What are the medical uses of selenium sulfide?

Medical Uses of Selenium Sulfide

Selenium sulfide is primarily indicated for three dermatologic conditions: tinea versicolor, seborrheic dermatitis of the scalp, and dandruff, with additional off-label uses for tinea capitis spore reduction and hyperkeratosis. 1

FDA-Approved Indications

Tinea Versicolor

• Selenium sulfide 2.5% lotion is effective for treating tinea versicolor, applied to affected body surfaces 1
• A double-blind study demonstrated significant superiority over vehicle when applied daily for 10 minutes for 7 consecutive days 2
• Important caveat: Selenium sulfide is classified as Pregnancy Category C when used on body surfaces for tinea versicolor and should not ordinarily be used in pregnant women 1

Seborrheic Dermatitis and Dandruff

• Selenium sulfide (1% or 2.5%) is FDA-approved for seborrheic dermatitis of the scalp and dandruff treatment 1
• Clinical efficacy is substantial: in a 4-week study, mean total dandruff scores decreased from 11.5 at baseline to 2.5 at week 4 (p=0.001) 3
• Application frequency: Use 2-3 times per week for optimal results 4
• After initial treatment with ketoconazole, selenium disulfide provides additional clinical improvement with continued reduction in both adherent (-0.8, p=0.0002) and non-adherent flakes (-0.7, p=0.0081) 5

Guideline-Supported Adjunctive Use

Tinea Capitis (Spore Transmission Reduction)

• The British Association of Dermatologists recommends selenium sulfide 1% shampoo as an adjunctive topical agent to reduce spore transmission in tinea capitis, though oral antifungal therapy remains the primary treatment 6, 7
• Topical therapy alone is not recommended for management of tinea capitis itself 6
• Other effective agents for spore reduction include povidone-iodine and ketoconazole 2% shampoos 6

Off-Label Uses

Hyperkeratosis

• Topical selenium sulfide (2.5% lotion/shampoo or 2.75% foam) provides rapid, complete, and sustained improvement for palmar and plantar hyperkeratosis 8
• This represents an emerging therapeutic option for both congenital and acquired hyperkeratosis, particularly when involving palms and soles 8

Meibomian Gland Dysfunction

• Selenium sulfide is used as part of eyelid cleansing schedules (daily or several times weekly) for ocular surface disease, though this is an off-label application 7

Mechanism of Action

Selenium sulfide exerts a cytostatic effect on epidermal and follicular epithelial cells, reducing corneocyte production 1. Additionally, it provides antimicrobial effects against both fungal (Malassezia spp.) and bacterial (Staphylococcus spp.) organisms implicated in seborrheic dermatitis 5.

Critical Safety Considerations

Contraindications and Precautions

• Absolute contraindication: Allergy to any ingredient 1
• Do not use when acute inflammation or exudation is present, as increased absorption may occur 1
• Not established as safe in infants 1

Common Adverse Effects

• Skin irritation (most common) 1
• Occasional increase in normal hair loss 1
• Hair discoloration (minimized by thorough rinsing) 1
• Mild transitory contact dermatitis of primary irritant type may occur due to detergent base 2

Clinical Pitfall

Thorough rinsing after application is essential to avoid hair discoloration and minimize irritation 1. In the 2024 Indian study, no adverse events were reported when proper application technique was followed 3.