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Selenium disulfide
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<h2 id="medical-uses">Medical uses</h2> <p>Selenium disulfide is sold as an <a href="/facts/Antifungal_medication/WEk5nS2B">antifungal</a> agent in <a href="/facts/Shampoo/ww9bFmT2">shampoos</a> (such as <a href="/facts/Selsun_Blue/mywmMtxL">Selsun Blue</a>) for the treatment of <a href="/facts/Dandruff/JnKQHFzM">dandruff</a> and <a href="/facts/Seborrheic_dermatitis/d1CfhTDG">seborrheic dermatitis</a> associated in the scalp with fungi of genus <i><a href="/facts/Malassezia/3uoNQqbL">Malassezia</a></i>.<a class="footnote-ref" id="fnref:16" href="#fn:16"><sup>16</sup></a><a class="footnote-ref" id="fnref:17" href="#fn:17"><sup>17</sup></a><a class="footnote-ref" id="fnref:18" href="#fn:18"><sup>18</sup></a> It is also used on the body to treat <a href="/facts/Tinea_versicolor/y4wzgMrl">tinea versicolor</a> (pityriasis versicolor), a type of <a href="/facts/Fungal/BHo5DP59">fungal</a> skin infection caused by a different species of <i>Malassezia</i>.<a class="footnote-ref" id="fnref:19" href="#fn:19"><sup>19</sup></a><a class="footnote-ref" id="fnref:20" href="#fn:20"><sup>20</sup></a> </p><p>A 2015 <a href="/facts/Systematic_review/dGvq3BGx">systematic review</a> of topical treatments for seborrheic dermatitis of the scalp identified only a single <a href="/facts/Randomized_controlled_trial/LG9lkyVx">randomized controlled trial</a> evaluating selenium disulfide for the condition.<a class="footnote-ref" id="fnref:21" href="#fn:21"><sup>21</sup></a> It was a three-arm trial of 246 people with moderate to severe dandruff and compared treatment with 2% <a href="/facts/Ketoconazole/UQcvnER5">ketoconazole</a> shampoo (n=97), 2.5% selenium disulfide shampoo (n=100), and placebo (shampoo base with no antiseborrheic agent) (n=49) for 29 days.<a class="footnote-ref" id="fnref:22" href="#fn:22"><sup>22</sup></a><a class="footnote-ref" id="fnref:23" href="#fn:23"><sup>23</sup></a> The study found a 73% reduction in dandruff score with ketoconazole, a 67% reduction with selenium disulfide, and a 45% reduction with placebo.<a class="footnote-ref" id="fnref:24" href="#fn:24"><sup>24</sup></a><a class="footnote-ref" id="fnref:25" href="#fn:25"><sup>25</sup></a> 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 <a href="/facts/Evidence_quality/InK1lB9l">evidence quality</a> is low.<a class="footnote-ref" id="fnref:26" href="#fn:26"><sup>26</sup></a> It also found that while selenium disulfide has infrequent side effects, it seems to have more side effects than ketoconazole shampoo.<a class="footnote-ref" id="fnref:27" href="#fn:27"><sup>27</sup></a> Consequently, the review concluded that selenium disulfide should not be considered as a <a href="/facts/First-line_therapy/2ytkGbgT">first-line therapy</a> but instead should be used as an alternative treatment after other therapies like ketoconazole shampoo have proven not effective.<a class="footnote-ref" id="fnref:28" href="#fn:28"><sup>28</sup></a> </p><p>A 2015 review recommended topical antifungal agents, topical corticosteroids, and topical <a href="/facts/Calcineurin_inhibitor/ctlB3Hda">calcineurin inhibitors</a> like <a href="/facts/Tacrolimus/Apj3X5S6">tacrolimus</a> as the main treatments for seborrheic dermatitis based on good-quality evidence, rather than selenium disulfide for which evidence is much more limited.