Dandruff and Seborrheic Dermatitis

W. Steven Pray, PhD, RPh, Professor of Nonprescription Products and Devices, School of Pharmacy, Southwestern Oklahoma State University, Weatherford, OK

US Pharmacist. 2001;26(4) 

In This Article

Treatment Options

The original panel assigned to review OTC products for dandruff and seborrheic dermatitis produced a document in 1982, which was mostly affirmed (with few changes) in the final rule published by the FDA in 1991.[7] Several ingredients were found to be safe and effective for self-treatment of dandruff and seborrheic dermatitis in the 1991 final rule. Salicylic acid, selenium sulfide, zinc pyrithione and coal tar are effective in treating both conditions while sulfur and ketoconzole are effective in treating dandruff only and hydrocortisone is effective for seborrheic dermatitis only. These products can treat patients aged 2 years and older except for ketoconazole, which is not to be used to treat patients under the age of 12.

Salicylic Acid 1.8%-3%

Salicylic acid is available in the form of shampoo and foam. It functions by increasing the hydration of skin. Its mechanism may be lowering of the epidermal pH, producing an inflammation that allows skin to retain water. This artificially produced maceration causes the upper layer of the epidermis to shed. The keratolytic action removes the scales of dandruff and seborrheic dermatitis.

Selenium Sulfide 1%

Selenium sulfide is highly active in inhibiting the growth of P. ovale. It is also a proven cytostatic agent, slowing the growth of both hyperproliferative and normal cells in dandruff and seborrheic dermatitis. A 0.6% micronized form of selenium sulfide is also safe and effective for dandruff.

Zinc Pyrithione

Zinc pyrithione is safe and effective for dandruff in a 0.3%-2% concentration shampoo, and for seborrheic dermatitis in a 0.95%-2% concentration shampoo.

Hydrocortisone 0.25%-1%

Hydrocortisone cream is safe and effective for treatment of seborrheic dermatitis, but is not to be used to treat dandruff. This is because seborrheic dermatitis has an inflammatory component, while dandruff does not.

Coal Tar 0.5%-5%

Coal tar in its various forms (e.g., coal tar distillate, coal tar extract, coal tar solution) is effective for both conditions, but is perhaps not the best choice. In addition to its unpleasant odor, it can stain the skin and hair (especially if the patient's hair color is naturally light [gray or blond]) or has been artificially bleached. It also can cause folliculitis, irritant dermatitis, and allergic dermatitis. Coal tar may cause photosensitivity reactions, and patients should be cautioned to avoid sun exposure for up to 24 hours after using it. It is also potentially carcinogenic. This was demonstrated in a 1775 landmark study of chimney sweeps and their high incidence of scrotal cancer being induced by exposure to soot and coal tar. Coal tar has caused a rash of cancers in the anogenital area, leading to a precaution against application to the rectum, genital area or groin for creams, ointments and lotions. If the product is labeled for seborrheic dermatitis, the patient should be cautioned to consult a physician before use if the condition covers a large part of the body.

Sulfur 2%-5%

Sulfur, which is available in shampoo form, may function through a keratolytic action. It is approved for dandruff in a 2%-5% concentration. It may also be combined with salicylic acid for dandruff. The combination product is also a shampoo.

Ketoconazole 1%

Ketoconazole 1% shampoo was recently switched from prescription to nonprescription status. Its antifungal activity has been found to control the flaking, scaling, and itching of dandruff safely in patients over the age of 12 years. The patient is directed to use the shampoo every three to four days for up to eight weeks, then as needed to control dandruff. If the condition worsens or fails to improve in two to four weeks, the patient should see a physician. If the scalp is broken or inflamed, the patient should not use the product.

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