From the Guidelines
Seborrheic dermatitis of the scalp should be treated with a combination of medicated shampoos and topical treatments, prioritizing anti-fungal shampoos and topical corticosteroids to reduce inflammation and control the Malassezia yeast population. The treatment approach for seborrheic dermatitis of the scalp involves a multi-faceted strategy, including the use of anti-fungal shampoos, topical corticosteroids, and other medicated treatments.
- Medicated shampoos containing ketoconazole 1-2%, selenium sulfide, or zinc pyrithione can be used 2-3 times weekly to control the Malassezia yeast population, as seborrheic dermatitis is more pronounced in patients with an overgrowth of this yeast 1.
- For more severe cases, adding a topical corticosteroid solution or foam, such as fluocinolone 0.01% or clobetasol 0.05%, can help reduce inflammation when applied directly to the scalp once or twice daily for 1-2 weeks.
- Coal tar shampoos can also be used to slow skin cell growth and reduce scaling, although their use may be limited due to potential side effects and interactions.
- It is essential to maintain this treatment regimen, as seborrheic dermatitis is a chronic condition that often recurs, and consistent management can help control symptoms and improve quality of life.
- In cases where symptoms persist or worsen, consulting a dermatologist for further evaluation and potential prescription of stronger medications or alternative treatments is recommended.
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 the treatment of seborrheic dermatitis on the scalp, Ketoconazole Cream 2% should be applied to the affected area twice daily for four weeks or until clinical clearing 2.
- The treatment duration is four weeks or until the scalp shows clinical clearing.
- If there is no clinical improvement after the treatment period, the diagnosis should be redetermined.
From the Research
Treatment Options for Seborrheic Dermatitis on the Scalp
- Topical antifungal and anti-inflammatory agents are the most commonly used treatments for seborrheic dermatitis on the scalp 3, 4, 5.
- Over-the-counter shampoos, such as those containing selenium sulfide, pyrithione zinc, or ketoconazole, can be used as first-line agents for treatment of scalp seborrheic dermatitis 4, 5.
- Antifungal shampoos (long-term) and topical corticosteroids (short-term) can be used as second-line agents for treatment of scalp seborrheic dermatitis 4.
- Topical tacrolimus, a calcineurin inhibitor, has been shown to be effective in treating seborrheic dermatitis of the scalp, with more prolonged remission than topical betamethasone 6.
- Combination therapy of topical steroid or topical tacrolimus, and zinc pyrithione may be recommended for treating seborrheic dermatitis of the scalp 6.
Systemic Therapy for Seborrheic Dermatitis
- Systemic therapy is reserved for widespread lesions or cases that are refractory to topical treatment 3.
- Oral antifungals, such as itraconazole, terbinafine, fluconazole, and ketoconazole, have been used to treat seborrheic dermatitis, but the quality of evidence is generally low 7.
- The clinical efficacy outcome reported for oral therapies varies considerably between studies, preventing statistical analysis and direct comparison between treatments 7.