Cytostatic

  • Selenium sulfide e.g. Selsun blue, Selenium sulfide 2.5%
  • Zinc pyrithione e.g. T-gel daily control

Inhibiting cell growth & division

Note: Selenium sulfide & Zinc pyrithione also have antimicrobial effect

Food & drug administration (FDA)

  • Scaling/Dandruff: Salicylic acid, Selenium sulfide, Zinc pyrithione, Tar, Ketoconazole
  • Seborrheic dermatitis:
    • Selenium sulfide, Tar, Ketoconazole, Ciclopirox, Fluocinonide
  • Psoriasis: 
    • Tar, Clobetasol

Off label

  • Adjunctive tx for Tinea capitis:
    • Selenium sulfide, Ketoconazole, Ciclopirox

  • Irritant contact dermatitis
  • Allergic contact dermatitis
  • Tar: 
    • Unpleasant odor, stain hair greenish-brown color & stains clothing, phototoxicity

General mechanism of action of all shampoos

  • Solubilize sebum & dirt to allow being rinsed away by water
  • Rising off substrates of Pityrosporum + lipids that promote inflammatory signaling

Safety

  • Salicylic acid: small amounts absorbed however rapidly excreted
  • Tar: significant potential for systemic absorption
  • Corticosteroids: very small amounts absorbed, but can cause local side effects e.g. skin atrophy
  • Children: Not tested, & not recommended.
  • Exceptions:
    1. Ketoconazole in cradle cap
    2. Tar/Corticosteroids in psoriasis
    3. Salicylic acid can be used in children >6 yrs