From the Guidelines
Seborrheic dermatitis of the ears should be treated with topical antifungal medications and anti-inflammatory medications to reduce inflammation and itch, as recommended in the clinical practice guideline for acute otitis externa 1. The treatment approach involves a combination of medicated products and proper ear hygiene. For mild cases, regular cleansing using a gentle, fragrance-free soap and warm water can help remove excess oil and scale buildup.
- Topical antifungal treatments, such as those containing ketoconazole or ciclopirox, can be applied to affected areas once or twice daily for 2-4 weeks to reduce the amount of yeast present.
- Low-potency topical corticosteroids, such as hydrocortisone, can be applied sparingly twice daily for up to 7-10 days to reduce inflammation and itching. Key considerations in managing seborrheic dermatitis of the ears include:
- Avoiding scratching the affected areas to prevent secondary infection
- Being consistent with treatment, as seborrheic dermatitis is a chronic condition that often requires ongoing management
- Using maintenance therapy, such as ketoconazole shampoo diluted with water and applied to the ears 1-2 times weekly, to help prevent recurrence 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.
- Treatment for seborrheic dermatitis of the ears: Ketoconazole Cream 2% can be applied to the affected area twice daily for four weeks or until clinical clearing 2.
- Alternative treatment: Hydrocortisone can temporarily relieve itching associated with seborrheic dermatitis, but its use should be under the advice and supervision of a doctor 3.
From the Research
Treatment Options for Seborrheic Dermatitis of the Ears
- Topical antifungal and anti-inflammatory agents are commonly used to treat seborrheic dermatitis, including in the ears 4
- Ketoconazole gel 2% has been shown to be effective in treating moderate to severe seborrheic dermatitis, and may be used in the ears 5
- Other treatment options for seborrheic dermatitis include selenium sulfide, pyrithione zinc, and terbinafine solution, which may also be used in the ears 6
- A suspension of human cerumen in glycerine has been used to treat seborrheic dermatitis of the ear canal, with patients instructed to place two drops in the external ear canal once a week 7
Considerations for Treatment
- The primary underlying pathogenic mechanisms of seborrheic dermatitis comprise Malassezia proliferation and inflammation, so treatment focuses on clearing signs of the disease and ameliorating associated symptoms 4
- Systemic therapy is reserved for widespread lesions or cases that are refractory to topical treatment 4
- Oral therapies, such as itraconazole and terbinafine, may be prescribed in severe or unresponsive cases of seborrheic dermatitis 8
Specific Treatment Regimens
- Ketoconazole dosing regimen for seborrheic dermatitis was 200 mg daily for 4 weeks 8
- Itraconazole dosing regimen for seborrheic dermatitis was generally 200 mg/day for the first week of the month followed by 200 mg/day for the first 2 days for 2-11 months 8
- Terbinafine was prescribed at 250 mg/day either as a continuous (4-6 weeks) or as an intermittent regimen (12 days per month) for 3 months 8