Which active ingredients should ciclopirox olamine be combined with?

Often mistaken for ciclopirox olamine due to their similar names and closely related chemical structures, the piroctone olamine is nonetheless a distinct active ingredient, primarily used to eliminate scalp dandruff. While ciclopirox is a broad-spectrum antifungal effective against both dermatophyte fungi responsible for skin and nail mycoses and yeasts, the piroctone olamine targets yeasts more specifically, in particular Malassezia, whose proliferation is one of the causes of dandruff and seborrheic dermatitis. Moreover, the efficacy of piroctone olamine does not cease upon rinsing. It exhibits good adherence to the scalp and hair, allowing it to continue exerting its fungistatic properties well after application.

The combination of ciclopirox olamine and piroctone olamine could be relevant for more effectively and comprehensively managing dandruff and seborrheic dermatitis. The ciclopirox olamine may exert its antifungal and anti-inflammatory effects, reducing redness and itching associated with dandruff, while piroctone olamine could enhance ciclopirox olamine’s antifungal activity and help rebalance the microbial flora by limiting the proliferation of Malassezia. This dual antifungal action, combined with a soothing potential, could make this combination very interesting.

Although combining ciclopirox olamine with piroctone olamine appears promising, no clinical study has yet demonstrated the therapeutic benefit of this combination.

Sarcosine is an amino acid derivative that is generating increasing interest in hair care cosmetics, particularly for nurturing the scalp. Its main advantage lies in its ability to purify the scalp while rebalancing the skin microbiome. Sarcosine indeed acts on two levels: it reduces excess sebum and scalp flaking, while promoting its recolonization by six beneficial bacterial and fungal strains, such as Veillonella parvula and Rothia aeria, creating a more resilient environment against external aggressors. Thanks to this dual action, sarcosine appears to be an interesting active ingredient for scalps prone to dandruff, inflammation, or hyperseborrhea.

Combining sarcosine with ciclopirox olamine may be relevant for managing scalps with dandruff or affected by seborrheic dermatitis.

This combination allows for simultaneous action on the various causes of dandruff. As noted above, ciclopirox olamine targets yeasts and soothes redness and itching. Meanwhile, sarcosine restores the scalp microbiota and absorbs excess sebum, which reduces the risk of recurrence.

The salicylic acid is a keratolytic agent very commonly used in dermatological and cosmetic applications. This lipophilic ingredient can penetrate deep into the pores to unclog them, but also promote the elimination of dead cells at the surface of the epidermis. That is why the salicylic acid is so valued for treating oily and acne-prone skin, as well as for individuals with dandruff or suffering from seborrheic dermatitis. Salicylic acid also has an anti-inflammatory action that helps soothe the itching associated with scalp imbalances.

It is prudent to combine salicylic acid with ciclopirox olamine: the former regulates desquamation, while the latter targets fungal proliferation.

A comparative study evaluated the efficacy of a shampoo combining 1.5% ciclopirox olamine and 3% salicylic acid versus a shampoo containing 2% ketoconazole, a reference antifungal, in 154 individuals with dandruff, including 70 with seborrheic dermatitis. Participants applied their shampoo three times weekly for four weeks and a significant improvement was observed by dermatologists in both groups.

The effects achieved with the shampoo combining salicylic acid and ciclopirox olamine were similar to those observed with the ketoconazole shampoo (26% reduction in dandruff and 80.5% reduction in the area affected by seborrheic dermatitis). Moreover, no side effects were reported in either group, suggesting a good tolerability of the ciclopirox olamine and salicylic acid combination and a genuine benefit for managing dandruff and scalp inflammation.

The glycerin is an indispensable ingredient in cosmetics for its moisturizing and protective properties. Naturally present in the skin, it acts as a humectant, meaning it attracts and retains water in the outer layers of the epidermis, thus helping to maintain proper skin hydration. Glycerin strengthens the skin barrier and contributes to reducing transepidermal water loss. Well tolerated, glycerin is also recognized for its soothing and healing effects. Glycerin is often combined with ciclopirox olamine in scalp or nail treatments. Although this antifungal active ingredient is generally well tolerated, it is often applied to areas already compromised by local inflammation, significant scaling, or frequent washing. In this context, glycerin is beneficial for maintaining moisture in the skin or nail and improving comfort.

