From the Guidelines
Medicated shampoos, particularly those containing coal tar or salicylic acid, are effective for treating psoriasis, while ketoconazole or coal tar shampoos work well for seborrheic dermatitis, and ketoconazole, selenium sulfide, zinc pyrithione, or salicylic acid shampoos are suitable for dandruff. When using medicated shampoos, it is essential to apply them to wet hair, massage into the scalp, leave on for 3-5 minutes (or as directed on the product), then rinse thoroughly 1. The choice of vehicle can significantly alter the use and penetration of the medication, and different vehicles are indicated for different body sites, such as solutions, foams, shampoos, sprays, oils, gels, or other vehicles for hair-bearing areas like the scalp 1. Patient education and matching treatment regimens to individual patient goals can facilitate adherence to topical treatment and improve treatment outcomes 1. Some key points to consider when using medicated shampoos include:
- Applying the shampoo to wet hair and massaging it into the scalp
- Leaving the shampoo on for 3-5 minutes before rinsing
- Using the shampoo 2-3 times weekly initially, then reducing to once weekly for maintenance
- Considering prescription-strength products if symptoms persist after 2-3 weeks of regular use
- Choosing a vehicle that is suitable for the individual patient's skin type and preferences, such as oil-based preparations for African American patients 1. It is crucial to prioritize the patient's treatment goals and tailor the treatment regimen accordingly, as some patients may prefer complete clearance of their disease, while others may be content with treatment of only their most visible lesions 1. In terms of specific ingredients, coal tar reduces cell turnover, salicylic acid removes scale, and zinc pyrithione has both antifungal and antibacterial properties 1. Overall, medicated shampoos can be an effective treatment option for various scalp conditions, and by considering individual patient needs and preferences, healthcare providers can help improve treatment outcomes and patient satisfaction.
From the FDA Drug Label
FOR DERMATOLOGICAL USE ONLY. NOT FOR OPHTHALMIC, ORAL OR INTRAVAGINAL USE. The FDA drug label does not answer the question.
From the Research
Medicated Shampoo for Seborrhoeic Dermatitis
- Medicated shampoos, such as ketoconazole and zinc pyrithione, have been found to be effective in treating seborrhoeic dermatitis of the scalp 2, 3, 4, 5.
- A systematic review of 14 studies found that topical treatments, including bifonazole, ciclopirox, ketoconazole, pyrithione zinc, selenium sulfide, tar shampoo, terbinafine, and topical corticosteroids, were effective in treating seborrhoeic dermatitis of the scalp 2.
- A multicenter randomized trial found that ketoconazole 2% shampoo was significantly more effective than zinc pyrithione 1% shampoo in treating severe dandruff and seborrheic dermatitis, with a 73% improvement in the total dandruff severity score compared to 67% for zinc pyrithione 1% 3.
- Another study found that a combination shampoo of ketoconazole 2% and zinc pyrithione 1% was safe and effective in treating moderate to severe dandruff, with a reduction of > 90% in dandruff scores and significant improvement in other signs and symptoms such as erythema and itching 5.
- A narrative review of ketoconazole shampoo for seborrheic dermatitis of the scalp found that it was a promising treatment option, with numerous trials displaying significant improvement in irritation and scaling of scalp seborrheic dermatitis and optimally low relapse rates, as well as little to no side effects 4.
Types of Medicated Shampoos
- Ketoconazole shampoo: found to be effective in treating seborrhoeic dermatitis of the scalp, with significant improvement in irritation and scaling and low relapse rates 3, 4, 5.
- Zinc pyrithione shampoo: found to be effective in treating seborrhoeic dermatitis of the scalp, although less effective than ketoconazole shampoo in some studies 3, 5.
- Combination shampoos: found to be safe and effective in treating moderate to severe dandruff, with a combination of ketoconazole 2% and zinc pyrithione 1% being a promising option 5.