Does tachyphylaxis occur in long-term management of scalp seborrheic dermatitis with pyrithione zinc-based treatments?

Int J Dermatol. 2009 Jan;48(1):79-85. doi: 10.1111/j.1365-4632.2009.03794.x.


Background: Scalp seborrheic dermatitis and dandruff (SD/D) are chronic conditions requiring long-term treatment. There is a common belief that patients frequently experience decreasing benefits over time when using a single product. This physiologic accommodation is termed tachyphylaxis.

Aim: To systematically investigate the anecdotal belief that tachyphylaxis occurs in long-term treatment of SD/D using quantitative clinical assessments.

Methods: An international questionnaire completed by 722 dermatologists assessed the belief of tachyphylaxis incidence with pyrithione zinc (PTZ)-based shampoos, time course, occurrence relative to active ingredients, and effect of switching products. Two double-blind, randomized, clinical evaluations were conducted, 24- and 48-week studies, whereby a 1% PTZ shampoo, a 2% PTZ shampoo, or a matched placebo control shampoo was used by each subject for the duration of the study. Dermatologists assessed the adherent scalp flaking (scale of 0-10) at baseline and at specified intervals.

Results: Sixty-four per cent of responding dermatologists believed tachyphylaxis occurred with PTZ products, and most felt that tachyphylaxis occurred within 3 months of use. Evaluation of mean treatment responses vs. placebo and individual responses as a function of study duration showed a consistent benefit for all products at all time points; therefore, no evidence for tachyphylaxis was found (within 48 weeks of treatment).

Conclusion: No evidence for tachyphylaxis in SD/D treatment by PTZ-based shampoos was found. Compliance could explain the decreasing response rate seen over time; the solution is to choose an affordable therapeutic product that is effective long term without cosmetic trade-offs.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Topical
  • Dermatitis, Seborrheic / diagnosis
  • Dermatitis, Seborrheic / drug therapy*
  • Dermatology
  • Female
  • Hair Preparations / adverse effects*
  • Humans
  • Incidence
  • Long-Term Care
  • Male
  • Multicenter Studies as Topic
  • Organometallic Compounds / adverse effects*
  • Organometallic Compounds / therapeutic use
  • Pyridines / adverse effects*
  • Pyridines / therapeutic use
  • Risk Assessment
  • Scalp Dermatoses / diagnosis
  • Scalp Dermatoses / drug therapy*
  • Sensitivity and Specificity
  • Surveys and Questionnaires
  • Tachyphylaxis*
  • Time Factors


  • Hair Preparations
  • Organometallic Compounds
  • Pyridines
  • pyrithione zinc