Selsun Blue is an over-the-counter brand of dandruff shampoo now owned by Sanofi . First made by Abbott Laboratories , the brand was bought by Chattem in 2002. Chattem was acquired by Sanofi in 2010, although in some markets, it is sold by Rohto Pharmaceutical instead. Selsun Blue has been marketed as a more effective alternative to brand leader Head & Shoulders due to its superior performance in randomized trials.
48-415: Over the counter Selsun Blue contains 1% selenium sulfide as its active ingredient in its most popular version (the word "Selsun" is a portmanteau of sel enium su lfide + n ). Chattem announced that on November 1, 2005, they would introduce a new line of shampoos under the brand name Selsun Salon. These contained a different active ingredient than Selsun Blue, pyrithione zinc 1%, and are oriented toward
96-851: A GnRH analogue , male-limited precocious puberty . In any case, the risk of hepatotoxicity with ketoconazole limits its use in all of these indications, especially in those that are benign such as hirsutism. Ketoconazole has been used to prevent the testosterone flare at the initiation of GnRH agonist therapy in men with prostate cancer. Oral ketoconazole has various contraindications , such as concomitant use with certain other drugs due to known drug interactions . Other contraindications of oral ketoconazole include liver disease , adrenal insufficiency , and known hypersensitivity to oral ketoconazole. Vomiting, diarrhea, nausea, constipation, abdominal pain, upper abdominal pain, dry mouth, dysgeusia , dyspepsia , flatulence , tongue discoloration may occur. The drug may cause adrenal insufficiency so
144-412: 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 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
192-484: 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,
240-432: A composition that approximates to SeS 2 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 n S 8−n . Many selenium sulfides are known, as indicated by Se- NMR spectroscopy. Selenium sulfide
288-415: A result of mutations in the sterol biosynthesis pathway. Defects in the sterol 5-6 desaturase enzyme reduce the toxic effects of azole inhibition of the 14-alpha demethylation step. Multidrug-resistance (MDR) genes can also play a role in reducing cellular levels of the drug. As azole antifungals all act at the same point in the sterol pathway, resistant isolates are normally cross-resistant to all members of
336-410: A second-line treatment for certain forms of advanced prostate cancer and for the suppression of glucocorticoid synthesis in the treatment of Cushing's syndrome . However, in the treatment of prostate cancer, concomitant glucocorticoid administration is needed to prevent adrenal insufficiency . Ketoconazole has additionally been used, in lower dosages, to treat hirsutism and, in combination with
384-539: A steroidogenesis inhibitor in men, women, and children at dosages of 200 to 1,200 mg/day. Numerous small studies have investigated the effects of oral ketoconazole on hormone levels in humans. It has been found in men to significantly decrease testosterone and estradiol levels and to significantly increase luteinizing hormone , progesterone , and 17α-hydroxyprogesterone levels, whereas levels of androstenedione , follicle-stimulating hormone , and prolactin were unaffected. The ratio of testosterone to estradiol
432-553: A type of fungal skin infection caused by a different species of Malassezia . A 2015 systematic review of topical treatments for seborrheic dermatitis of the scalp identified only a single randomized controlled trial 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 shampoo (n=97), 2.5% selenium disulfide shampoo (n=100), and placebo (shampoo base with no antiseborrheic agent) (n=49) for 29 days. The study found
480-448: Is a keratolytic agent that assists with cell shedding or flaking. The base brand consists of six types including Medicated with menthol, 2-in-1, Normal to Oily, Moisturizing, Itchy Dry Scalp, and Deep Cleansing with micro beads. The first four types contain the active ingredient selenium sulfide which has been shown to have anti-fungal properties. More specifically, selenium sulfide, an anti-infective agent, relieves itching and flaking of
528-509: Is a stub . You can help Misplaced Pages by expanding it . Selenium disulfide Selenium disulfide , also known as selenium sulfide , is a chemical compound and medication used to treat seborrheic dermatitis , dandruff , 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 , among others. Use
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#1733269693676576-521: Is a risk of systemic absorption and associated toxicity . Systemic symptoms may include tremors , weakness , lethargy , lower abdominal pain , and occasional vomiting . These symptoms usually resolve within 10 days following exposure. Selenium disulfide acts as an antifungal and keratolytic agent to treat seborrheic dermatitis and dandruff. The systemic absorption and toxicity of orally administered selenium sulfide has been studied in animals. Topical use of selenium sulfide in
