Zinc pyrithione

The complex compound represented by three sulfur atoms and two oxygen atoms is called zinc perithione: dermatologists have been using it for many decades to treat many skin diseases, which is due to the bright antimicrobial and fungicidal ability of the substance.

Zinc pyrithione has been successfully used for psoriasis and seborrhea, and it can be applied not only to the skin but also to the scalp. The first known application of this compound is the treatment of dandruff. [1]

Indications Zinc pyrithione

Zinc pyrithione has a number of therapeutic properties:

• destroys fungal and microbial flora, including Gram-positive and Gram-negative bacteria;
• insoluble in water, which allows to achieve the most targeted action of the drug;
• is well adhered to various surfaces, which favors the targeted action of the drug for a long time;
• has complex pharmacological characteristics and complex action.

Zinc pyrithione is a chemically active substance with a pronounced anti-inflammatory activity, which can be equaled only to the action of glucocorticoids - in particular, clobetasol propionate.

Zinc pyrithione is prescribed for most dermatologic pathologies, including those of idiopathic origin. The drug is suitable for the treatment of fungal, bacterial infections, atopic dermatitis, neurodermatitis, allergic processes, eczema. It is successfully used to eliminate acne rashes, psoriasis (both during relapse and remission), seborrhea and various manifestations of shingles. [2]

Zinc pyrithione is part of the preparations that are used in such pathologies:

• psoriasis (including in the hair area);
• dandruff and seborrhea;
• pruritic dermatoses;
• eczematous lesions;
• dermatitis and neurodermatitis;
• excessive flaking, itching;
• seborrheic dermatitis, varicolored lichen;
• acne.

Zinc pyrithione for dandruff.

A few years ago, scientists conducted an experiment to compare the effectiveness of zinc pyrithione shampoos and other detergents in combating dandruff. All participants were washed one half of the scalp with zinc pyrithione shampoo and the other half with regular shampoo. After some time, the results were summarized, during which the zinc-containing detergents showed much greater effectiveness.

The researchers then conducted the following blind controlled experiment involving more than 600 participants. It was proved that zinc pyrithione quickly reaches the hair follicles and has the necessary therapeutic effect. Moreover, this effect exceeds that of any other zinc-containing drugs, as well as the common fungicidal agent in dermatology, climbazole.

Using shampoos that contain zinc pyrithione, it is necessary to follow the instructions marked on the bottle. Do not expect instant results: it may take a few days or even weeks to completely eliminate dandruff, which depends on the severity of the process and individual characteristics of the body.

In addition, we should not forget that shampoos with zinc pyrithione belong to therapeutic preparations. Therefore, they should not be used chaotically, or constantly. It is better to limit yourself to the period of the recommended course of use. [3]

Release form

Zinc pyrithione is included in various dermatological products used to treat fungal and bacterial skin lesions, psoriasis, seborrhea and various manifestations of shingles. Zinc compounds are added to hair washes, as well as to creams, ointments, aerosols and other preparations. Zinc pyrithione is also available as a powder for preparing suspensions.

Shampoo is excellent for combating fungal and bacterial lesions of the hair, seborrhea. Zinc pyrithione in the composition of shampoos successfully gets rid of dandruff and flaking, makes hair more manageable and healthy.

Creams and ointments based on zinc pyrithione are suitable for the complex therapy of psoriasis, atopic and other dermatitis, as well as for other skin problems that require antibacterial, antifungal and anti-inflammatory treatment. Such preparations are a good substitute for hormonal ointments, as they are less aggressive, and they can be used without fear for a long time. Gel, which has similar characteristics, can be an alternative to ointments.

Aerosol is another common and convenient form of release. Standard aerosols contain 0.2% zinc pyrithione: the liquid has an oily structure of light colors and a specific aroma. Aerosol spray is used for application to damaged skin in psoriasis, eczema, neurodermatitis.

An alternative to shampoos with zinc pyrithione can be solid or liquid soap. These cleaning products are no less good at eliminating dandruff and flaking, softening and protecting the skin.

Therapeutic lotion with zinc pyrithione is used to get rid of dandruff (added to shampoo) or to treat the skin if necessary to eliminate itching and restore normal physiological protection of the skin.

