What are the treatment options for seborrheic dermatitis?

From the Guidelines

Seborrheic dermatitis is best treated with a combination of antifungal and anti-inflammatory medications. For mild cases, start with over-the-counter antifungal shampoos containing ketoconazole 1%, selenium sulfide, or zinc pyrithione, used 2-3 times weekly. Apply the shampoo to affected areas, leave on for 5 minutes, then rinse thoroughly. For facial involvement, use ketoconazole 2% cream or hydrocortisone 1% cream twice daily for 1-2 weeks. More severe cases may require prescription-strength medications like ketoconazole 2% shampoo or fluocinolone 0.01% solution for the scalp. For persistent cases, intermittent use of low-potency topical steroids like hydrocortisone 1% can help control inflammation, but limit use to 1-2 weeks to avoid skin thinning. Maintenance therapy with antifungal products once or twice weekly can prevent recurrence. This treatment approach works because seborrheic dermatitis involves both Malassezia yeast overgrowth and inflammatory response - antifungals address the yeast component while anti-inflammatory agents reduce redness, scaling, and itching.

Some key points to consider when treating seborrheic dermatitis include:

• Keeping skin clean and avoiding triggers like stress and extreme temperatures can also help manage this chronic condition 1.
• Topical treatment approaches may offer symptomatic relief and may help skin healing, with different areas of skin requiring different treatment approaches, such as gels for seborrhoeic areas 1.
• Patients should be advised to avoid sun exposure, skin irritants, and scratching of the skin in the affected area 1.
• It is essential to maintain good standards of hygiene, keep the irradiated area clean, and use a pH-neutral synthetic detergent to minimize the risk of infection 1.

In terms of specific treatment options, some studies suggest that:

• Topical antifungal medications can reduce the amount of yeast present and topical anti-inflammatory medications can reduce inflammation and itch 1.
• Ketoconazole 2% cream or hydrocortisone 1% cream can be used for facial involvement, and ketoconazole 2% shampoo or fluocinolone 0.01% solution can be used for the scalp.
• Maintenance therapy with antifungal products once or twice weekly can prevent recurrence.

Overall, the goal of treatment is to reduce symptoms, prevent recurrence, and improve quality of life for patients with seborrheic dermatitis.

From the FDA Drug Label

DOSAGE & ADMINISTRATION SECTION ... Seborrheic dermatitis: Ketoconazole Cream 2% should be applied to the affected area twice daily for four weeks or until clinical clearing. Uses temporarily relieves itching associated with minor skin irritations, inflammation, and rashes due to: ... seborrheic dermatitis The treatment options for seborrheic dermatitis include:

• Topical ketoconazole 2% cream applied twice daily for four weeks or until clinical clearing 2
• Topical hydrocortisone for temporary relief of itching associated with seborrheic dermatitis 3

From the Research

Treatment Options for Seborrheic Dermatitis

The treatment options for seborrheic dermatitis include:

• Antifungal agents, such as fluconazole 4 and ketoconazole 5, 6, which can be used to eradicate Malassezia spp. and reduce the skin lipids
• Topical corticosteroids, such as clobetasol propionate 4, 6, which can be used to suppress the inflammatory response
• Keratolytics, which can be used to remove scales and crusts
• Calcineurin inhibitors, which can be used to reduce inflammation
• Topical non-pharmacological products, such as cosmetics or medical devices, which can be used to improve clinical outcomes and avoid the long-term use of drugs 7
• Specific cleansers, moisturizers, and sunscreens, which can be used to manage facial seborrheic dermatitis 7

Treatment Regimens

Different treatment regimens have been studied, including:

• Fluconazole 50 mg/day for two weeks, with or without topical clobetasol propionate 0.05% ointment 4
• Ketoconazole shampoo 2% used alone or in combination with clobetasol propionate 0.05% shampoo 5, 6
• Itraconazole 200 mg/day for a week, followed by a maintenance therapy of a single dose of 200 mg every 2 weeks 8
• Combination therapy of twice-weekly clobetasol propionate 0.05% shampoo alternating with twice-weekly ketoconazole 2% shampoo 6

Efficacy and Safety

The efficacy and safety of these treatment options have been evaluated in several studies, with results showing that:

• Fluconazole treatment was successful, effective, and safe in patients with seborrheic dermatitis 4
• Combination therapy of clobetasol propionate and ketoconazole was significantly more efficacious than ketoconazole alone in decreasing the overall disease severity 6
• Itraconazole treatment was beneficial in patients with moderate to severe seborrheic dermatitis 8
• All regimens were well tolerated without inducing any skin atrophy or significant adverse events 6