624-1335: Is also decreased during oral ketoconazole therapy in men. Suppression of testosterone levels by ketoconazole is generally partial and has often been found to be transient. Better effects on suppression of testosterone levels have been observed in men when ketoconazole is combined with a GnRH agonist to suppress the hypothalamic–pituitary–gonadal axis , which prevents compensatory upregulation of luteinizing hormone secretion and consequent activation of gonadal testosterone production. In premenopausal women with polycystic ovary syndrome , ketoconazole has been found to significantly decrease levels of androstenedione and testosterone and significantly increase levels of 17α-hydroxyprogesterone and estradiol. Studies in postmenopausal women with breast cancer have found that ketoconazole significantly decreases androstenedione levels, slightly decreases estradiol levels, and does not affect estrone levels. This indicates minimal inhibition of aromatase by ketoconazole in vivo in humans. Ketoconazole has also been found to decrease levels of endogenous corticosteroids , such as cortisol , corticosterone , and aldosterone , as well as vitamin D . Ketoconazole has been found to displace dihydrotestosterone and estradiol from sex hormone-binding globulin in vitro , but this
672-423: Is also used as a treatment for dandruff (seborrheic dermatitis of the scalp) and for seborrheic dermatitis on other areas of the body, perhaps acting in these conditions by suppressing levels of the fungus Malassezia furfur on the skin. Ketoconazole has activity against many kinds of fungi that may cause human disease, such as Candida , Histoplasma , Coccidioides , and Blastomyces (although it
720-610: Is available widely throughout the world. In 2013, the European Medicines Agency 's Committee for Medicinal Products for Human Use (CHMP) recommended that a ban be imposed on the use of oral ketoconazole for systemic use in humans throughout the European Union, after concluding that the risk of serious liver injury from systemic ketoconazole outweighs its benefits. As of March 2019, oral levoketoconazole (developmental code name COR-003, tentative brand name Recorlev)
768-411: Is increased by the ketoconazole. As an antifungal, ketoconazole is structurally similar to imidazole , and interferes with the fungal synthesis of ergosterol , a constituent of fungal cell membranes , as well as certain enzymes . As with all azole antifungal agents, ketoconazole works principally by inhibiting the enzyme cytochrome P450 14α-demethylase (CYP51A1). This enzyme participates in
816-457: 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. Selenium disulfide is available in the form of a prescription drug as a 2.25% medical shampoo . In the United States , a 1% strength is available over-the-counter , and a 2.5% strength is also available with
864-476: Is not active against Aspergillus ), chromomycosis and paracoccidioidomycosis . First made in 1977, ketoconazole was the first orally-active azole antifungal medication. However, ketoconazole has largely been replaced as a first-line systemic antifungal medication by other azole antifungal agents, such as fluconazole and/or itraconazole , because of ketoconazole's greater toxicity, poorer absorption, and more limited spectrum of activity. Ketoconazole
912-464: Is not recommended in children less than 2–5 years old. Use in pregnancy or breastfeeding has not been studied. It consists of a mixture of inorganic covalent compounds having an approximate empirical formulas of SeS 2 . Selenium disulfide acts as a keratolytic and antifungal agent. Selenium disulfide was approved for medical use in the United States at least as early as 1951. It
960-515: Is on the World Health Organization's List of Essential Medicines . Selenium disulfide is available as a generic medication and over the counter . Selenium disulfide is sold as an antifungal agent in shampoos (such as Selsun Blue ) for the treatment of dandruff and seborrheic dermatitis associated in the scalp with fungi of genus Malassezia . It is also used on the body to treat tinea versicolor (pityriasis versicolor),
1008-540: Is taken by mouth was withdrawn in the European Union and in Australia in 2013, and in China in 2015. In addition, its use was restricted in the United States and Canada in 2013. Topically administered ketoconazole is usually prescribed for fungal infections of the skin and mucous membranes, such as athlete's foot , ringworm , candidiasis (yeast infection or thrush), jock itch , and tinea versicolor . Topical ketoconazole
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#17332696936761056-438: 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 trials 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. Ketoconazole Ketoconazole , sold under
1104-686: Is used orally in dosages of 200 to 400 mg per day in the treatment of superficial and deep fungal infections. Ketoconazole shampoo in conjunction with an oral 5α-reductase inhibitor such as finasteride or dutasteride has been used off label to treat androgenic alopecia . It was speculated that antifungal properties of ketoconazole reduce scalp microflora and consequently may reduce follicular inflammation that contributes to alopecia. Limited clinical studies suggest ketoconazole shampoo used either alone or in combination with other treatments may be useful in reducing hair loss in some cases. The side effects of ketoconazole are sometimes harnessed in
1152-544: Is very lipophilic and tends to accumulate in fatty tissues. Ketoconazole is a synthetic imidazole . It is a nonsteroidal compound. It is a racemic mixture of two enantiomers , levoketoconazole ((2 S ,4 R )-(−)-ketoconazole) and dextroketoconazole ((2 R ,4 S )-(+)-ketoconazole). Levoketoconazole is under development for potential clinical use as a steroidogenesis inhibitor with better tolerability and less toxicity than ketoconazole. Other steroidogenesis inhibitors besides ketoconazole and levoketoconazole include
