From the Guidelines
Seborrheic dermatitis can be effectively managed with a combination of medicated shampoos, topical treatments, and lifestyle modifications. For mild cases, start with anti-dandruff shampoos containing ketoconazole 2% (like Nizoral), selenium sulfide 1% (like Selsun Blue), or zinc pyrithione 1% (like Head & Shoulders) 1. Apply the shampoo to affected areas, leave on for 5-10 minutes before rinsing, and use 2-3 times weekly. Some key points to consider when managing seborrheic dermatitis include:
- Keeping the skin clean and dry to reduce the risk of infection
- Avoiding skin irritants, such as perfumes, deodorants or alcohol-based lotions 1
- Using gentle cleansers and avoiding harsh soaps that can irritate the skin
- Applying topical antifungal creams containing ketoconazole 2% or hydrocortisone 1% to affected areas twice daily for 1-2 weeks
- Using prescription-strength topical corticosteroids like fluocinolone 0.01% for short-term use (7-10 days) to reduce inflammation
- Considering topical calcineurin inhibitors such as tacrolimus 0.1% or pimecrolimus 1% for facial involvement without the side effects of steroids These treatments work because seborrheic dermatitis is linked to an inflammatory reaction to Malassezia yeast that naturally lives on the skin, combined with excess oil production 1. Reducing stress and maintaining a healthy diet may also help prevent flare-ups. Treatment typically needs to be ongoing as seborrheic dermatitis tends to recur, but with consistent management, symptoms can be well controlled.
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. Uses temporarily relieves itching associated with minor skin irritations, inflammation, and rashes due to: ... seborrheic dermatitis
Treatment options for seborrheic dermatitis include:
- Ketoconazole Cream 2% applied twice daily for four weeks or until clinical clearing 2
- Hydrocortisone to temporarily relieve itching associated with seborrheic dermatitis 3
From the Research
Treatment Options for Seborrheic Dermatitis
- Topical antifungal and anti-inflammatory agents are the most commonly used treatments for seborrheic dermatitis, as the primary underlying pathogenic mechanisms comprise Malassezia proliferation and inflammation 4
- 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
Topical Treatments
- Sertaconazole 2% cream has been shown to be effective in treating facial seborrheic dermatitis, with similar efficacy to hydrocortisone 1% cream 5
- Ketoconazole gel 2% is an effective treatment for moderate to severe seborrheic dermatitis, with a significant reduction in erythema and scaling 6
- Ketoconazole cream 2% is also an effective treatment, but ketoconazole gel 2% may offer advantages in patient acceptance and adherence to treatment due to its almost invisible application 6
Systemic Treatments
- Oral therapies can be prescribed in severe or unresponsive cases of seborrheic dermatitis, including itraconazole, terbinafine, fluconazole, ketoconazole, pramiconazole, prednisone, isotretinoin, and homeopathic mineral therapy 7
- The quality of evidence for oral therapies is generally low, and the clinical efficacy outcome reported varies considerably between studies, preventing statistical analysis and direct comparison between treatments 7
Diagnosis and Treatment
- Seborrheic dermatitis is a clinical diagnosis based on the location and appearance of the lesions, and treatment with antifungal agents such as topical ketoconazole is the mainstay of therapy for seborrheic dermatitis of the face and body 8
- Anti-inflammatory agents such as topical corticosteroids and calcineurin inhibitors should be used only for short durations due to possible adverse effects 8