From the Guidelines
The most effective treatment for seborrheic dermatitis of the scalp is topical coal tar shampoo, due to its antiproliferative and anti-inflammatory properties. This is based on the latest evidence from the Journal of the American Academy of Dermatology 1. Topical coal tar is available in both over-the-counter and prescription-strength formulations and can be used as monotherapy or in combination with other treatments.
Some key points to consider when using topical coal tar shampoo for seborrheic dermatitis of the scalp include:
- Its mechanism of action is unclear, but it has been identified as an aryl hydrocarbon receptor agonist
- It can be used in combination with phototherapy, but this has a theoretical increased risk of carcinogenicity with prolonged use
- Known adverse effects include folliculitis, irritation, contact dermatitis, and photosensitivity/phototoxicity
- Application and removal may also stain the skin, clothing, and tub/shower
In terms of treatment regimen, topical coal tar shampoo can be used 2-3 times weekly for at least 4 weeks, then reduced to once weekly for maintenance. However, the exact treatment regimen may vary depending on the individual patient and the severity of their seborrheic dermatitis. It is essential to weigh the potential benefits and risks of topical coal tar shampoo, particularly the theoretical increased risk of carcinogenicity with prolonged use, and consider alternative treatments if necessary.
Other treatment options for seborrheic dermatitis of the scalp may include antifungal shampoos, topical corticosteroids, and lifestyle modifications such as stress reduction and regular shampooing. However, topical coal tar shampoo is the most effective treatment option, according to the latest evidence from the Journal of the American Academy of Dermatology 1.
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. The best treatment for seborrheic dermatitis of the scalp, according to the drug label, is Ketoconazole Cream 2% applied twice daily for four weeks or until clinical clearing 2.
- Key points:
- Apply 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.
From the Research
Treatment Options for Seborrhea Dermatitis of the Scalp
- The treatment for seborrhea dermatitis of the scalp includes application of selenium sulfide, pyrithione zinc or ketoconazole-containing shampoos, topical ketoconazole cream or terbinafine solution, topical sodium sulfacetamide and topical corticosteroids 3.
- Antifungal and anti-inflammatory agents are the most commonly used treatments, with other therapies including lithium gluconate/succinate, coal tar, salicylic acid, selenium sulfide, sodium sulfacetamide, glycerin, benzoyl peroxide, aloe vera, mud treatment, and phototherapy 4.
- Over-the-counter shampoos are available for treatment of seborrheic dermatitis of the scalp, and patients should be directed to initiate therapy with one of these agents, with antifungal shampoos and topical corticosteroids used as second-line agents 5.
Comparison of Treatment Efficacies
- A comparative study found that topical tacrolimus was as effective as topical betamethasone, and showed more prolonged remission than topical betamethasone, with the combination therapy of topical steroid or topical tacrolimus, and zinc pyrithione recommended for treating seborrheic dermatitis of the scalp 6.
- Oral therapies, including itraconazole, terbinafine, fluconazole, ketoconazole, pramiconazole, prednisone, isotretinoin, and homeopathic mineral therapy, can be prescribed in severe or unresponsive cases, although the quality of evidence is generally low 7.
Recommended Treatment Approach
- Treatment should focus on clearing signs of the disease, ameliorating associated symptoms, and maintaining remission with long-term therapy 4.
- Patients with seborrheic dermatitis of the scalp should be instructed to initiate therapy with over-the-counter shampoos, with antifungal shampoos and topical corticosteroids used as second-line agents 5.