From the Guidelines
Seborrheic dermatitis should be treated with anti-fungal shampoos and topical antifungal creams, and maintenance therapy is crucial to prevent recurrences. The condition is characterized by red, scaly patches typically affecting areas with many oil glands, such as the scalp, face, and upper chest. For treatment, start with anti-fungal shampoos containing ketoconazole 2%, selenium sulfide, or zinc pyrithione, used 2-3 times weekly for the scalp 1. Leave the shampoo on for 5 minutes before rinsing. For facial involvement, use a mild cleanser and apply topical antifungal creams like ketoconazole 2% or low-potency corticosteroids such as hydrocortisone 1% twice daily for 1-2 weeks.
Some key points to consider in the treatment of seborrheic dermatitis include:
- The use of medicated shampoos, such as those containing ketoconazole or zinc pyrithione, to reduce the severity of symptoms 1
- The application of topical antifungal creams, such as ketoconazole or clotrimazole, to affected areas 1
- The importance of maintenance therapy to prevent recurrences, including continued use of medicated shampoos once weekly even after symptoms improve 1
- The potential triggers of flares, including stress, hormonal changes, and certain medical conditions like Parkinson's disease or HIV 1
It is also important to note that seborrheic dermatitis can be differentiated from other red, scaly skin conditions, such as atopic dermatitis, by its characteristic distribution and morphology 1. However, the provided evidence does not support the use of phototherapy or systemic agents in the treatment of seborrheic dermatitis, and therefore these options are not recommended.
Overall, the treatment of seborrheic dermatitis should focus on reducing symptoms and preventing recurrences, and should be tailored to the individual patient's needs and circumstances.
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. For treatment of dandruff and seborrheic dermatitis: Usually two applications each week for two weeks will afford control.
- Treatment duration and frequency for seborrheic dermatitis varies by medication:
- Key consideration: treatment should be tailored to the individual patient's response, with adjustments made as needed to achieve and maintain control of symptoms.
From the Research
Definition and Symptoms of Seborrheic Dermatitis
- Seborrheic dermatitis (SD) is a chronic, recurring inflammatory skin disorder that manifests as erythematous macules or plaques with varying levels of scaling associated with pruritus 4.
- The condition typically occurs as an inflammatory response to Malassezia species and tends to occur on seborrheic areas, such as the scalp, face, chest, back, axilla, and groin areas 4, 5, 6.
Treatment Options for Seborrheic Dermatitis
- Treatment focuses on clearing signs of the disease; ameliorating associated symptoms, such as pruritus; and maintaining remission with long-term therapy 4.
- The most commonly used treatment is topical antifungal and anti-inflammatory agents, such as ketoconazole, terbinafine, and corticosteroids 4, 5, 6.
- Other broadly used therapies include lithium gluconate/succinate, coal tar, salicylic acid, selenium sulfide, sodium sulfacetamide, glycerin, benzoyl peroxide, aloe vera, mud treatment, and phototherapy 4.
- Alternative therapies have also been reported, such as tea tree oil, Quassia amara, and Solanum chrysotrichum 4.
Maintenance Therapy and Relapse Prevention
- Maintenance therapy using zinc pyrithione or selenium disulfide containing shampoos can help prevent relapse in patients with seborrheic dermatitis 7.
- However, a study found that there was no statistically significant difference between the patients who relapsed in less than a month and patients that relapsed after more than a month in terms of product used in maintenance therapy (p=0.841) 7.