Selenium disulfide, also known as selenium sulfide, is a chemical compound and medication used to treat

seborrheic dermatitis Seborrhoeic dermatitis (also spelled seborrheic dermatitis in American English) is a long-term skin disorder. Symptoms include flaky, scaly, greasy, and occasionally itchy and inflamed skin. Areas of the skin rich in sebum, oil-producing gland ...

dandruff Dandruff is a skin condition of the scalp. Symptoms include flaking and sometimes mild itchiness. It can result in social or self-esteem problems. A more severe form of the condition, which includes inflammation of the skin, is known as s ...

, and pityriasis versicolor. It is applied to the affected area as a lotion or shampoo. Symptoms frequently return if treatment is stopped. Side effects may include hair discoloration, skin irritation, and risk of systemic absorption and

toxicity Toxicity is the degree to which a chemical substance or a particular mixture of substances can damage an organism. Toxicity can refer to the effect on a whole organism, such as an animal, bacteria, bacterium, or plant, as well as the effect o ...

, among others. Use is not recommended in children less than 2–5 years old. Use in

pregnancy Pregnancy is the time during which one or more offspring gestation, gestates inside a woman's uterus. A multiple birth, multiple pregnancy involves more than one offspring, such as with twins. Conception (biology), Conception usually occurs ...

breastfeeding Breastfeeding, also known as nursing, is the process where breast milk is fed to a child. Infants may suck the milk directly from the breast, or milk may be extracted with a Breast pump, pump and then fed to the infant. The World Health Orga ...

has not been studied. It consists of a mixture of

inorganic An inorganic compound is typically a chemical compound that lacks carbon–hydrogen bonds⁠that is, a compound that is not an organic compound. The study of inorganic compounds is a subfield of chemistry known as '' inorganic chemistry''. Inor ...

covalent compound A covalent bond is a chemical bond that involves the sharing of electrons to form electron pairs between atoms. These electron pairs are known as shared pairs or bonding pairs. The stable balance of attractive and repulsive forces between atom ...

s having an approximate

empirical formula In chemistry, the empirical formula of a chemical compound is the simplest whole number ratio of atoms present in a compound. A simple example of this concept is that the empirical formula of sulfur monoxide, or SO, is simply SO, as is the empir ...

s of SeS₂. Selenium disulfide acts as a

keratolytic Keratolytic () therapy is a type of medical treatment to remove warts, calluses and other lesions in which the epidermis produces excess skin. In this therapy, acidic topical medicines, such as Whitfield's ointment or Jessner's solution, are a ...

and

antifungal An antifungal medication, also known as an antimycotic medication, is a pharmaceutical fungicide or fungistatic used to treat and prevent mycosis such as athlete's foot, ringworm, candidiasis (thrush), serious systemic infections such as ...

agent. Selenium disulfide was approved for medical use in the United States at least as early as 1951. It is on the

World Health Organization's List of Essential Medicines The WHO Model List of Essential Medicines (aka Essential Medicines List or EML), published by the World Health Organization (WHO), contains the medications considered to be most effective and safe to meet the most important needs in a health s ...

. Selenium disulfide is available as a

generic medication A generic drug is a pharmaceutical drug that contains the same chemical substance as a drug that was originally protected by chemical patents. Generic drugs are allowed for sale after the patents on the original drugs expire. Because the active ch ...

and over the counter.

Medical uses

Selenium disulfide is sold as an

agent in

shampoo Shampoo () is a hair care product, typically in the form of a viscous liquid, that is formulated to be used for cleaning (scalp) hair. Less commonly, it is available in solid bar format. (" Dry shampoo" is a separate product.) Shampoo is use ...

s (such as Selsun Blue) for the treatment of

and

associated in the scalp with fungi of genus '' Malassezia''. It is also used on the body to treat

tinea versicolor Tinea versicolor (also pityriasis versicolor) is a condition characterized by a skin eruption on the trunk and proximal extremities. The majority of tinea versicolor is caused by the fungus '' Malassezia globosa'', although '' Malassezia furfur' ...

(pityriasis versicolor), a type of

fungal A fungus (: fungi , , , or ; or funguses) is any member of the group of eukaryotic organisms that includes microorganisms such as yeasts and molds, as well as the more familiar mushrooms. These organisms are classified as one of the tradit ...

skin infection caused by a different species of ''Malassezia''. A 2015

systematic review A systematic review is a scholarly synthesis of the evidence on a clearly presented topic using critical methods to identify, define and assess research on the topic. A systematic review extracts and interprets data from published studies on ...

of topical treatments for seborrheic dermatitis of the scalp identified only a single

randomized controlled trial A randomized controlled trial (or randomized control trial; RCT) is a form of scientific experiment used to control factors not under direct experimental control. Examples of RCTs are clinical trials that compare the effects of drugs, surgical ...

evaluating selenium disulfide for the condition. It was a three-arm trial of 246 people with moderate to severe dandruff and compared treatment with 2%

ketoconazole Ketoconazole, sold under the brand name Nizoral, among others, is an antiandrogen, antifungal drug, antifungal, and antiglucocorticoid medication used to treat a number of fungal infections. Applied to the skin it is used for fungal skin inf ...

