What are the treatment options for seborrheic dermatitis of the scalp?

From the Guidelines

Seborrheic dermatitis of the scalp can be effectively treated with a combination of medicated shampoos and topical treatments, prioritizing anti-fungal shampoos and topical corticosteroids to reduce inflammation and prevent recurrences. When considering treatment options, it's essential to focus on the most recent and highest-quality studies. However, the provided evidence does not include recent or high-quality studies specifically addressing seborrheic dermatitis of the scalp treatment. Given the available information, a reasonable approach would be to start with anti-fungal shampoos containing ketoconazole 1-2% (like Nizoral), selenium sulfide (like Selsun Blue), or zinc pyrithione (like Head & Shoulders), using them 2-3 times weekly 1. Some key points to consider when treating seborrheic dermatitis of the scalp include:

• Applying the shampoo to the scalp, leaving it on for 5-10 minutes before rinsing, and continuing for several weeks even after symptoms improve
• Using topical corticosteroids such as fluocinolone 0.01% solution or clobetasol 0.05% solution for more severe cases, applied directly to affected areas twice daily for up to two weeks
• Considering topical calcineurin inhibitors like tacrolimus 0.1% ointment for maintenance therapy
• Lifestyle modifications like managing stress, avoiding harsh hair products, and regular shampooing can also help control symptoms. It's crucial to note that seborrheic dermatitis is believed to be caused by an inflammatory reaction to Malassezia yeast that naturally lives on the skin, which explains why anti-fungal treatments are effective 1. The condition tends to be chronic with periods of flare-ups and remission, so maintaining a regular treatment schedule even when symptoms improve can help prevent recurrences. In the absence of specific guidance from the provided evidence, prioritizing patient-centered care and focusing on reducing morbidity, mortality, and improving quality of life is essential. Therefore, a treatment plan should be tailored to the individual patient's needs, taking into account the severity of symptoms, medical history, and potential interactions with other medications. By adopting a patient-centered approach and staying up-to-date with the latest evidence, healthcare providers can provide effective treatment and improve outcomes for patients with seborrheic dermatitis of the scalp.

From the FDA Drug Label

For treatment of dandruff and seborrheic dermatitis of the scalp. Massage 1 or 2 teaspoonfuls of shampoo into wet scalp. Allow to remain on scalp for 2 to 3 minutes. Rinse scalp thoroughly. Repeat application and rinse thoroughly. For treatment of tinea versicolor, seborrheic dermatitis of scalp and treatment of dandruff. 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 scalp includes:

• Using selenium sulfide shampoo: massage 1 or 2 teaspoonfuls into wet scalp, leave on for 2 to 3 minutes, and rinse thoroughly 2
• Using ketoconazole cream 2%: apply twice daily for four weeks or until clinical clearing 3 Key points:
• Treatment duration and frequency may vary depending on the product and individual response
• It is essential to follow the application instructions and precautions for each product 2, 2, 3

From the Research

Treatment Options for Seborrheic Dermatitis of the Scalp

• Topical antifungals and corticosteroids are the mainstay of treatment for seborrheic dermatitis, as reported in 4 and 5.
• A study published in 4 found that the combination therapy of twice-weekly clobetasol propionate shampoo alternating with twice-weekly ketoconazole shampoo provided significantly greater efficacy than ketoconazole alone and a sustained effect in the treatment of moderate to severe scalp seborrhoeic dermatitis.
• Ketoconazole shampoo is a promising treatment option for seborrheic dermatitis of the scalp, with numerous trials displaying significant improvement in irritation and scaling, as well as low relapse rates and minimal side effects, according to 6.

Alternative Therapies

• Other broadly used therapies for seborrheic dermatitis include lithium gluconate/succinate, coal tar, salicylic acid, selenium sulfide, sodium sulfacetamide, glycerin, benzoyl peroxide, aloe vera, and mud treatment, as mentioned in 7.
• Alternative therapies such as tea tree oil, Quassia amara, and Solanum chrysotrichum have also been reported, although their effectiveness may vary, as noted in 7.

Systemic Therapy

• Systemic therapy is reserved for widespread lesions or cases that are refractory to topical treatment, and may include oral antifungals such as itraconazole, terbinafine, fluconazole, and ketoconazole, as discussed in 8.
• The quality of evidence for oral therapies is generally low, and the clinical efficacy outcome reported varies considerably between studies, making it difficult to compare treatments directly, according to 8.