<a class="footnote-ref" id="fnref:29" href="#fn:29"><sup>29</sup></a> However, the review did suggest use of over-the-counter selenium disulfide shampoos as an inexpensive option for managing mild symptoms of seborrheic dermatitis.<a class="footnote-ref" id="fnref:30" href="#fn:30"><sup>30</sup></a> </p> <h3>Available forms</h3> <p>Selenium disulfide is available in the form of a <a href="/facts/Prescription_drug/a2zNYPMq">prescription drug</a> as a 2.25% medical <a href="/facts/Shampoo/ww9bFmT2">shampoo</a>.<a class="footnote-ref" id="fnref:31" href="#fn:31"><sup>31</sup></a><a class="footnote-ref" id="fnref:32" href="#fn:32"><sup>32</sup></a> In the <a href="/facts/United_States/P0sCdLe5">United States</a>, a 1% strength is available <a href="/facts/Over-the-counter_drug/QI3FcgRf">over-the-counter</a>, and a 2.5% strength is also available with a <a href="/facts/Medical_prescription/4jt1T3mY">prescription</a>.<a class="footnote-ref" id="fnref:33" href="#fn:33"><sup>33</sup></a> In Canada, the 2.5% strength is available over-the-counter.<a class="footnote-ref" id="fnref:34" href="#fn:34"><sup>34</sup></a> <a href="/facts/Selsun_Blue/mywmMtxL">Selsun Blue</a> is an over-the-counter shampoo for dandruff with 1% selenium disulfide as its active ingredient.<a class="footnote-ref" id="fnref:35" href="#fn:35"><sup>35</sup></a><a class="footnote-ref" id="fnref:36" href="#fn:36"><sup>36</sup></a> </p> <h2 id="side-effects">Side effects</h2> <p><a href="/facts/Side_effect/PhuX2haY">Side effects</a> of selenium disulfide shampoo for dandruff appear to be infrequent.<a class="footnote-ref" id="fnref:37" href="#fn:37"><sup>37</sup></a><a class="footnote-ref" id="fnref:38" href="#fn:38"><sup>38</sup></a> A randomized controlled trial of 100 people who received selenium disulfide reported side effects of itching or burning sensation of the scalp (3 people), eruption near the hairline (1 person), <a href="/facts/Psoriasis/WW1k1LsH">psoriasis</a> (1 person), lightening or bleaching of hair color (2 people), orange staining of the scalp (1 person), and a chemical taste while shampooing (1 person).<a class="footnote-ref" id="fnref:39" href="#fn:39"><sup>39</sup></a><a class="footnote-ref" id="fnref:40" href="#fn:40"><sup>40</sup></a> </p><p>Selenium disulfide can cause discoloration of <a href="/facts/Nail_(anatomy)/s3GJf9R2">nails</a> and light <a href="/facts/Hair/L7vt9FL3">hair</a><a class="footnote-ref" id="fnref:41" href="#fn:41"><sup>41</sup></a> and can alter the color of <a href="/facts/Hair_dye/NyeYhUUF">hair dyes</a>. Several scattered case reports of orange to red–brown scalp discoloration with selenium sulfide shampoo exist.<a class="footnote-ref" id="fnref:42" href="#fn:42"><sup>42</sup></a><a class="footnote-ref" id="fnref:43" href="#fn:43"><sup>43</sup></a> The discoloration resolved shortly following discontinuation of selenium disulfide shampoo and its removal could be facilitated by lightly swabbing with <a href="/facts/Isopropyl_alcohol/7KqgIkUd">isopropyl alcohol</a>.<a class="footnote-ref" id="fnref:44" href="#fn:44"><sup>44</sup></a> Selenium disulfide may also discolor <a href="/facts/Metal/PT8hNX6R">metallic</a> <a href="/facts/Jewellery/DYt7cj0R">jewellery</a>. <a href="/facts/Case_report/gIQnMGCR">Case reports</a> of temporary diffuse <a href="/facts/Hair_loss/uEPKUafl">hair loss</a> with selenium disulfide shampoo exist as well.