Scalp Discoloration from Selenium Sulfide Shampoo: A Case Series and Review of the Literature

Abstract

We describe six patients who developed orange to red-brown scalp discoloration after application of selenium sulfide-containing shampoos. This phenomenon has been described only once previously. In all of the cases, the discoloration resolved shortly after discontinuing the selenium sulfide. Lightly swabbing with isopropyl alcohol facilitated removal of the discoloration. This simple technique serves as a painless diagnostic method, which may prevent unnecessary evaluation with a biopsy.

Treatment of Tinea Capitis

“…Contact dermatitis confirmed by patch testing has also been reported [71]. Hair discoloration has also been reported, with all cases being reversible within weeks after cessation [68, 72]. Chen et al [73] have found that 1% selenium sulfide shampoo is equally effective as 1% ciclopirox shampoo when used as an adjunctive treatment for tinea capitis.…”

“…It is available in two different concentrations. Shampoos containing 1% selenium sulfide are affordable and available over the counter, and a 2.25% selenium sulfide shampoo is more expensive and only available via prescription [68]. A study by Givens et al [69] demonstrated that the 1 and 2.5% preparations of selenium sulfide shampoos are equally effective.…”

Scalp discoloration from selenium sulphide: revisiting a report of terra firma-forme dermatosis of the scalp

“…M adam , A distinctive pattern of red‐brown scalp discoloration has recently been described in six children due to the usage of various selenium sulphide‐containing shampoos 1 . In light of this report, I believe that the interesting Clinical Cameo by Mallari and Sinclair 2 describing a 4‐year‐old child with striking red discoloration in a patch of alopecia areata represents this selenium sulphide staining phenomenon rather than the diagnosis of terra firma‐forme dermatosis given by the authors.…”

“…Moreover, terra firma‐forme dermatosis has otherwise never been reported in a patch of alopecia areata. Finally, the finding of (complete or partial) lesion removal with alcohol swabbing (but not soap and/or water) is not specific for terra firma‐forme dermatosis, but instead has been described in other disorders of retention hyperkeratosis (such as confluent and reticulated papillomatosis and acanthosis nigricans) 4,5 as well as selenium sulphide shampoo‐associated discoloration 1 . In summary, I believe it is instructive to revisit the case of Mallari and Sinclair and that clinicians maintain selenium sulphide staining in the differential diagnosis of unusual scalp discoloration, especially in children.…”

Yellow hair following sequential application of bacitracin zinc and selenium sulfide: Report of acquired xanthotrichosis and review of yellow hair discoloration

“…Topical agents Anthralin (acidic conditions) [15] Minoxidil 1.5% [16] Selenium sulfide (with/without bacitracin) [8,17,18] Tar shampoo [7] Systemic drugs Chloroquine [2] Cisplatin [2] Heptaminol [19] Mephenesin [2] Minoxidil [20] para-aminobenzoic acid [2] Sunitinib [2] Tamsulosin [3] Valproic acid [2] Systemic conditions Essential fatty acid deficiency [21] a Malignancy (leiomyosarcoma) [22] a Protein-calorie malnutrition [1] Vitamin B12 deficiency [23] a a some of these etiologies can also result in lightening of the hair color…”