Selenium Sulfide for Dandruff and Seborrheic Dermatitis
Selenium sulfide shampoo is highly effective for treating both dandruff and seborrheic dermatitis of the scalp, with FDA-approved dosing of twice weekly for two weeks initially, then maintenance at less frequent intervals as needed to maintain control. 1
Application Protocol
For scalp seborrheic dermatitis and dandruff, massage 1-2 teaspoonfuls into wet scalp, leave for 2-3 minutes, rinse thoroughly, then repeat the application and rinse again. 1 This protocol should be followed:
- Initial treatment phase: Apply twice weekly for 2 weeks 1
- Maintenance phase: After initial control, reduce frequency to weekly, every 2 weeks, or every 3-4 weeks depending on response 1
- Important: Should not be applied more frequently than required to maintain control 1
Mechanism and Efficacy
Selenium sulfide works through a cytostatic effect on epidermal and follicular epithelial cells, reducing corneocyte production. 1 Recent high-quality evidence demonstrates:
- 1% selenium disulfide with 0.9% salicylic acid reduced severe dandruff from 28.4% to 3.2% after 4 weeks, with 90.5% of patients reporting only mild or no dandruff 2
- Comparable efficacy to ketoconazole 2%: A 2024 randomized controlled trial showed 71% improvement in seborrheic dermatitis severity score with selenium disulfide versus 69% with ketoconazole at 28 days 3
- Superior relapse prevention: After initial corticosteroid treatment, only 16.7% relapsed with selenium disulfide maintenance versus 54.2% with vehicle at 8 weeks 4
Safety Considerations and Contraindications
Do not use selenium sulfide when acute inflammation or exudation is present, as increased absorption may occur. 1 Additional precautions include:
- Remove jewelry before use as product may damage it 1
- Avoid use in pregnancy for body surface applications (Category C) 1
- Safety not established in infants 1
- Patients allergic to any ingredients should not use 1
Adverse Effects
In decreasing order of severity: 1
- Skin irritation
- Occasional increase in normal hair loss (can be minimized by thorough rinsing)
- Hair discoloration (avoided by thorough rinsing after treatment)
- Oiliness or dryness of hair and scalp may occur
Essential Supportive Measures
To optimize treatment outcomes and prevent flares:
- Use mild, pH-neutral (pH 5) non-soap cleansers as soap substitutes to preserve natural skin lipids 5
- Apply fragrance-free emollients after bathing to damp skin to create a surface lipid film preventing water loss 5
- Avoid alcohol-containing preparations on the face as they significantly worsen dryness and trigger flares 5
- Keep nails short to minimize trauma from scratching 5
- Avoid hot water; use tepid water instead 5
When to Consider Alternative or Additional Therapy
Refer to dermatology if symptoms persist despite 4-6 weeks of appropriate selenium sulfide treatment, or if there is diagnostic uncertainty. 5 Consider adding:
- Low-potency topical corticosteroids (hydrocortisone 1% or prednicarbate 0.02%) for significant erythema and inflammation, limited to 2-4 weeks maximum, especially on the face 5
- Ketoconazole 2% shampoo as an alternative first-line option with 88% response rate 5
- Coal tar preparations (1% strength) to reduce inflammation and scaling in scalp involvement 5
Common Pitfalls to Avoid
- Do not use more frequently than needed - overuse does not improve efficacy and increases adverse effect risk 1
- Do not apply to acutely inflamed or exudative areas due to increased absorption risk 1
- Ensure thorough rinsing to prevent hair discoloration and minimize hair loss 1
- Watch for secondary bacterial infection (crusting, weeping) requiring antibiotic treatment 5
- Monitor for herpes simplex superinfection (grouped vesicles or punched-out erosions) requiring acyclovir 5