<a class="footnote-ref" id="fnref:45" href="#fn:45"><sup>45</sup></a><a class="footnote-ref" id="fnref:46" href="#fn:46"><sup>46</sup></a> Excessive environmental or occupational exposure to selenium has also been associated with hair loss and other adverse effects.<a class="footnote-ref" id="fnref:47" href="#fn:47"><sup>47</sup></a> However, hair loss has not been reported with topical selenium disulfide in several large studies.<a class="footnote-ref" id="fnref:48" href="#fn:48"><sup>48</sup></a> </p><p>Selenium disulfide should not be applied to damaged skin as there is a risk of <a href="/facts/Systemic_absorption/yxye1dtm">systemic absorption</a> and associated <a href="/facts/Toxicity/qa96rs60">toxicity</a>.<a class="footnote-ref" id="fnref:49" href="#fn:49"><sup>49</sup></a> Systemic symptoms may include <a href="/facts/Tremor/rD6ogM7X">tremors</a>, <a href="/facts/Weakness/U9wAgeLn">weakness</a>, <a href="/facts/Lethargy/wJFlYuB7">lethargy</a>, <a href="/facts/Lower_abdominal_pain/aF6gPB0G">lower abdominal pain</a>, and occasional <a href="/facts/Vomiting/R2vQkHqV">vomiting</a>.<a class="footnote-ref" id="fnref:50" href="#fn:50"><sup>50</sup></a> These symptoms usually resolve within 10 days following exposure.<a class="footnote-ref" id="fnref:51" href="#fn:51"><sup>51</sup></a> </p> <h2 id="pharmacology">Pharmacology</h2> <h3>Pharmacodynamics</h3> <p>Selenium disulfide acts as an <a href="/facts/Antifungal/WEk5nS2B">antifungal</a> and <a href="/facts/Keratolytic/hEtMwHCa">keratolytic</a> agent to treat seborrheic dermatitis and dandruff.<a class="footnote-ref" id="fnref:52" href="#fn:52"><sup>52</sup></a><a class="footnote-ref" id="fnref:53" href="#fn:53"><sup>53</sup></a><a class="footnote-ref" id="fnref:54" href="#fn:54"><sup>54</sup></a> </p> <h3>Pharmacokinetics</h3> <p>The systemic <a href="/facts/Absorption_(pharmacokinetics)/LCezQPJK">absorption</a> and <a href="/facts/Toxicity/qa96rs60">toxicity</a> of <a href="/facts/Oral_administration/vNQcvLVx">orally administered</a> selenium sulfide has been studied in animals.<a class="footnote-ref" id="fnref:55" href="#fn:55"><sup>55</sup></a><a class="footnote-ref" id="fnref:56" href="#fn:56"><sup>56</sup></a> 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.<a class="footnote-ref" id="fnref:57" href="#fn:57"><sup>57</sup></a><a class="footnote-ref" id="fnref:58" href="#fn:58"><sup>58</sup></a><a class="footnote-ref" id="fnref:59" href="#fn:59"><sup>59</sup></a><a class="footnote-ref" id="fnref:60" href="#fn:60"><sup>60</sup></a><a class="footnote-ref" id="fnref:61" href="#fn:61"><sup>61</sup></a> However, application of selenium disulfide to damaged skin can result in systemic absorption and has been associated with cases of toxicity.<a class="footnote-ref" id="fnref:62" href="#fn:62"><sup>62</sup></a> Selenium disulfide appears to be much less toxic than other selenium <a href="/facts/Salt_(chemistry)/lsSKwGpn">salts</a>, which may be attributed to its low <a href="/facts/Aqueous_solubility/eRNr3MH2">aqueous solubility</a> and very poor systemic absorption.<a class="footnote-ref" id="fnref:63" href="#fn:63"><sup>63</sup></a> </p> <h2 id="chemistry">Chemistry</h2> <h3>Composition</h3> <p>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, SenS8−n.