What are the solutions to seborrheic dermatitis?

Scalp seborrheic dermatitis: what is it?

The seborrheic dermatitis of the scalp is a common chronic inflammatory condition, primarily affecting sebum-rich areas. On the head, it causes scales and scalp desquamation, resulting in crusts in the hair that can be white or yellow. These deposits can detach easily during combing or showering, but when inflammation is present, they thicken and leave the scalp scaly, sometimes with papules and crusts on the skull. Flare-ups occur episodically, accompanied by itching, irritation, and flaking of the scalp skin, which can impair quality of life. The condition is not contagious, and the crusts affect both adults and the elderly as well as children.

The exact origin of seborrheic dermatitis remains partially understood, but a key element is the proliferation of the yeast Malassezia, which uses sebum to produce irritating fatty acids, triggering an inflammatory reaction. This interaction could explain the presence of redness, scaling, and crusts on the scalp, especially in people with an irritated scalp. Various factors, such as hormonal influences (notably androgens), lifestyle, and environment, appear to modulate individual susceptibility.

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What are the treatment options for scalp seborrheic dermatitis?

There are several treatments available to slow the progression of seborrheic dermatitis on the scalp. Here is a non-exhaustive list of solutions.

First of all, there are shampoos containing selenium sulfide (1 to 2.5%). This is an antifungal agent that will limit the proliferation of the yeast Malassezia. However, its mechanism of action remains unknown. Selenium sulfide also has a cytostatic effect on epidermal keratinocytes, meaning that it slows their turnover, thus preventing excessive scalp flaking. This treatment should initially be applied daily, left on for 5 to 10 minutes, and then used twice weekly. Selenium sulfide is a safe, non-toxic, and effective solution.

Several studies have been conducted on selenium sulfide and its effects on seborrheic dermatitis and dandruff. One of these was conducted with 34 participants presenting with scalp dandruff and evaluated the efficacy of a shampoo containing 2.5% selenium sulfide, applied every three days for four weeks. Among the 30 participants who completed the trial, the total dandruff score decreased significantly. Participants also reported a reduced itching, decreased scalp greasiness, and good product tolerability, while investigators rated the results as “very good” or “excellent” across all subjects, with erythema resolving by the end of the study. No adverse effects were observed.

35,7%

reduction in the dandruff score after one week.

57.1%

dandruff score reduction after two weeks.

78.3%

reduction in dandruff score after four weeks.

It is also possible to use shampoos containing salicylic acid. These shampoos can be effective in treating scalp seborrheic dermatitis. Salicylic acid can penetrate the skin’s outer layers due to its lipid-soluble chemical structure. Once absorbed, it acts by dissolving the adhesive bonds between dead skin cells, thereby promoting their detachment and removal. Thanks to its keratolytic activity, salicylic acid can help remove dead skin cells, thereby promoting cellular renewal and the scalp’s healing process. Salicylic acid also plays a role in the cascade of inflammatory reactions and inhibits the synthesis of prostaglandin E2, molecules responsible for redness. This helps soothe the scalp by reducing the itching and irritation caused by seborrheic dermatitis. Shampoos with salicylic acid should be used twice a week.

However, salicylic acid does not have antifungal activity. In cases of seborrheic dermatitis of the scalp, it must therefore be combined with an antifungal agent, even though its keratolytic properties make it a useful adjuvant.

A study involving 95 individuals with seborrheic dermatitis evaluated the efficacy of a shampoo containing 1% selenium sulfide and 0.9% salicylic acid, used three times weekly over four weeks. The results demonstrated a clear improvement: severe seborrheic dermatitis cases declined from 28.4% to just 3.2%, while 90.5% of participants exhibited only mild flakes or none at all. Scores for itching, irritation, and scaling also saw a significant reduction, and nearly nine out of ten participants reported satisfaction with the product and willingness to recommend it.

Effets d'un shampooing à l'acide salicylique et au sulfure de sélénium sur différents paramètres de la dermite séborrhéique. — Effects of a salicylic acid and selenium sulfide shampoo on various parameters of seborrheic dermatitis.
Source: WEI A. & al. A study on dermatologists’ self-assessment of the efficacy of a 1% selenium disulfide – 0.9% salicylic acid -based shampoo for scalp seborrheic dermatitis. Archives of Dermatological Research (2025).

To combat scalp crusts caused by seborrheic dermatitis, you might also turn to treatments with ciclopirox olamine or piroctone olamine. These two antifungal agents are commonly used in anti-dandruff products. Ciclopirox olamine works by disrupting the cell membrane of Malassezia and exhibits interesting anti-inflammatory activity that helps reduce redness and irritation of an inflamed or scaly scalp. Piroctone olamine, on the other hand, inhibits fungal growth by blocking iron metabolism, which is essential for the survival of Malassezia, resulting in a progressive reduction of flaking and crusts in the hair. Often well tolerated, these actives can be incorporated into shampoos or lotions and represent a relevant option for relieving seborrheic dermatitis. Several clinical studies, some of which are presented below, demonstrate the efficacy of piroctone olamine and ciclopirox olamine.

Study	Participants	Protocol	Results
ROSENMAN & al. (2000)	82 individuals with seborrheic dermatitis.	Twice-weekly application for 4 weeks of a shampoo containing 1% ciclopirox olamine or a placebo.	Resolution or significant improvement was observed in 93% of participants in the control group versus 41% in the placebo group.
GOODE & al. (2002)	154 individuals with dandruff, including 70 with seborrheic dermatitis.	Apply a shampoo containing 1.5% ciclopirox olamine plus 3% salicylic acid, or a shampoo containing 2% ketoconazole, three times per week for four weeks.	A 22% reduction in dandruff and a 62.5% decrease in the area of seborrheic dermatitis were achieved with the ciclopirox olamine and salicylic acid shampoo, compared to a 26% reduction in dandruff and an 80.5% decrease in the area of seborrheic dermatitis with the ketoconazole shampoo.
SHARIFI-RAD & al. (2015)	30 individuals with dandruff.	A shampoo containing plant extracts, 1% piroctone olamine, and zinc PCA was used three times per week for two months, over a five-week treatment period.	Complete elimination of dandruff was achieved in 15 patients as early as week 2, in 12 patients after 4 weeks, and in 3 patients by the end of week 5.
PI & al. (2025)	20 subjects with moderate to severe seborrheic dermatitis.	Pre-application every 1–3 days of a gel containing salicylic acid, piroctone olamine, and zinc PCA, and a cleansing lotion containing salicylic acid and piroctone olamine for 4 weeks, then use of the lotion alone for 12 weeks.	By week 4, significant reductions were observed in dandruff scores (55.1%), itching (53.2%), and erythema (29%), with these improvements maintained thereafter. Overall clinical improvement reached 80%.