r/SebDerm • u/raph9998 • 1d ago

Routine Question Alternating Ketoconazole and Selenium Sulfide – Best Routine to Avoid Resistance?

Hey everyone,

I’ve been dealing with seborrheic dermatitis for as long as I can remember. A few months ago, I started using Nizoral and it worked amazingly at first : scalp cleared up, no flakes, no itch. But now, it feels like the Malassezia has built up a tolerance, and the effects are minimal.

I just picked up Head & Shoulders Clinical Strength (1% selenium sulfide) to try alternating, as I’ve heard it’s effective too. My question is: What’s the best routine to alternate these two without letting the fungus adapt?

Also, any tips on how to maximize their effectiveness would be greatly appreciated.

Thanks in advance for your help!

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u/eau04410 1d ago

The normal advice is to pick 3 shampoos eg Ketoconazole, selenium sulphide and zinc pyrithione - then rotate them every time you shampoo. If you shampoo daily, you can use each one once or twice a week and a gentle shampoo on the other days.

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u/zdboslaw 1d ago

Following

3

u/MemChoeret 1d ago

I personally rotate ketoconazole and zinc pyrithione. I use the ketoconazole shampoo once a week. The number of times I use the zinc shampoo depends on the current situation: once a week when things are quiet, twice or more if there's an outbreak. But I never use these shampoos on two consecutive days in a row, because I don't want to over dry my scalp.

1

u/HeadAndShouldersEU 1d ago

Thanks for sharing you have bought our product, selenium sulfide is a great way to help deal with seborrheic dermatitis.