In pharmacies you can often find a substance - powder with zinc pyrithione, packed in polyethylene bags. Such powder is used both for the production of shampoos and other therapeutic products, as well as for the preparation of medicinal substances for external use.

Titles

Zinc compounds are very important for the human body. They play a crucial role in the physiological processes occurring in the skin and appendages. Micronutrient deficiencies and mineral metabolism disorders often become a pathogenetic component of many dermatologic diseases.

It should be noted that the most pronounced effect of treatment with zinc pyrithione is noted in those patients in whom the presence of this trace element in the skin is insufficient.

• Cinocap is an aerosol preparation for external application, 0.2%, in a 58 g cylinder.
• Friderm zinc - shampoo in a 150 ml bottle (active ingredient 20 mg/1 ml).
• Skin-cap is an external aerosol preparation of 0.2%, in cylinders of 35 or 70 g (nozzle included).
• Keto Plus is a shampoo with ketoconazole and zinc pyrithione in 60 ml bottles (20 mg, 10 mg per 1 ml). Refers to antifungal and antiseborrheic agents, as it contains 20 mg of ketoconazole and 10 g of zinc pyrithione.
• Skin Cap is a 0.2% external cream, in a 15g or 50g tube, or in a 5g sachet.
• Cinocap is an external cream 0.2% in tubes of 25 or 50 g.
• Skin-cap - shampoo 1% in bottles of 50 ml, 150 ml, 400 ml, or in the form of sachets of 5 g (in a package of 5 pcs.).
• Mirrolla zinc pyrithione is an anti-dandruff shampoo that helps to restore the health of the skin in the scalp area and eliminates irritation. The presence of zinc pyrithione in this shampoo is 1%, volume - 150 ml.
• Sebokler is another shampoo from Mirrolla Lab, which effectively combines the properties of zinc pyrithione and ketoconazole. The product helps to get rid of dandruff after just a few applications.

Pharmacodynamics

Pharmacological features of zinc pyrithione consist in bacteriostatic, fungicidal, antiseborrheic, antipsoriatic effect of the drug. The spectrum of activity covers most gram-positive and gram-negative microorganisms, staphylococci, streptococci, bacillary flora (synegnoic, intestinal), Proteus, fungal flora and other pathogens. The most pronounced activity is noted in relation to fungal infection Pityrosporum (ovale, orbiculare), which is relevant in the treatment of hyperproliferative processes in patients with psoriasis, seborrhea and so on.

Zinc pyrithione provokes selective cytostasis, including in relation to skin cells at the stage of hyperproliferation. In addition, the drug normalizes cell membranes, stabilizes the active state of some membrane-bound enzymes. The accumulation of the substance is noted in deep epidermal layers.

Penetration into the circulatory system is negligible.

Zinc pyrithione moisturizes the skin well, eliminates itching and burning, inhibits hyperproliferative processes of pathological cell growth in the superficial skin layers, gets rid of excessive flaking. Acts on pathogenic flora present both on the surface and in the depth of the epidermis. [4]

Pharmacokinetics

External use of zinc pyrithione does not imply systemic action of the drug. The active component accumulates in the epidermis and superficial dermal layers. The degree of systemic absorption is small, delayed. Detection of the substance in the circulatory system is insignificant: only traces of the drug can be observed.

Transdermal absorption depends mainly on the integrity of the epidermal barrier, concentration content and physicochemical features of the compound in the composition of the external preparation. Systemic absorption increases dramatically with dermal injury. Although in clinical terms, the degree of percutaneous absorption of the main substance is not of particular importance, as it does not entail the appearance of side effects.

The zinc compound can be toxic when taken internally in large doses, but ingestion of such a toxic dose is unlikely because even smaller amounts of the drug induce a gag reflex in humans. [5]

Dosing and administration

The method of application depends on the form of the product. For example, shampoo is first shaken well, then poured a little into the palm of the hand and applied to moisturized hair. Distributed throughout the hair massaging movements, as if rubbing. Then the shampoo is washed off with warm running water, reapplied and left for an optimal effect for 5-6 minutes. After that, the head is rinsed thoroughly, trying to completely wash off the product. It is recommended to repeat the procedure every other day, or once every three days - at least for two weeks. In general, the treatment course can be up to 1 month. To prevent exacerbation of the disease (for example, seborrhea) can be used shampoo once a week.

