Which active ingredients should ciclopirox olamine be combined with?

Often mistaken for ciclopirox olamine because of the similarity of their names and their closely related chemical structures, the piroctone olamine is nonetheless a distinct active ingredient, primarily used to eliminate dandruff from the scalp. While ciclopirox is a broad‐spectrum antifungal capable of acting on both dermatophyte fungi responsible for cutaneous and ungual mycoses as well as yeasts, piroctone olamine primarily targets yeasts, notably Malassezia, whose proliferation is one of the causes of dandruff and seborrhoeic dermatitis. Furthermore, the efficacy of piroctone olamine does not end at rinsing. It exhibits strong adhesion to the scalp and hair, enabling it to continue exerting its fungistatic properties long after application.

The combination of ciclopirox olamine and piroctone olamine could be relevant to managing dandruff and seborrheic dermatitis more effectively and comprehensively. The ciclopirox olamine could exert its antifungal and anti-inflammatory effects, reducing the redness and itching associated with dandruff, while piroctone olamine could enhance the antifungal activity of ciclopirox olamine and contribute to rebalancing the microbial flora by limiting the proliferation of Malassezia. This dual antifungal action, combined with a soothing potential, could make this combination highly attractive.

Although combining ciclopirox olamine and piroctone olamine appears promising, no clinical trial has yet demonstrated the benefit of this combination.

Sarcosine is an amino acid derivative that is attracting growing interest in hair care cosmetics, particularly for caring for the scalp. Its main advantage lies in its ability to purify the scalp while rebalancing the skin microbiota. Sarcosine indeed acts on two levels: it reduces excess sebum and scalp flaking, while promoting its recolonisation by six beneficial bacterial and fungal strains, such as Veillonella parvula and Rothia aeria, creating a more resilient environment against external aggressions. Thanks to this dual action, sarcosine appears to be an interesting active ingredient for scalps prone to dandruff, inflammation or hyperseborrhoea.

Combining sarcosine and ciclopirox olamine may be relevant for managing scalps presenting with dandruff or affected by seborrhoeic dermatitis.

This combination allows for simultaneous action on the various causes of dandruff. As noted above, ciclopirox olamine targets yeasts and soothes redness and itching. Meanwhile, sarcosine restores the scalp microbiota and absorbs excess sebum, which reduces the risk of recurrence.

The salicylic acid is a keratolytic active ingredient very often used in dermatological and cosmetic care. This lipophilic compound is capable of penetrating deeply into the skin’s pores to unclog them, but also to promote the removal of dead skin cells from the surface of the epidermis. That is why salicylic acid is so valued for treating oily or acne-prone skin, as well as for individuals with dandruff or suffering from seborrhoeic dermatitis. Salicylic acid also exhibits an anti-inflammatory action that helps soothe itching associated with scalp imbalances.

It is advisable to combine salicylic acid with ciclopirox olamine: while the former regulates desquamation, the latter targets fungal proliferation.

A comparative study assessed the efficacy of a shampoo combining 1.5% ciclopirox olamine and 3% salicylic acid versus a shampoo containing 2% ketoconazole, a reference antifungal, in 154 individuals with dandruff, including 70 affected by seborrhoeic dermatitis. Participants applied their shampoo three times per week for four weeks and a significant improvement was observed by dermatologists in both groups.

The effects achieved with the shampoo combining salicylic acid and ciclopirox olamine were comparable to those observed with ketoconazole shampoo (a 26% reduction in dandruff and an 80.5% decrease in the area affected by seborrhoeic dermatitis). Moreover, no adverse effects were reported in either group, suggesting a good tolerability of the ciclopirox olamine and salicylic acid combination and a genuine benefit in managing dandruff and scalp inflammation.

The glycerin is a staple cosmetic ingredient valued for its hydrating and protective properties. Naturally present in the skin, it acts as a humectant, that is, it attracts and retains water in the superficial layers of the epidermis, thereby helping to maintain proper skin hydration. Glycerin strengthens the skin barrier and contributes to reducing transepidermal water loss. Well tolerated, glycerin is also recognised for its soothing and healing effects. Glycerin is often combined with ciclopirox olamine in treatments for the scalp or nails. Although this antifungal active ingredient is generally well tolerated, it is frequently applied to areas already compromised by local inflammation, significant desquamation or repeated washing. In this context, glycerin is valuable for maintaining skin or nail hydration and improving comfort.

