What is the treatment for seborrheic dermatitis on the face?

From the Guidelines

Seborrheic dermatitis on the face should be treated with a combination of antifungal and anti-inflammatory medications to reduce inflammation and itch. The treatment approach involves gentle skin care, application of emollients, and the use of topical antifungal medications to reduce the amount of yeast present, as well as topical anti-inflammatory medications to reduce inflammation and itch 1. Key considerations in managing seborrheic dermatitis include:

• Using gentle cleansers like non-soap cleansers or zinc pyrithione soap to wash the affected areas once or twice daily
• Applying over-the-counter antifungal creams containing ketoconazole 1% or 2% to affected areas once or twice daily for 2-4 weeks
• Utilizing hydrocortisone cream (0.5-1%) for short periods (up to 7 days) to reduce inflammation and itching
• Considering prescription-strength topical steroids like desonide or fluocinolone for more severe cases, but using them sparingly on the face and only for short durations to avoid skin thinning
• Exploring topical calcineurin inhibitors such as tacrolimus (0.03% or 0.1%) or pimecrolimus (1%) as steroid-free alternatives for longer-term use without the side effects of steroids. Given that seborrheic dermatitis is a chronic condition with periods of flare-ups and remission, maintenance therapy with weekly use of antifungal products may be necessary to prevent recurrence, as the condition is believed to be caused by an inflammatory reaction to Malassezia yeast that naturally lives on the skin 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. temporarily relieves itching associated with minor skin irritations, inflammation, and rashes due to: ... seborrheic dermatitis The treatment for seborrheic dermatitis on the face is:

• Ketoconazole Cream 2% applied twice daily for four weeks or until clinical clearing 2
• Hydrocortisone for temporary relief of itching associated with seborrheic dermatitis 3

From the Research

Treatment Options for Seborrheic Dermatitis on the Face

The treatment for seborrheic dermatitis on the face involves a combination of topical and oral medications, as well as non-pharmacological approaches. Some of the treatment options include:

• Topical antifungal agents, such as azoles (bifonazole, itraconazole, and ketoconazole), allylamines (terbinafine), benzylamines (butenafine), hydroxypyridones (ciclopirox), and immunomodulators (pimecrolimus and tacrolimus) 4
• Topical non-pharmacological products, such as cosmetics or medical devices, with antimicrobial and anti-inflammatory ingredients like zinc, piroctone olamine, dihydroavenanthramide, biosaccharide gum-2, and stearyl glycyrrhetinate 5
• Non-steroidal topical therapy, including creams containing zinc PCA, piroctone olamine, hydroxyphenyl propamidobenzoic acid, biosaccharide gum-2, and stearyl glycyrrhetinate 6
• Antifungal agents, such as topical ketoconazole, and anti-inflammatory agents, like topical corticosteroids and calcineurin inhibitors 7
• Over-the-counter shampoos and topical creams or solutions, including selenium sulfide, pyrithione zinc, ketoconazole, and terbinafine 8

Oral Therapy

In cases where seborrheic dermatitis is widespread, oral therapy may be preferred, including:

• Ketoconazole
• Itraconazole
• Terbinafine 4

Non-Pharmacological Approaches

Non-pharmacological approaches, such as:

• Using specific cleansers, moisturizers, and sunscreens formulated as light creams or gel/creams
• Avoiding triggers, like cold temperatures and stress
• Maintaining good skin hygiene 5, 6