shampoo (n=97), 2.5% selenium disulfide shampoo (n=100), and placebo (shampoo base with no antiseborrheic agent) (n=49) for 29days. The study found a 73% reduction in dandruff score with ketoconazole, a 67% reduction with selenium disulfide, and a 45% reduction with placebo. Based on the study, the systematic review concluded that selenium disulfide may be effective in the treatment of dandruff but that the available evidence is limited and overall evidence quality is low. It also found that while selenium disulfide has infrequent side effects, it seems to have more side effects than ketoconazole shampoo. Consequently, the review concluded that selenium disulfide should not be considered as a first-line therapy but instead should be used as an alternative treatment after other therapies like ketoconazole shampoo have proven not effective. A 2015 review recommended topical antifungal agents, topical corticosteroids, and topical calcineurin inhibitors like

tacrolimus Tacrolimus, sold under the brand name Prograf among others, is an immunosuppressive drug. After Allotransplantation, allogenic organ transplant, the risk of organ Transplant rejection, rejection is moderate. To lower the risk of organ rejectio ...

as the main treatments for seborrheic dermatitis based on good-quality evidence, rather than selenium disulfide for which evidence is much more limited. However, the review did suggest use of over-the-counter selenium disulfide shampoos as an inexpensive option for managing mild symptoms of seborrheic dermatitis.

Available forms

Selenium disulfide is available in the form of a

prescription drug A prescription drug (also prescription medication, prescription medicine or prescription-only medication) is a pharmaceutical drug that is permitted to be dispensed only to those with a medical prescription. In contrast, over-the-counter drugs c ...

as a 2.25% medical

. In the

United States The United States of America (USA), also known as the United States (U.S.) or America, is a country primarily located in North America. It is a federal republic of 50 U.S. state, states and a federal capital district, Washington, D.C. The 48 ...

, a 1% strength is available

over-the-counter Over-the-counter (OTC) drugs are medicines sold directly to a consumer without a requirement for a prescription from a healthcare professional, as opposed to prescription drugs, which may be supplied only to consumers possessing a valid pres ...

, and a 2.5% strength is also available with a prescription. In Canada, the 2.5% strength is available over-the-counter. Selsun Blue is an over-the-counter shampoo for dandruff with 1% selenium disulfide as its active ingredient.

Side effects

Side effect In medicine, a side effect is an effect of the use of a medicinal drug or other treatment, usually adverse but sometimes beneficial, that is unintended. Herbal and traditional medicines also have side effects. A drug or procedure usually use ...

s of selenium disulfide shampoo for dandruff appear to be infrequent. A randomized controlled trial of 100 people who received selenium disulfide reported side effects of itching or burning sensation of the scalp (3people), eruption near the hairline (1person),

psoriasis Psoriasis is a long-lasting, noncontagious autoimmune disease characterized by patches of abnormal skin. These areas are red, pink, or purple, dry, itchy, and scaly. Psoriasis varies in severity from small localized patches to complete b ...

(1person), lightening or bleaching of hair color (2people), orange staining of the scalp (1person), and a chemical taste while shampooing (1person). Selenium disulfide can cause discoloration of nails and light

hair Hair is a protein filament that grows from follicles found in the dermis. Hair is one of the defining characteristics of mammals. The human body, apart from areas of glabrous skin, is covered in follicles which produce thick terminal and ...

and can alter the color of

hair dye Hair coloring, or hair dyeing, is the practice of changing the color of the hair on humans' heads. The main reasons for this are cosmetic: to cover gray or white hair, to alter hair to create a specific look, to change a color to suit preferen ...

s. Several scattered case reports of orange to red–brown scalp discoloration with selenium sulfide shampoo exist. The discoloration resolved shortly following discontinuation of selenium disulfide shampoo and its removal could be facilitated by lightly swabbing with

isopropyl alcohol Isopropyl alcohol (IUPAC name propan-2-ol and also called isopropanol or 2-propanol) is a colorless, flammable, organic compound with a pungent alcoholic odor. Isopropyl alcohol, an organic polar molecule, is miscible in water, ethanol, an ...

. Selenium disulfide may also discolor

metal A metal () is a material that, when polished or fractured, shows a lustrous appearance, and conducts electrical resistivity and conductivity, electricity and thermal conductivity, heat relatively well. These properties are all associated wit ...

lic

jewellery Jewellery (or jewelry in American English) consists of decorative items worn for personal adornment such as brooches, ring (jewellery), rings, necklaces, earrings, pendants, bracelets, and cufflinks. Jewellery may be attached to the body or the ...