While the combination of ciclopirox olamine and glycerine is frequently encountered in cosmetics, it has not yet been studied in clinical trials.

The tea tree essential oil is well known for its antimicrobial and antifungal properties. It primarily acts by disrupting the cell membrane of microorganisms, resulting in their destruction. Several studies in vitro have demonstrated its effectiveness against fungi such as Malassezia furfur and Candida albicans, but also against bacteria such as Staphylococcus aureus and Staphylococcus epidermidis. The tea tree essential oil is therefore frequently used topically on blemishes and is sometimes found in anti-dandruff treatments. It can be assumed that combining it with ciclopirox olamine could offer a complementary antifungal effect, particularly for scalps or skin areas prone to mixed bacterial and fungal colonisation.

However, to date, no clinical study has yet evaluated the combination of ciclopirox and tea tree essential oil.

Urea is a multifunctional active ingredient. Indeed, it provides multiple benefits that are rarely combined in a single compound. Urea notably exhibits keratolytic, hydrating and emollient properties. At low concentrations (2 to 10%), it primarily functions as a moisturising agent by promoting water retention in the stratum corneum. At higher concentrations (above 10%), urea exerts a desquamating effect by disrupting the bonds between corneocytes, thereby facilitating the removal of scales and thinning thick keratin layers. Urea is therefore particularly useful in hyperkeratotic or scaly dermatoses, such as the psoriasis or certain nail mycoses. It can be hypothesised that combining urea with ciclopirox olamine could be relevant to enhance the cutaneous absorption of ciclopirox by rendering the skin or nail more permeable. This would be especially advantageous in cases of onychomycosis, where the nail plate is very dense.

Once more, further research is required to determine the relevance of combining ciclopirox olamine with urea.

Charcoal extract is increasingly used in cosmetics for its absorbent, purifying and soothing properties. Thanks to its porous structure, it acts like a sponge that captures excess sebum and impurities on the skin’s surface. This characteristic of charcoal extract explains why it is mainly found in shampoos designed for individuals with rapidly oiling scalps. It may be beneficial to combine charcoal extract with ciclopirox olamine in shampoos or scalp serums formulated for scalps prone to greasy dandruff. This combination was tested in a clinical study involving 274 individuals suffering from dandruff or seborrhoeic dermatitis. Participants applied twice weekly for four weeks a shampoo containing 1% ciclopirox olamine and 4% charcoal extract, or a shampoo containing 2% ketoconazole.

The combination of ciclopirox olamine with charcoal extract appears to offer efficacy comparable to that of a reference anti-dandruff treatment.

• BOORMAN G. & al. Comparative efficacy of shampoos containing coal tar (4.0% w/w; Tarmed), coal tar (4.0% w/w) plus ciclopirox olamine (1.0% w/w; Tarmed AF) and ketoconazole (2.0% w/w; Nizoral) for the treatment of dandruff/seborrhoeic dermatitis. Journal of Dermatological Treatment (1999).

• GOODE K. & al. A randomised, single-blind, single-centre clinical trial to evaluate comparative clinical efficacy of shampoos containing ciclopirox olamine (1.5%) and salicylic acid (3%), or ketoconazole (2%, Nizoral ) for the treatment of dandruff/seborrhoeic dermatitis. Journal of Dermatological Treatment (2002).

• LEREBOUR G. Use of an n-acylated sarcosinate as an agent against microbial adhesion (2008).

• RAO R. & al. Tea tree oil: a promising essential oil. Journal of Essential Oil Research (2017).

• ABDO H. M. Excellent response of dermatophytoma and nail splitting to nail plate debridement plus topical ciclopirox olamine 1% solution. Skin Appendage Disorders (2021).

• LIN Y. S. & al. Moisture retention of glycerin solutions with various concentrations: A comparative study. Scientific Reports (2022).

• BUDZISZ E. & al. Ciclopirox and ciclopirox olamine: Antifungal agents in dermatology with expanding therapeutic potential. Applied Sciences (2024).

• PI L. & 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. Journal of Cosmetic Dermatology (2025).