Salicylic Acid and Piroctone Olamine Combination Treatment is Highly Successful for Scalp SD Treatment

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A novel combination treatment involving salicylic acid and piroctone olamine is highly effective and safe for patients with moderate to severe seborrheic dermatitis (SD) on the scalp.¹ The pre-application gel combined with a cleansing lotion provided rapid yet stable symptom relief and a lower recurrence rate, offering the potential to become a standardized treatment option.

The prospective cohort study took place at the Yanbian University Hospital in China. It included 20 participants between the ages of 20 and 42, with a mean age of 27.05. Of this total, 60% were female and 40% were male. Each patient had a clinical diagnosis of moderate to severe SD.

For 4 weeks, participants evenly applied the gel once a week. Patients were instructed to massage the affected area to allow sebum and dirt to dissolute before rinsing off with water. The cleansing lotion was used every 1-3 days, depending on how frequently the patient washes their hair. The foam was lathered and left on the areas for 3 to 5 minutes before being rinsed off. Then, maintenance treatment continued for 12 weeks with the cleansing lotion. Follow-up visits occurred every 4 weeks.

The pre-application gel ingredients consisted of topical salicylic acid, piroctone olamine, PCA zinc, and decyl glucoside along with moisturizing agents of panthenol, glycerin, allantoin, hydrolyzed corn starch, and bisabolol. In the cleansing lotion, salicylic acid, piroctone olamine, and antimicrobial peptide were the main antifungal agents. These were combined with sodium lauryl sulfate, sodium lauroylsarcosinate, potassium coco-glycinate, coco-methyl-glucamine, panthenol, glycerin, and niacinamide.

“The combined therapy in this study utilized a two-step treatment approach with a pre-application gel and a cleansing lotion: the pre-application gel, used before shampooing, delivers a high concentration of active ingredients, softens scales, reduces inflammation, and controls sebum production; the cleansing lotion, applied during shampooing, further removes loosened scales and excess oils, thereby reinforcing the therapeutic effects,” the authors further explained.

Clinicians measured dandruff severity, itching, erythema, and greasiness with a 4-point scale at baseline, week 1, week 4, week 8, week 12, and week 16. Quantifiable trichoscopic data and macroscopic photographs were also utilized.

At week 4, the average dandruff score had decreased significantly. This metric decreased from 2.45 at baseline to 1.10 (p < 0.01), which was a 90% success rate. The average itchiness score also reduced from 2.35 to 1.10 (p < 0.01).

The erythema score dropped from 1.55 to 1.10 (p < 0.05) and continued to improve at subsequent follow-ups for 40% of the patients. Additionally, the greasiness score decreased from 2.60 to 1.40 (p < 0.01) before stabilizing to 1.00 at week 8 and beyond.

After 16 weeks, the disease severity of 18 patients improved to mild after previously being moderate or severe. Overall, clinical improvement was at a rate of 80% by week 16.

Only 2 patients experienced recurrent dandruff between weeks 12 and 16 which subsequently resolved after increasing the frequency of the cleansing lotion. No other adverse events were reported, making the overall treatment well-tolerated.

There were some limitations such as the study design without randomization and the small, geographically concentrated sample size. Future research should include larger, multicenter, randomized controlled trials that assess long-term efficacy and relapse rates past the 16-week mark.

Commonly used anti-inflammatory SD treatments include selenium sulfide, ketoconazole, corticosteroids, and calcineurin inhibitors. Although these provide short-term results, prolonged use can lead to adverse events such as irritation, burning, rashes, and other local infections.² This confirms the need for safe and effective long-term therapies that are user-friendly with fewer adverse effects.

References

1. Ge L, Liu Z, Xu S, et 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. J Cosmet Dermatol. 2025;24(1):e16742. doi:10.1111/jocd.16742

2. Mangion SE, Mackenzie L, Roberts MS, Holmes AM. Seborrheic dermatitis: topical therapeutics and formulation design. Eur J Pharm Biopharm. 2023;185:148-164. doi:10.1016/j.ejpb.2023.01.023