Selenium disulfide: a key ingredient to rebalance the scalp microbiome and sebum quality in the management of dandruff.

BACKGROUND: Dandruff is a chronic and relapsing scalp condition characterized by flaky scalp. Environmental and host factors (exposome) may alter the sebaceous gland activity, sebum composition, epidermal barrier function, and scalp microbiome balance, resulting in dandruff. Selenium disulfide (SeS2) improves the clinical signs of dandruff. OBJECTIVES: To investigate the mode of action of SeS2 shampoo during treatment and relapse phases. MATERIALS & METHODS: Two single-center studies assessed dandruff severity, subjective efficacy perception, microbial balance, microbiota diversity and sebum lipids. RESULTS: SeS2 significantly (p≤0.01) reduced scaling and led to a significant decrease of Malassezia and Staphylococcus spp. counts in both lesional and non-lesional areas, compared to the vehicle at D28 returning to baseline levels at D56. Cutibacterium spp. levels were not different between the SeS2 and the vehicle treatment groups but had significantly increased with SeS2 (p<0.001) in the lesional zone at D56. The ratio Malassezia spp./Cutibacterium spp. decreased significantly in lesional zones compared to baseline levels, at both D28 and D35 (p<0.001). The total squalene content significantly increased (p<0.05), whereas peroxided squalene had significantly decreased by almost 50% at D31. The ratio triglycerides/free fatty acids significantly (p<0.0001) increased, almost 5-fold, between D0 and D31. SeS2 shampoo was very well tolerated. CONCLUSION: SeS2 is beneficial in scalp dandruff, even after treatment interruption. It is well tolerated, rebalances the equilibrium between the main bacterial and fungal populations, and improves sebum quality.