Case report In medicine, a case report is a detailed report of the symptoms, signs, diagnosis, treatment, and follow-up of an individual patient. Case reports may contain a demographic profile of the patient, but usually describe an unusual or novel occurrenc ...

s of temporary diffuse

hair loss Hair loss, also known as alopecia or baldness, refers to a loss of hair from part of the head or body. Typically at least the head is involved. The severity of hair loss can vary from a small area to the entire body. Inflammation or scarring ...

with selenium disulfide shampoo exist as well. Excessive environmental or occupational exposure to selenium has also been associated with hair loss and other adverse effects. However, hair loss has not been reported with topical selenium disulfide in several large studies. Selenium disulfide should not be applied to damaged skin as there is a risk of systemic absorption and associated

. Systemic symptoms may include

tremor A tremor is an involuntary, somewhat rhythmic muscle contraction and relaxation involving neural oscillations, oscillations or twitching movements of one or more body parts. It is the most common of all involuntary movements and can affect the h ...

weakness Weakness is a symptom of many different medical conditions. The causes are many and can be divided into conditions that have true or perceived muscle weakness. True muscle weakness is a primary symptom of a variety of skeletal muscle diseases, ...

lethargy Lethargy is a state of tiredness, sleepiness, weariness, fatigue, sluggishness, or lack of energy. It can be accompanied by depression, decreased motivation, or apathy. Lethargy can be a normal response to inadequate sleep, overexertion, overw ...

, lower abdominal pain, and occasional

vomiting Vomiting (also known as emesis, puking and throwing up) is the forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose. Vomiting can be the result of ailments like food poisoning, gastroenteritis, pre ...

. These symptoms usually resolve within 10days following exposure.

Pharmacology

Pharmacodynamics

Selenium disulfide acts as an

and

agent to treat seborrheic dermatitis and dandruff.

Pharmacokinetics

The systemic absorption and

of orally administered selenium sulfide has been studied in animals. Topical use of selenium sulfide in the form of a shampoo or lotion in humans does not appear to normally increase circulating or urinary selenium levels. However, application of selenium disulfide to damaged skin can result in systemic absorption and has been associated with cases of toxicity. Selenium disulfide appears to be much less toxic than other selenium

salt In common usage, salt is a mineral composed primarily of sodium chloride (NaCl). When used in food, especially in granulated form, it is more formally called table salt. In the form of a natural crystalline mineral, salt is also known as r ...

s, which may be attributed to its low aqueous solubility and very poor systemic absorption.

Chemistry

Composition

Selenium disulfide has a composition that approximates to SeS₂ and is sometimes called selenium sulfide. However, as used in proprietary formulations, it is not a pure chemical compound but a mixture of eight-membered-ring compounds where the overall Se:S ratio is 1:2. The specific chemicals contain a variable number of S and Se atoms, Se_nS_8−n.Cyclic selenium sulfides R. Steudel, R. Laitinen, Topics in Current Chemistry, (1982), 102, 177-197 Many selenium sulfides are known, as indicated by ⁷⁷Se-

NMR Nuclear magnetic resonance (NMR) is a physical phenomenon in which atomic nucleus, nuclei in a strong constant magnetic field are disturbed by a weak oscillating magnetic field (in the near and far field, near field) and respond by producing ...

spectroscopy.

History

Selenium sulfide was introduced for medical use in the United States in 1951. Selenium monosulfide, along with elemental selenium and sulfur, has been used in medicinal preparations in the past, causing confusion and contradiction as to exactly what form selenium is in any given topical preparation.

Society and culture

Popular culture

In the film ''

Evolution Evolution is the change in the heritable Phenotypic trait, characteristics of biological populations over successive generations. It occurs when evolutionary processes such as natural selection and genetic drift act on genetic variation, re ...

'' selenium was mentioned as an active ingredient of

Head & Shoulders Head & Shoulders (H&S) is an American brand of anti- dandruff and non-dandruff shampoo produced by parent company Procter & Gamble. The active anti-fungal ingredient in Head & Shoulders is piroctone olamine or zinc pyrithione, with some "cl ...

. A group of academics, therefore, tried to use this brand of shampoo to stop an alien invasion after discovering that the alien life form was sensitive to selenium.

Research

Selenium disulfide has been suggested to be effective as a treatment for

hyperkeratosis Hyperkeratosis is thickening of the stratum corneum (the outermost layer of the epidermis, or skin), often associated with the presence of an abnormal quantity of keratin,Kumar, Vinay; Fausto, Nelso; Abbas, Abul (2004) ''Robbins & Cotran Pathol ...

based on a small case series of three treated patients. It has also been reported to be effective in the treatment of scalp psoriasis based on clinical observation of over 100treated patients and two case reports of dramatic response. Selenium sulfide is under development for the treatment of meibomianitis (meibomian gland dysfunction) and dry eyes in topical and ophthalmic formulations. As of March 2021, it is in phase 2/ 3

clinical trial Clinical trials are prospective biomedical or behavioral research studies on human subject research, human participants designed to answer specific questions about biomedical or behavioral interventions, including new treatments (such as novel v ...

s for meibomianitis and phase 2 trials for dry eyes. The developmental code name of selenium sulfide for these uses is AZR-MD-001 and it is being developed by Azura Ophthalmics.