From the FDA Drug Label
DOSAGE & ADMINISTRATION SECTION ... Seborrheic dermatitis: Ketoconazole Cream 2% should be applied to the affected area twice daily for four weeks or until clinical clearing. The correct script for seb derm is Ketoconazole Cream 2% applied twice daily for four weeks or until clinical clearing 1.
- Drug: Ketoconazole Cream 2%
- Dose: Apply to affected area
- Frequency: Twice daily
- Duration: Four weeks or until clinical clearing
From the Research
For seborrheic dermatitis, I recommend using a zinc pyrithione shampoo with a concentration of 1%, applied to the scalp 2-3 times per week, as it has been shown to be effective in alleviating symptoms 2.
Treatment Regimen
- Apply the shampoo to wet hair, massage gently into the scalp, leave on for 5-10 minutes to allow the active ingredient to work, then rinse thoroughly.
- Common over-the-counter options include Head & Shoulders Clinical Strength or DermaZinc shampoo.
- For more severe cases, alternating with a ketoconazole 2% shampoo (such as Nizoral) can be beneficial, as it has been shown to be more effective than zinc pyrithione 1% in some studies 2.
- A typical regimen would be using zinc pyrithione shampoo twice weekly and ketoconazole once weekly.
- Most patients should continue this regimen for at least 4 weeks, then reduce to maintenance use (1-2 times weekly) once symptoms improve.
Mechanism of Action
- Zinc pyrithione works by having both antifungal and antibacterial properties that target Malassezia yeast, which plays a role in seborrheic dermatitis, while also helping to reduce the inflammation and flaking associated with the condition.
- Ketoconazole also has antifungal properties, which can help to reduce the severity of symptoms.
Additional Considerations
- For persistent or severe cases that don't respond to over-the-counter options, consult a dermatologist for prescription-strength alternatives.
- Other treatment options, such as selenium sulfide, pyrithione zinc or ketoconazole-containing shampoos, topical ketoconazole cream or terbinafine solution, topical sodium sulfacetamide and topical corticosteroids, may also be considered 3.