Keratinolytics for Meibomian Gland Dysfunction and Dry Eye disease from MGD

Thank you to our wonderful patient who sent the below video.

Using keratinolytics makes sense to me for patients with MGD, particularly in patients who have rosacea. One of the key components of Lipiflow is the removal of the keratin layer covering the meiboman glands that is often present prior to Lipiflow. Similarly, IPL may help decrease keratin formation over the meibomian gland orifice.

Selenium disulfide

Selenium disulfide, also known as selenium sulfide, is a medication used to treat many skin conditions. I have recommended this in the past but it can burn and cause allergy in some patients. The below video makes a case of how Selenium disulfide can break sulfide bonds and stop keratin formation. It may help in some patients who can tolerate it.

This company will come out with drops or ointment likely. But there are over the counter options which I have recommended in the past which can help some patients. Is it better than Tea Tree Oil, Avenova, Acuicyn? I don’t know: they will all say they kill Demodex and it will take years and money to perform a head to head study.

Here are some over the counter products that I have recommended in the past.

1% Selenium Sulfide

Below is a nice review article on different keratinolytics: ketoconazole works as well but is very strong & not necessarily needed.

SLC

https://www.medicinenet.com/ketoconazole_vs_selenium_sulfide/article.htm

Ketoconazole vs. Selenium Sulfide

Ketoconazole and selenium sulfide are antifungal agents used to treat itching, flaking, scaling, and dry skin on the scalp due to dandruff. Ketoconazole and selenium sulfide are also used for treating seborrhea (a red, itchy rash) and tinea versicolor, a fungal infection of the skin.
Brand names for ketoconazole include Nizoral, Nizoral A-D, Ketodan, Extina, Xolegel, and Kuric. Brand names for selenium sulfide include Head & Shoulders, Selsun Blue, SelRx, and Selsun Rx.
Side effects of ketoconazole and selenium sulfide that are similar include hair loss (rare), and scalp tingling.
Side effects of ketoconazole that are different from selenium sulfide include rash, itching, nausea, vomiting, abdominal pain, headache, dizziness, fatigue, impotence, blood count abnormalities, serious allergic reactions (anaphylaxis), and depression.
Side effects of selenium sulfide that are different from ketoconazole include oily hair, dry hair, dry scalp, hair loss, hair discoloration, scalp irritation, skin irritation, sweating, burning sensation, garlic breath, or tremor.

What are ketoconazole and selenium sulfide?

Ketoconazole is an anti-fungal medication in the same family of drugs as fluconazole (Diflucan), itraconazole (Sporanox), and miconazole (Micatin, Monistat). It prevents growth of several types of fungi by preventing production of the membranes that surround fungal cells. It is an anti-fungal medication prescribed to treat fungal infections such as thrush, ringworm, jock itch, athlete’s foot, dandruff, tinea versicolor, blastomycosis, histoplasmosis, and coccidiomycosis.

Selenium sulfide is a chemical agent commonly used for treating dandruff. It is an antifungal agent that also relieves itching, flaking, scaling, and dry skin on the scalp due to dandruff. Selenium sulfide is also used for treating seborrhea and tinea versicolor, a fungal infection of the skin.

What are the side effects of ketoconazole and selenium sulfide?

Ketoconazole

Ketoconazole generally is well tolerated. Commonly reported side effects of ketoconazole are:

rash,
itching,
nausea,
vomiting,
abdominal pain,
headache,
dizziness,
fatigue,
impotence, and
blood count abnormalities.

Other important side effects of ketoconazole are rare; they include:

serious allergic reactions (anaphylaxis),
severe depression,
hair loss, and
tingling sensations.

Liver dysfunction also has been reported. Signs of liver problems include unusual fatigue, loss of appetite, nausea and vomiting, yellowing of the skin (jaundice), dark urine, and pale stools. Development of these symptoms while taking ketoconazole should be reported to a physician.

Selenium Sulfide

The common side effects of selenium sulfide are:

Oily hair
Dry hair
Dry scalp
Hair loss
Hair discoloration

Other side effects of selenium sulfide include:

Scalp irritation
Skin irritation
Tingling
Sweating
Burning
Garlic breath
Tremor

What is the dosage of ketonazole vs. selenium sulfide?

Ketonazole

Ketoconazole may be taken with or without food. The oral dose range is 200-400 mg daily. Recurrent tinea versicolor is treated with 400 mg monthly. Topical formulations are administered to affected areas once or twice daily.

Selenium Sulfide

For treating dandruff, 5-10 mL of shampoo or lotion should be massaged into wet scalp 2 times per week for 2 weeks then once every 1-2 weeks to control dandruff. The shampoo or lotion should be left on the scalp for 2 to 3 minutes, then rinsed off3 or 4 times with water. The application should be repeated.

Tinea versicolor should be treated by applying lotion or shampoo to the affected area, leaving it on the skin for 10 minutes and then washing it off with water. It should be applied every day for 7 days. The foam should be rubbed into the affected skin every 12 hours.

What drugs interact with ketonazole and selenium sulfide?

Ketonazole

There are no drug interactions listed for topical ketonazole.

Selenium Sulfide

There are no drug interactions listed for topical selenium sulfide.

Selenium sulfideListen to pronunciation

Common brands: SelRx, Tersi Foam, Selsun Blue Moisturizing

Antifungal

It can treat dandruff, fungal infections of the skin, and seborrhea of the scalp.

Brands: SelRx, Tersi Foam, Selsun Blue Moisturizing, Anti-Dandruff, Anti-Dandruff With Menthol, Dandruff Shampoo (selen-aloe), and Dandruff Shampoo-Menthol