Creams and ointments containing zinc pyrithione are used twice a day (sometimes three times, but no more), applying a small layer to the affected areas of the skin. The treatment course may last on average 4-6 weeks (more often - 3-4 weeks).

Aerosol preparations with zinc pyrithione are sprayed on the affected area from a distance of about 15 centimeters, 2 or 3 times a day. Treatment is continued until the clinical picture of the disease is eliminated + another week. Before direct use, the spray bottle should be shaken and held vertically when spraying. If it is supposed to treat the hair area, it is necessary to use a special nozzle to the cylinder, which should be present in the kit.

Application for children

In the skin and some other structures prone to intensive renewal, the concentration of zinc is always higher. For example, the presence of the trace element in epidermal tissue is 20% of its total content in the body. The mineral is necessary for an adequate skin condition, since its deficiency is observed in the development of all sorts of dermatological problems and deterioration of wound healing.

With zinc deficiency is associated with the deterioration of the regenerative properties of skin and mucous tissues, the appearance of immune pathologies. In addition, this trace element is involved in the development of persistent inflammation in pediatric atopic dermatitis.

In this regard, external therapy of children's skin diseases often involves the use of drugs and their combinations, which would affect all pathogenetic components of the disease. Today, zinc pyrithione is used especially often - mainly in the form of the preparation Skin-cap, which has anti-inflammatory, antibacterial effect, successfully coping with the manifestations of atopic dermatitis.

The ability of zinc pyrithione to stimulate apoptosis is determined by both zinc ions and the drug molecule, which is able to renew keratinocyte homeostasis and suppress inflammation.

By the way, zinc pyrithione activated (original Skin-cap), unlike the conventional drug is more stable in aqueous solutions, has a pronounced clinical efficacy in pediatrics. In atopic dermatitis clinical success is manifested in the elimination of skin symptoms, reducing the intensity of itching, alleviating the course of the disease. To enhance the effect, it is recommended to include dietary therapy and internal administration of zinc-containing medicines.

Use Zinc pyrithione during pregnancy

Zinc is a valuable mineral that plays an important role in many biological processes, including protein synthesis, cell division and nucleic acid metabolism. According to research by scientists, eight out of ten pregnant women have varying degrees of deficiency of this trace element. However, the possibility of internal intake of zinc-containing preparations during pregnancy is often limited. As for the external use of such means - for example, zinc pyrithione - the harm of such an additive has not been scientifically confirmed. The use of creams, shampoos, etc. During pregnancy and breastfeeding has not been accompanied by any negative consequences.

Contraindications

External agents containing zinc pyrithione should not be used by people suffering from hypersensitivity and intolerance to the components of the drug. Do not use the product if there are open wounds and lesions on the skin.

It is important to adhere to the basic rules of use:

• apply the preparations in doses according to the instructions;
• do not administer orally;
• creams and ointments should not be used more than 2-3 times a day;
• Do not continue treatment for more than six consecutive weeks;
• if the skin disease recurs, the repeated use of the drug is limited to 2-4 weeks (in atopic dermatitis, repeated use for up to 5 weeks is allowed).

Avoid contact of the product with the eyes. If this happens, rinse thoroughly and as soon as possible with warm running water. [6]

Side effects Zinc pyrithione

Zinc pyrithione is usually well tolerated under the conditions of its external use according to the instructions. Minor side effects may be expressed in the form of mild itching, dry skin. Such symptoms should not be a reason to stop treatment. If there is an allergy, swelling, skin rash, then it is necessary to urgently consult a doctor: it may be an individual hypersensitivity, and the external drug will have to be replaced by another.

Experts point out the possibility of these side effects:

• transient itching sensation, skin irritation;
• slight hyperemia;
• a transient burning sensation;
• dryness.

In the vast majority of cases, such signs disappear on their own on the second day of application of the therapeutic and prophylactic agent. If this does not happen, you should consult your doctor.