<a class="footnote-ref" id="fnref:64" href="#fn:64"><sup>64</sup></a> </p><p>Many selenium sulfides are known, as indicated by 77Se-<a href="/facts/NMR/pGYAn9Bz">NMR</a> spectroscopy.<a class="footnote-ref" id="fnref:65" href="#fn:65"><sup>65</sup></a> </p> <h2 id="history">History</h2> <p>Selenium sulfide was introduced for medical use in the United States in 1951.<a class="footnote-ref" id="fnref:66" href="#fn:66"><sup>66</sup></a><a class="footnote-ref" id="fnref:67" href="#fn:67"><sup>67</sup></a> </p><p>Selenium monosulfide, along with elemental selenium and sulfur, has been used in medicinal preparations in the past,<a class="footnote-ref" id="fnref:68" href="#fn:68"><sup>68</sup></a> causing confusion and contradiction<a class="footnote-ref" id="fnref:69" href="#fn:69"><sup>69</sup></a> as to exactly what form selenium is in any given topical preparation. </p> <h2 id="society-and-culture">Society and culture</h2> <h3>Popular culture</h3> <p>In the film <i><a href="/facts/Evolution_(2001_film)/VV34c2A6">Evolution</a></i> selenium was mentioned as an active ingredient of <a href="/facts/Head_%26_Shoulders/zFP0j8bN">Head & Shoulders</a>. 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.<a class="footnote-ref" id="fnref:70" href="#fn:70"><sup>70</sup></a> </p> <h2 id="research">Research</h2> <p>Selenium disulfide has been suggested to be effective as a treatment for <a href="/facts/Hyperkeratosis/8x6CXBfM">hyperkeratosis</a> based on a small <a href="/facts/Case_series/2NQBzYJK">case series</a> of three treated patients.<a class="footnote-ref" id="fnref:71" href="#fn:71"><sup>71</sup></a> It has also been reported to be effective in the treatment of <a href="/facts/Scalp_psoriasis/WW1k1LsH">scalp psoriasis</a> based on clinical observation of over 100 treated patients and two case reports of dramatic response.<a class="footnote-ref" id="fnref:72" href="#fn:72"><sup>72</sup></a> </p><p>Selenium sulfide is under development for the treatment of meibomianitis (meibomian gland dysfunction) and <a href="/facts/Dry_eyes/2Q9eA0jM">dry eyes</a> in topical and <a href="/facts/Ophthalmic_drug_administration/VlyFY5Nl">ophthalmic</a> formulations.<a class="footnote-ref" id="fnref:73" href="#fn:73"><sup>73</sup></a><a class="footnote-ref" id="fnref:74" href="#fn:74"><sup>74</sup></a><a class="footnote-ref" id="fnref:75" href="#fn:75"><sup>75</sup></a> As of March 2021, it is in <a href="/facts/Phases_of_clinical_research/o8hEodVu">phase 2</a>/<a href="/facts/Phases_of_clinical_research/o8hEodVu">3</a> <a href="/facts/Clinical_trial/q8LMr832">clinical trials</a> for meibomianitis and phase 2 trials for dry eyes.<a class="footnote-ref" id="fnref:76" href="#fn:76"><sup>76</sup></a> The developmental code name of selenium sulfide for these uses is AZR-MD-001 and it is being developed by Azura Ophthalmics.<a class="footnote-ref" id="fnref:77" href="#fn:77"><sup>77</sup></a> </p> <h2 id="further-reading">Further reading</h2> <ul><li>Danby FW, Maddin WS, Margesson LJ, Rosenthal D (December 1993). <a href="https://archive.today/20130414215405/http://www.eblue.org/article/0190-9622(93)70282-X">"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"</a>. <i>Journal of the American Academy of Dermatology</i>. 29 (6): 1008–1012. <a href="/facts/Doi_(identifier)/muM9Etpq">doi</a>:<a href="https://doi.org/10.1016%2F0190-9622%2893%2970282-x">10.1016/0190-9622(93)70282-x</a>. <a href="/facts/PMID_(identifier)/JlHAvMHt">PMID</a> <a href="https://pubmed.ncbi.nlm.nih.gov/8245236">8245236</a>. Archived from <a href="http://www.eblue.org/article/0190-9622(93)70282-X">the original</a> on 14 April 2013.