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.


Ketoconazole vs. Selenium Sulfide

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 (MicatinMonistat). 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 thrushringwormjock itch, athlete’s foot, dandrufftinea 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 generally is well tolerated. Commonly reported side effects of ketoconazole are:
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 fatigueloss 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?


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?


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
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
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