1200-731: The androgen receptor . This effect is thought to be quite weak however, even with high oral doses of ketoconazole. Ketoconazole, along with miconazole , has been found to act as an antagonist of the glucocorticoid receptor . Ketoconazole is a racemic mixture consisting of cis -(2 S ,4 R )-(−) and cis -(2 R ,4 S )-(+) enantiomers. The cis -(2 S ,4 R ) isomer was more potent in inhibiting progesterone 17α,20-lyase than its enantiomer ( IC 50 values of 0.05 and 2.38 μ M, respectively) and in inhibiting 11β-hydroxylase (IC 50 values of 0.152 and 0.608 μ M, respectively). Both isomers were relatively weak inhibitors of human placental aromatase . Oral ketoconazole has been used clinically as
1248-425: The sterol biosynthesis pathway that leads from lanosterol to ergosterol . Lower doses of fluconazole and itraconazole are required to kill fungi compared to ketoconazole, as they have been found to have a greater affinity for fungal cell membranes. Resistance to ketoconazole has been observed in a number of clinical fungal isolates, including Candida albicans . Experimentally, resistance usually arises as
1296-421: The European Union and Australia, and strict restrictions were placed on the use of oral ketoconazole in the United States and Canada. Oral ketoconazole is indicated for use in these countries when the indication is a severe or life-threatening systemic infection and alternatives are unavailable. However, topical ketoconazole, which does not distribute systemically, is safe and widely used still. Ketoconazole HRA
1344-407: The alien life form was sensitive to selenium. Selenium disulfide has been suggested to be effective as a treatment for hyperkeratosis 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 100 treated patients and two case reports of dramatic response. Selenium sulfide
1392-428: The azole family. As an antiandrogen , ketoconazole operates through at least two mechanisms of action. First, and most notably, high oral doses of ketoconazole (e.g. 40 mg three times per day) block both testicular and adrenal androgen biosynthesis, leading to a reduction in circulating testosterone levels. It produces this effect through inhibition of 17α-hydroxylase and 17,20-lyase , which are involved in
1440-600: The brand name Nizoral among others, is an antiandrogen , antifungal , and antiglucocorticoid medication used to treat a number of fungal infections . Applied to the skin it is used for fungal skin infections such as tinea , cutaneous candidiasis , pityriasis versicolor , dandruff , and seborrheic dermatitis . Taken by mouth it is a less preferred option and only recommended for severe infections when other agents cannot be used. Other uses include treatment of excessive male-patterned hair growth in women and Cushing's syndrome . Common side effects when applied to
1488-423: The first hour following overdose of oral ketoconazole. The concomitant use of the following medications is contraindicated with ketoconazole tablets: And is not recommended: Ritonavir is known for increasing activity of the ketoconazole so it is recommended to reduce dosage. There is also a list of drugs which significantly decrease systemic exposure to the ketoconazole and drugs whose systemic exposure
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1536-460: 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 salts , which may be attributed to its low aqueous solubility and very poor systemic absorption. Selenium disulfide has
1584-516: The fungal cell membrane , thereby slowing growth. Ketoconazole was patented in 1977 by Belgian pharmaceutical company Janssen , and came into medical use in 1981. It is available as a generic medication and formulations that are applied to the skin are over the counter in the United Kingdom . In 2022, it was the 175th most commonly prescribed medication in the United States, with more than 2 million prescriptions. The formulation that
1632-661: The gland conditions. It recommends oral tablets should not be a first-line treatment for any fungal infection. It should be used for the treatment of certain fungal infections, known as endemic mycoses, only when alternative antifungal therapies are not available or not tolerated. As contraindication it should not be used in people with acute or chronic liver disease. Anaphylaxis after the first dose may occur. Other cases of hypersensitivity include urticaria . The topical formulations have not been associated with liver damage, adrenal problems, or drug interactions. These formulations include creams, shampoos, foams, and gels applied to
1680-487: The higher-end shampoo market. Other active ingredients such as salicylic acid and botanicals are in other versions of Selsun Blue brand dandruff shampoo. In 2011, the Selsun Blue brand consisted of 15 products spread across two brand segments, Naturals and Base. The Naturals line of products contains the active ingredient salicylic acid in addition to 8 moisturizers & botanicals plus vitamins B5 & E. Salicylic acid
