Key Points
- Both ketoconazole and selenium sulfide have antifungal properties.
- Ketoconazole can also help with hair loss, while selenium sulfide may help with resistant fungal biofilms.
- Ketoconazole is available over-the-counter at a concentration of 1% and by prescription at 2%. Selenium sulfide is available over-the-counter at a concentration of 1% and by prescription at 2.5%.
Selenium sulfide and ketoconazole are some of the most effective ingredients found in dandruff shampoos. These ingredients can help multiple skin conditions like dandruff, seborrheic dermatitis, Malassezia folliculitis aka fungal acne, or tinea versicolor.
But is one better than the other? How are selenium sulfide and ketoconazole different?
Selenium sulfide
Selenium sulfide is an ingredient with antifungal properties. It can reduce the burden of Malassezia (a fungus) which is associated with several skin conditions like dandruff, seborrheic dermatitis, tinea versicolor, etc.
In addition, it can decrease cell proliferation. This can decrease the build-up of dead skin cells and help with symptoms of scaly skin, flakiness, or itching.
Sometimes fungi can form a layer of matrix around them which protects them and makes them more resistant to treatment. This film is called a biofilm.
Selenium sulfide can disrupt this film and can be beneficial for chronic or resistant cases.
Side effects
Selenium sulfide can lead to skin irritation, itching, burning, and excessive oiliness. It can stain light-colored hair, clothing, or metals.
Although it is often associated with hair loss, we don’t have any research data which directly links it to hair loss.
These shampoos have the classic sulfur smell which lingers on, so make sure to rinse them well.
Concentration used
Selenium sulfide is available over the counter at a concentration of 1%. A higher concentration of 2.5% is available only via prescription in the US.
Ketoconazole
Ketoconazole is an azole antifungal that can benefit several skin conditions where fungi are the causative or associated factor. Some of these are tinea versicolor, dandruff, fungal acne, and seborrheic dermatitis.
It inhibits the synthesis of lanosterol, altering the fungal membrane and preventing its growth. It can decrease the burden of Malassezia fungus in dandruff, seborrheic dermatitis, Malassezia folliculitis, and tinea versicolor.
It may also benefit the skin through its anti-inflammatory properties.
Ketoconazole can inhibit the enzyme responsible for the conversion of testosterone to dihydrotestosterone (DHT). DHT is responsible for hair loss. So, this can be beneficial for androgenic alopecia or male pattern baldness.
Ketoconazole is well-known by the brand name Nizoral. Over the counter, it is available at 1% concentration.
Side effects
It can lead to redness, irritation, or burning in some people. It can also dry out the hair.
Concentration used
Ketoconazole at a concentration of 1% is available over the counter and 2% is available via prescription. The prescription form can be a shampoo, cream, or gel.
Differences
Both selenium sulfide and ketoconazole have antifungal properties and can be beneficial for dandruff, seborrheic dermatitis, or tinea versicolor.
The anti-inflammatory and anti-androgenic properties of ketoconazole may additionally benefit someone who is dealing with dandruff and hair loss.
Selenium sulfide can benefit in decreasing itching and scaliness by decreasing cell turnover. It can also be effective against fungi biofilms.
However, selenium sulfide is not well tolerated. Some people with lighter hair may not be able to use selenium sulfide.
Research data
There are few studies that directly compare these ingredients.
A 1993 study compared ketoconazole 2% and selenium sulfide 2.5% shampoos in the treatment of moderate to severe dandruff. Both were equally effective. However, ketoconazole 2% shampoo was better tolerated.
One study done in a lab found that ketoconazole can start inhibiting the growth of fungus Malassezia at a lower concentration as compared to zinc pyrithione and selenium sulfide.
Another study compared ketoconazole 2% and selenium sulfide 2.5% shampoos in the treatment of pityriasis versicolor. 95% of patients treated with ketoconazole shampoo were cured while 85% of patients treated with selenium sulfide shampoo were cured. Although there was no significant difference in the response rates in the two groups.
Overall, the studies suggest that ketoconazole may be more effective than selenium sulfide. A higher concentration of ketoconazole of 2% is superior to 1% for treating dandruff and scalp seborrheic dermatitis as suggested in the literature (study).
Which one should you choose?
- If you have lighter hair or cannot tolerate a strong sulfur smell, ketoconazole may be a better option.
- If you are dealing with both dandruff and hair loss, ketoconazole may be a better option.