Overdose

There is no information about cases of overdose of zinc pyrithione in external use. However, experts do not recommend using the product more than three times a day and for longer than six weeks in a row.

Since zinc pyrithione has practically no systemic action, a general overdose in the body is considered impossible, provided that the rules described in the instructions are followed. In case of accidental ingestion of large doses of the drug, induce vomiting, rinse the victim's stomach, give a laxative and consult a doctor.

If the external preparation in the form of a cream or ointment is prescribed for a child, it is necessary to ensure that the baby does not touch the application area with hands, do not try to comb the treated skin, do not lick the product. For safety reasons, zinc pyrithione should not be left freely available to children.

Interactions with other drugs

Zinc pyrithione should not be used on the same area of the skin at the same time as external agents based on corticosteroid hormones.

Simultaneous application of zinc pyrithione with minoxidil solution in androgenetic alopecia causes moderate but persistent activation of hair growth. This suggests a common mechanism of their effect.

No other clinically significant drug interactions are known.

Storage conditions

Preparations containing zinc pyrithione are usually stored in cool conditions (can be stored in the refrigerator). The optimum temperature range for the preservation of ointments and creams is from 4 to 20°C, and for shampoos from 15 to 24°C.

Zinc-containing preparations should be kept out of reach of children, away from heating elements and ultraviolet rays.

Zinc pyrithione must not be frozen or heated to temperatures above 40°C.

Shelf life

As standard, zinc pyrithione can be stored and used for two years. However, there are different products based on this active component. Therefore, the shelf life of a particular drug should be clarified when studying the package and instructions.

Analogs

Zinc pyrithione is an active and auxiliary component of many external medicines. However, sometimes there is a need to find other, similar in action means without zinc pyrithione in the composition. Below we offer to familiarize ourselves with the most famous of them.

• Cream or ointment Belosalik, Croatian production (Belupo) - available in tubes of 15 or 35 g. The composition is represented by betamethasan and salicylic acid.
• Pauercort cream 0.05% is intended for patients with dermatitis of different etiologies. The cream is produced by the Icelandic company Glenmark, and the composition is represented by the active ingredient clobetasol. The bottle is small - only 15 ml.
• Xamiol cream gel from Leo Pharma is a combination of calcipotriol and betamethasone, which is successfully used to treat atopic dermatitis.
• Acriderm cream is another hormonal remedy with betamethasone. Among the auxiliary components may be propylparahydroxybenzoate, salicylic acid or zinc oxide. The cream is packaged in aluminum tubes of 15 or 30 g.
• Beloderm ointment/cream from Belupo (Croatia) also has a hormonal base in the form of betamethasone. It is available in tubes of 15 or 30 g, 1 piece in a carton.
• Flucinar ointment or gel is represented by fluocinolone, a synthetic glucocorticosteroid. It is available by prescription. Available packaging: small tubes of 15 g.
• Lokoid cream, ointment or emulsion contains hydrocortisone, a synthetic non-halogenated corticosteroid. Despite the hormonal component, Lokoid can be used from early childhood.
• Cindol is an external remedy based on zinc oxide. The suspension is available in bottles of different volumes: 100 and 125 ml.
• Desitin is a cream based on zinc oxide. It is produced in plastic tubes of 57 g.

If the doctor prescribed exactly zinc pyrithione, it is possible to replace it with an analog only after additional medical consultation. Do not make such decisions on your own.

Literature used

• Kruglova L.S., Petrii M.N., Gensler E.M. Evaluation of the effectiveness of the use of activated pyrithione zinc in the therapy of patients with psoriasis. Clinical Dermatology and Venereology. 2019;18(5):616-623.
• Activated zinc pyrithione in atopic dermatitis in children. Mechanism of action, clinical efficacy. Petrovsky. Pediatric Pharmacology. Vol. 6, No. 2- 2009;6(2):67-71)
• In situ formation of zinc pyrithione. HANI Rahim (US), POLSON George A. (US), 2001
• Evaluation of clinical efficacy of a shampoo containing 1.5% cyclopyroxamine and 1% zinc pyrithione to eliminate symptoms of seborrheic dermatitis. Author: Yudina M.M.