1728-510: The imidazole group of antifungals. Oral ketoconazole has been replaced with oral fluconazole or itraconazole for many mycoses . Due to incidence of serious liver toxicity , the use of oral ketoconazole was suspended in France in July 2011, following review. This event triggered an evaluation of oral ketoconazole throughout the rest of the European Union. In 2013, oral ketoconazole was withdrawn in
1776-486: The level of the adrenocortical hormones should be monitored while taking it. Oral ketoconazole at a dosage range of 400 to 2,000 mg/day has been found to result in a rate of gynecomastia of 21%. In July 2013, the US Food and Drug Administration (FDA) issued a warning that taking ketoconazole by mouth can cause severe liver injuries and adrenal gland problems: adrenal insufficiency and worsening of other related to
1824-429: The nonsteroidal compound aminoglutethimide and the steroidal compound abiraterone acetate . Ketoconazole was discovered in 1976 at Janssen Pharmaceuticals . It was patented in 1977, followed by introduction in the United States in July 1981. Following its introduction, ketoconazole was the only systemic antifungal available for almost a decade. Ketoconazole was introduced as the prototypical medication of
1872-492: 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 as the main treatments for seborrheic dermatitis based on good-quality evidence, rather than selenium disulfide for which evidence
1920-1126: The scalp (3 people), eruption near the hairline (1 person), psoriasis (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). Selenium disulfide can cause discoloration of nails and light hair and can alter the color of hair dyes . 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 . Selenium disulfide may also discolor metallic jewellery . Case reports of temporary diffuse hair loss 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
1968-527: The scalp and removes the dry, scaly particles commonly referred to as dandruff or seborrhea . Selenium sulfide is also used to treat tinea versicolor , a fungal infection of the skin. Deep Cleansing was launched by Chattem in January 2011. In addition to the active ingredient salicylic acid, the product contains scrubbing micro beads. Like Chattem’s other products, Selsun Blue is sold through mass merchandisers, drug and food retailers. This product article
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2016-414: The skin include redness. Common side effects when taken by mouth include nausea , headache , and liver problems . Liver problems may result in death or the need for a liver transplantation . Other severe side effects when taken by mouth include QT prolongation , adrenocortical insufficiency , and anaphylaxis . It is an imidazole and works by hindering the production of ergosterol required for
2064-580: The skin, unlike the ketoconazole tablets, which are taken by mouth. Ketoconazole is categorized as pregnancy category C in the US. Research in animals has shown it to cause teratogenesis when administered in high doses. A subsequent trial in Europe failed to show a risk to infants of mothers receiving ketoconazole. In the event of an overdose of oral ketoconazole, treatment should be supportive and based on symptoms . Activated charcoal may be administered within
2112-402: The synthesis and degradation of steroids, including the precursors of testosterone . Due to its efficacy at reducing systemic androgen levels, ketoconazole has been used with some success as a treatment for androgen-dependent prostate cancer. Second, ketoconazole is an androgen receptor antagonist , competing with androgens such as testosterone and dihydrotestosterone (DHT) for binding to
2160-808: The treatment of non-fungal conditions. While ketoconazole blocks the synthesis of the sterol ergosterol in fungi, in humans, at high dosages (>800 mg/day), it potently inhibits the activity of several enzymes necessary for the conversion of cholesterol to steroid hormones such as testosterone and cortisol . Specifically, ketoconazole has been shown to inhibit cholesterol side-chain cleavage enzyme , which converts cholesterol to pregnenolone , 17α-hydroxylase and 17,20-lyase , which convert pregnenolone into androgens , and 11β-hydroxylase , which converts 11-deoxycortisol to cortisol . All of these enzymes are mitochondrial cytochrome p450 enzymes. Based on these antiandrogen and antiglucocorticoid effects, ketoconazole has been used with some success as
2208-492: Was approved for use in the European Union for treatment of Cushing's syndrome in November 2013. Ketoconazole is the generic name of the drug and its INN Tooltip International Nonproprietary Name , USAN Tooltip United States Adopted Name , BAN Tooltip British Approved Name , and JAN Tooltip Japanese Accepted Name . Ketoconazole has been marketed under a large number of brand names. Ketoconazole
2256-508: 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. In the film Evolution selenium was mentioned as an active ingredient of Head & Shoulders . A group of academics, therefore, tried to use this brand of shampoo to stop an alien invasion after discovering that
2304-408: Was not found to be relevant in vivo . Ketoconazole has been found to inhibit the activity of the cation channel TRPM5 . When administered orally, ketoconazole is best absorbed at highly acidic levels, so antacids or other causes of decreased stomach acid levels will lower the drug's absorption. Absorption can be increased by taking it with an acidic beverage, such as cola . Ketoconazole
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