</li> <li>Grover RW (April 1956). "Diffuse hair loss associated with selenium (selsun) sulfide shampoo". <i>Journal of the American Medical Association</i>. 160 (16): 1397–1398. <a href="/facts/Doi_(identifier)/muM9Etpq">doi</a>:<a href="https://doi.org/10.1001%2Fjama.1956.02960510023006">10.1001/jama.1956.02960510023006</a>. <a href="/facts/PMID_(identifier)/JlHAvMHt">PMID</a> <a href="https://pubmed.ncbi.nlm.nih.gov/13306564">13306564</a>.</li> <li>Givens TG, Murray MM, Baker RC (July 1995). "Comparison of 1% and 2.5% selenium sulfide in the treatment of tinea capitis". <i>Archives of Pediatrics & Adolescent Medicine</i>. 149 (7): 808–811. <a href="/facts/Doi_(identifier)/muM9Etpq">doi</a>:<a href="https://doi.org/10.1001%2Farchpedi.1995.02170200098016">10.1001/archpedi.1995.02170200098016</a>. <a href="/facts/PMID_(identifier)/JlHAvMHt">PMID</a> <a href="https://pubmed.ncbi.nlm.nih.gov/7795774">7795774</a>.</li> <li>Ransone JW, Scott NM, Knoblock EC (February 1961). "Selenium sulfide intoxication". <i>The New England Journal of Medicine</i>. 264 (8): 384–385. <a href="/facts/Doi_(identifier)/muM9Etpq">doi</a>:<a href="https://doi.org/10.1056%2FNEJM196102232640806">10.1056/NEJM196102232640806</a>. <a href="/facts/PMID_(identifier)/JlHAvMHt">PMID</a> <a href="https://pubmed.ncbi.nlm.nih.gov/13739506">13739506</a>.</li> <li>Laitinen RS, Pakkanen TA (1987). "77Se NMR spectroscopic characterization of selenium sulfide ring molecules Se<i>n</i>S8−<i>n</i>". <i>Inorganic Chemistry</i>. 26 (16): 2598. <a href="/facts/Doi_(identifier)/muM9Etpq">doi</a>:<a href="https://doi.org/10.1021%2Fic00263a010">10.1021/ic00263a010</a>.</li></ul> <h2 id="references">References</h2> <ol> <li id="fn:1"><p>World Health Organization (2009). Stuart MC, Kouimtzi M, Hill SR (eds.). WHO Model Formulary 2008. World Health Organization. p. 297. hdl:10665/44053. ISBN 9789241547659. <a href="9789241547659" target="_blank">9789241547659</a> <a href="#fnref:1" class="footnote-back-ref">↩</a></p></li> <li id="fn:2"><p>Faergemann J (2000). "Management of seborrheic dermatitis and pityriasis versicolor". American Journal of Clinical Dermatology. 1 (2): 75–80. doi:10.2165/00128071-200001020-00001. PMID 11702314. S2CID 43516330. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:2" class="footnote-back-ref">↩</a></p></li> <li id="fn:3"><p>Hamilton R (2015). Tarascon Pocket Pharmacopoeia 2015 Deluxe Lab-Coat Edition. Jones & Bartlett Learning. p. 194. ISBN 9781284057560. <a href="9781284057560" target="_blank">9781284057560</a> <a href="#fnref:3" class="footnote-back-ref">↩</a></p></li> <li id="fn:4"><p>"Selenium Sulfide". The American Society of Health-System Pharmacists. Archived from the original on 18 January 2017. Retrieved 8 January 2017. <a href="https://www.drugs.com/monograph/selenium-sulfide.html" target="_blank">https://www.drugs.com/monograph/selenium-sulfide.html</a> <a href="#fnref:4" class="footnote-back-ref">↩</a></p></li> <li id="fn:5"><p>World Health Organization (2009). Stuart MC, Kouimtzi M, Hill SR (eds.). WHO Model Formulary 2008. World Health Organization. p. 297. hdl:10665/44053. ISBN 9789241547659. <a href="9789241547659" target="_blank">9789241547659</a> <a