While the combination of ciclopirox olamine and glycerin is frequently encountered in cosmetics, it has not yet been studied in clinical trials.

The tea tree essential oil is well known for its antimicrobial and antifungal properties. It primarily works by disrupting the cell membrane of microorganisms, leading to their destruction. Several studies in vitro have demonstrated its effectiveness against fungi such as Malassezia furfur and Candida albicans, as well as against bacteria like Staphylococcus aureus and Staphylococcus epidermidis. The tea tree essential oil is therefore frequently used topically to treat blemishes and is sometimes included in anti-dandruff products. It can be hypothesized that combining it with ciclopirox olamine could provide a complementary antifungal effect, particularly for the scalp or skin areas prone to mixed bacterial and fungal colonization.

However, to date, no clinical study has evaluated the combination of ciclopirox and tea tree essential oil.

Urea is a multifunctional active compound. It indeed provides several benefits that are rarely combined in a single ingredient. Urea notably exhibits keratolytic, moisturizing, and softening properties. At low concentrations (2 to 10%), it primarily acts as a humectant by promoting water retention in the stratum corneum. At higher concentrations (above 10%), urea exerts a desquamating action by disrupting the bonds between corneocytes, thus facilitating scale removal and thinning thick keratin layers. Urea is therefore particularly useful in hyperkeratotic or scaly dermatoses, such as psoriasis or certain nail fungal infections. It can be hypothesized that combining urea with ciclopirox olamine could be relevant for enhancing the cutaneous absorption of ciclopirox by increasing skin or nail permeability. This would be especially advantageous in cases of onychomycosis, where the stratum corneum is very dense.

Again, further research is needed to determine the relevance of combining ciclopirox olamine and urea.

Charcoal extract is increasingly used in cosmetics for its absorbent, purifying, and soothing properties. Its porous structure allows it to act like a sponge that captures excess sebum and impurities on the surface of the skin. This characteristic of charcoal extract explains why it is primarily found in shampoos designed for individuals whose scalps become oily quickly. It may be advantageous to combine charcoal extract with ciclopirox olamine in shampoos or hair serums formulated for scalps prone to oily dandruff. This combination was evaluated in a clinical study involving 274 participants suffering from dandruff or seborrheic dermatitis. Participants applied twice weekly for 4 weeks a shampoo containing 1% ciclopirox olamine and 4% charcoal extract or a shampoo containing 2% ketoconazole.

The combination of ciclopirox olamine with charcoal extract appears to provide efficacy comparable to that of a standard anti-dandruff treatment.

• BOORMAN G. & al. Comparative efficacy of shampoos containing coal tar (4.0% w/w; Tarmed), coal tar (4.0% w/w) plus ciclopirox olamine (1.0% w/w; Tarmed AF) and ketoconazole (2.0% w/w; Nizoral) for the treatment of dandruff/seborrhoeic dermatitis. Journal of Dermatological Treatment (1999).

• GOODE K. & al. A randomised, single-blind, single-centre clinical trial to evaluate comparative clinical efficacy of shampoos containing ciclopirox olamine (1.5%) and salicylic acid (3%), or ketoconazole (2%, Nizoral ) for the treatment of dandruff/seborrhoeic dermatitis. Journal of Dermatological Treatment (2002).

• LEREBOUR G. Use of an n-acylated sarcosinate as an agent against microbial adhesion (2008).

• RAO R. & al. Tea tree oil: a promising essential oil. Journal of Essential Oil Research (2017).

• ABDO H. M. Excellent response of dermatophytoma and nail splitting to nail plate debridement plus topical ciclopirox olamine 1% solution. Skin Appendage Disorders (2021).

• LIN Y. S. & al. Moisture retention of glycerin solutions with various concentrations: A comparative study. Scientific Reports (2022).

• BUDZISZ E. & al. Ciclopirox and ciclopirox olamine: Antifungal agents in dermatology with expanding therapeutic potential. Applied Sciences (2024).

• PI L. & al. A cohort clinical study on the efficacy of topical salicylic acid/piroctone olamine dandruff pre-gel and cleanser in improving symptoms of moderate to severe seborrheic dermatitis of the scalp. Journal of Cosmetic Dermatology (2025).