- If your dandruff doesn’t respond to ketoconazole, you can try switching to selenium sulfide.
Some people use more than one ingredient in rotation for dandruff. However, make sure you start with one product at a time and see how your skin reacts to it.
In severe cases or if you don’t see improvement, it’s best to see a doctor for a prescription strength formulation.
We often choose the right shampoo but don’t use it the right way. So, we don’t see any improvement.
Always follow the instructions on the product. If it’s a prescription shampoo, follow the guidelines of your treating physician.
The most important thing is to leave the lather on the scalp or affected area for a few minutes (usually 2-5 minutes). This will give time for the anti-fungal ingredients to work.
Shampoo with ketoconazole
- Nizoral – 1% Ketoconazole (contains fragrance, dyes, and sulfates) [Amazon] []
Shampoos with selenium sulfide
- Head & Shoulders Clinical Strength Dandruff Shampoo and Conditioner, Dry Scalp Rescue with Manuka Honey – 1% Selenium sulfide (contains sulfates, dyes, and fragrance) [Amazon] [Target]
- Selsun Blue Moisturizing with Aloe Dandruff Shampoo – 1% Selenium sulfide (contains sulfates, dyes, and fragrance) [Walmart] [Target]
- Selsun Blue 2-in-1 Anti-dandruff Shampoo & Conditioner – 1% Selenium sulfide (contains fragrance and sulfates) [Amazon] [Walmart]
Summary
Selenium sulfide and ketoconazole have antifungal properties and are often found in dandruff shampoos. Both are effective although ketoconazole may be more efficient than selenium sulfide.
Everyone’s skin is different so which ingredient will work best for one will depend on individual needs.
If your dandruff, seborrheic dermatitis, or skin condition does not improve or get worse, it’s best to see a doctor.
Read more:
References
- Danby FW, Maddin WS, Margesson LJ, Rosenthal D. A randomized, double-blind, placebo-controlled trial of ketoconazole 2% shampoo versus selenium sulfide 2.5% shampoo in the treatment of moderate to severe dandruff. J Am Acad Dermatol. 1993 Dec;29(6):1008-12. doi: 10.1016/0190-9622(93)70282-x. PMID: 8245236.
- Van Cutsem J, Van Gerven F, Fransen J, Schrooten P, Janssen PA. The in vitro antifungal activity of ketoconazole, zinc pyrithione, and selenium sulfide against Pityrosporum and their efficacy as a shampoo in the treatment of experimental pityrosporosis in guinea pigs. J Am Acad Dermatol. 1990 Jun;22(6 Pt 1):993-8. doi: 10.1016/0190-9622(90)70140-d. PMID: 2142498.
- Piérard-Franchimont C, De Doncker P, Cauwenbergh G, Piérard GE. Ketoconazole shampoo: effect of long-term use in androgenic alopecia. Dermatology. 1998;196(4):474-7. doi: 10.1159/000017954. PMID: 9669136.
- J. Van Cutsem, F. Van Gerven, J. Fransen, P. Schrooten, P.A.J. Janssen. The in vitro antifungal activity of ketoconazole, zinc pyrithione, and selenium sulfide against Pityrosporum and their efficacy as a shampoo in the treatment of experimental pityrosporosis in guinea pigs, Journal of the American Academy of Dermatology. Volume 22, Issue 6, Part 1,1990, Pages 993-998, ISSN 0190-9622.
- Rafi AW, Katz RM. Pilot Study of 15 Patients Receiving a New Treatment Regimen for Androgenic Alopecia: The Effects of Atopy on AGA. ISRN Dermatol. 2011;2011:241953. doi: 10.5402/2011/241953. Epub 2011 Apr 11. PMID: 22363845; PMCID: PMC3262531.
- Piérard-Franchimont C, Piérard GE, Arrese JE, De Doncker P. Effect of ketoconazole 1% and 2% shampoos on severe dandruff and seborrhoeic dermatitis: clinical, squamometric and mycological assessments. Dermatology. 2001;202(2):171-6. doi: 10.1159/000051628. PMID: 11306850.
- Aggarwal K, Jain VK, Sangwan S. Comparative study of ketoconazole versus selenium sulphide shampoo in pityriasis versicolor. Indian J Dermatol Venereol Leprol. 2003 Mar-Apr;69(2):86-7. PMID: 17642841.
Disclaimer: This blog post is for information purposes only and does not replace medical advice.