href="#fnref:5" class="footnote-back-ref">↩</a></p></li> <li id="fn:6"><p>World Health Organization (2009). Stuart MC, Kouimtzi M, Hill SR (eds.). WHO Model Formulary 2008. World Health Organization. p. 297. hdl:10665/44053. ISBN 9789241547659. <a href="9789241547659" target="_blank">9789241547659</a> <a href="#fnref:6" class="footnote-back-ref">↩</a></p></li> <li id="fn:7"><p>"Selenium Sulfide". The American Society of Health-System Pharmacists. Archived from the original on 18 January 2017. Retrieved 8 January 2017. <a href="https://www.drugs.com/monograph/selenium-sulfide.html" target="_blank">https://www.drugs.com/monograph/selenium-sulfide.html</a> <a href="#fnref:7" class="footnote-back-ref">↩</a></p></li> <li id="fn:8"><p>"Selenium sulfide topical Use During Pregnancy". Drugs.com. Archived from the original on 16 January 2017. Retrieved 13 January 2017. <a href="https://www.drugs.com/pregnancy/selenium-sulfide-topical.html" target="_blank">https://www.drugs.com/pregnancy/selenium-sulfide-topical.html</a> <a href="#fnref:8" class="footnote-back-ref">↩</a></p></li> <li id="fn:9"><p>Mitchell SC (2003). Biological Interactions Of Sulfur Compounds. CRC Press. p. 174. ISBN 9780203362525. Archived from the original on 16 January 2017. <a href="9780203362525" target="_blank">9780203362525</a> <a href="#fnref:9" class="footnote-back-ref">↩</a></p></li> <li id="fn:10"><p>Mitchell SC, Nickson RM, Waring RH (August 1993). "The Biological Activity of Selenium Sulfide". Sulfur Reports. 13 (2): 279–289. doi:10.1080/01961779308048957. eISSN 1029-0508. ISSN 0196-1772. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:10" class="footnote-back-ref">↩</a></p></li> <li id="fn:11"><p>Borda LJ, Perper M, Keri JE (March 2019). "Treatment of seborrheic dermatitis: a comprehensive review". The Journal of Dermatological Treatment. 30 (2): 158–169. doi:10.1080/09546634.2018.1473554. PMID 29737895. S2CID 13686180. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:11" class="footnote-back-ref">↩</a></p></li> <li id="fn:12"><p>Gupta AK, Madzia SE, Batra R (2004). "Etiology and management of Seborrheic dermatitis". Dermatology. 208 (2): 89–93. doi:10.1159/000076478. PMID 15056994. S2CID 22432032. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:12" class="footnote-back-ref">↩</a></p></li> <li id="fn:13"><p>"Selenium Sulfide". The American Society of Health-System Pharmacists. Archived from the original on 18 January 2017. Retrieved 8 January 2017. <a href="https://www.drugs.com/monograph/selenium-sulfide.html" target="_blank">https://www.drugs.com/monograph/selenium-sulfide.html</a> <a href="#fnref:13" class="footnote-back-ref">↩</a></p></li> <li id="fn:14"><p>World Health Organization (2019). World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization. hdl:10665/325771. WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO. <a href="/wiki/World_Health_Organization" target="_blank">/wiki/World_Health_Organization</a> <a href="#fnref:14" class="footnote-back-ref">↩</a></p></li> <li id="fn:15"><p>Hamilton R (2015). Tarascon Pocket Pharmacopoeia 2015 Deluxe Lab-Coat Edition. Jones & Bartlett Learning. p. 194. ISBN 9781284057560. <a href="9781284057560" target="_blank">9781284057560</a> <a href="#fnref:15" class="footnote-back-ref">↩</a></p></li> <li id="fn:16"><p>"Selenium(IV) sulfide". Pharmacy Codes. 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