescribers. These are the options most commonly prescribed:
Antifungal · Rx
Ketoconazole 2% Shampoo
Ketoconazole 2% antifungal shampoo for dandruff and seborrhoeic dermatitis.
View product →Scalp Inflammation · Rx
Betacap Scalp Application
Potent betamethasone valerate 0.1% liquid for inflamed, itchy scalp conditions.
View product →Descaling · Rx
Cocois Ointment
Coal tar, salicylic acid and sulphur ointment for thick, stubborn scalp scale.
View product →Scalp Psoriasis · Rx
Dovobet Gel
Calcipotriol and betamethasone dipropionate gel for plaque psoriasis.
View product →References
- NICE Clinical Knowledge Summaries. Psoriasis: management of scalp psoriasis. 2025. cks.nice.org.uk
- NICE Clinical Knowledge Summaries. Seborrhoeic dermatitis. 2025. cks.nice.org.uk
- British National Formulary. Topical corticosteroids: potency classification. bnf.nice.org.uk
- NICE. Psoriasis: assessment and management (CG153). nice.org.uk
- Primary Care Dermatology Society. Seborrhoeic dermatitis of the scalp. pcds.org.uk
Medical disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional for diagnosis and treatment. In a medical emergency, call 999.