From the Guidelines
The treatment of seborrheic dermatitis typically involves a combination of medicated shampoos, topical anti-inflammatory agents, and proper skin care. For mild cases, over-the-counter antifungal shampoos containing ketoconazole 1%, selenium sulfide, zinc pyrithione, or coal tar should be applied to affected areas 2-3 times weekly, leaving on for 5-10 minutes before rinsing 1. For facial involvement, topical antifungal creams like ketoconazole 2% can be applied twice daily for 2-4 weeks. Topical corticosteroids such as hydrocortisone 1% or desonide 0.05% may be used for short periods (7-10 days) to control inflammation. Some key points to consider in the treatment of seborrheic dermatitis include:
- The use of topical antifungal medications to reduce the amount of yeast present
- The use of topical anti-inflammatory medications to reduce inflammation and itch
- Avoiding triggers like stress and harsh skin products
- Maintaining good skin hygiene and using gentle, fragrance-free cleansers For more severe or resistant cases, prescription-strength options include ketoconazole 2% shampoo, fluocinolone 0.01% shampoo, or topical calcineurin inhibitors like pimecrolimus 1% or tacrolimus 0.1% ointment, which can be used for longer periods without the side effects of steroids 1. Maintenance therapy with medicated shampoo once or twice weekly is often necessary to prevent recurrence. These treatments work by targeting the Malassezia yeast that contributes to seborrheic dermatitis and by reducing the inflammatory response. It's worth noting that while narrowband ultraviolet B phototherapy has been studied for various skin conditions, its use in seborrheic dermatitis is not well-established, and more research is needed to determine its efficacy and safety for this condition 1.
From the FDA Drug Label
Seborrheic dermatitis: Ketoconazole Cream 2% should be applied to the affected area twice daily for four weeks or until clinical clearing. temporarily relieves itching associated with minor skin irritations, inflammation, and rashes due to: ... seborrheic dermatitis The treatment of seborrheic dermatitis is:
- Topical ketoconazole 2% cream applied twice daily for four weeks or until clinical clearing 2
- Topical hydrocortisone to temporarily relieve itching associated with seborrheic dermatitis 3
From the Research
Treatment Options for Seborrheic Dermatitis
The treatment of seborrheic dermatitis focuses on clearing signs of the disease, ameliorating associated symptoms, and maintaining remission with long-term therapy 4. The primary underlying pathogenic mechanisms comprise Malassezia proliferation and inflammation, and the most commonly used treatment is topical antifungal and anti-inflammatory agents.
Topical Treatments
- Topical antifungal agents such as ketoconazole cream or terbinafine solution 5
- Topical corticosteroids and calcineurin inhibitors, which should be used only for short durations due to possible adverse effects 6
- Selenium sulfide, pyrithione zinc or ketoconazole-containing shampoos for scalp seborrhea 5
- Topical sodium sulfacetamide 5
Systemic Treatments
- Reserved for widespread lesions or cases refractory to topical treatment 4
- Oral antifungals such as itraconazole, terbinafine, fluconazole, and ketoconazole 7
- Itraconazole dosing regimen: 200 mg/day for the first week of the month followed by 200 mg/day for the first 2 days for 2-11 months 7
- Terbinafine: 250 mg/day either as a continuous (4-6 weeks) or as an intermittent regimen (12 days per month) for 3 months 7