What is the treatment for seborrheic dermatitis of the eyebrows?

From the Guidelines

Seborrheic dermatitis affecting the eyebrows can be effectively treated with a combination of antifungal and anti-inflammatory medications, as recommended in the most recent guidelines 1. The treatment approach involves:

• Starting with a gentle cleanser like a non-soap cleanser or baby shampoo diluted with water to wash the eyebrow area daily, removing scales and excess oil
• Applying an over-the-counter antifungal cream containing ketoconazole 2% or ciclopirox 1% to the affected areas twice daily for 2-4 weeks
• Using a low-potency topical steroid like hydrocortisone 1% cream for no more than 7-10 days to avoid skin thinning, or non-steroidal options like pimecrolimus (Elidel) or tacrolimus (Protopic) for longer periods if needed
• Maintenance therapy involves using the antifungal product 1-2 times weekly after the condition improves This treatment approach works because seborrheic dermatitis is associated with an inflammatory reaction to Malassezia yeast that naturally lives on the skin, with the antifungals reducing the yeast population and the anti-inflammatory medications addressing the immune response 1. Some key points to consider:
• The patient must understand that a cure is usually not possible, but continual daily treatment can significantly improve symptoms 1
• Treatments that may be helpful include warm compresses, artificial tears, eyelid cleansing, and topical anti-inflammatory agents 1
• It is essential to instruct patients to avoid using compresses that are so hot that they burn the skin 1
• Proper counseling of patients with neurotrophic corneas is important in order to avoid injury to corneal epithelium 1 If symptoms persist beyond 2-4 weeks of treatment or worsen, consult a dermatologist as prescription-strength medications may be necessary.

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. If a patient shows no clinical improvement after the treatment period, the diagnosis should be redetermined.

• Treatment for Seborrheic dermatitis: Apply Ketoconazole Cream 2% to the affected area twice daily for four weeks or until clinical clearing.
• Key consideration: If no clinical improvement is seen after the treatment period, the diagnosis should be redetermined 2

From the Research

Treatment Options for Eyebrow 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 3
• 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 3
• Alternative therapies have also been reported, such as tea tree oil, Quassia amara, and Solanum chrysotrichum 3

Comparison of Treatment Efficacy

• Sertaconazole 2% cream has been shown to be an effective treatment for seborrheic dermatitis, with a significant reduction in symptoms and improvement in clinical scores 4, 5
• Ketoconazole 2% cream is also an effective treatment for seborrheic dermatitis, with a significant reduction in symptoms and improvement in clinical scores 6, 7
• A meta-analysis found that sertaconazole 2% cream was associated with a significantly higher percentage of patients with mild symptoms and a lower percentage of patients with moderate or severe symptoms compared to other topical treatments 5

Specific Treatment Studies

• A study comparing sertaconazole 2% cream to ketoconazole 2% cream found that both treatments were effective in reducing symptoms of seborrheic dermatitis, but sertaconazole may be an excellent alternative therapeutic modality 4
• A study evaluating the efficacy of ketoconazole gel 2% found that it was an effective treatment for moderate to severe seborrheic dermatitis, with a significant reduction in symptoms and improvement in clinical scores 6
• A double-blind comparative study found that ketoconazole 2% cream was as effective as hydrocortisone 1% cream in treating seborrheic dermatitis, with no significant difference in clinical response or side effects between the two groups 7