How is seborrheic dermatitis treated?

Treatment of Seborrheic Dermatitis

Seborrheic dermatitis should be treated with topical ketoconazole cream 2% applied twice daily for four weeks as first-line therapy, with topical low-potency corticosteroids like hydrocortisone used short-term for inflammation control. 1, 2

First-Line Treatment Options

Antifungal Agents

• Topical ketoconazole 2% cream: Apply to affected areas twice daily for four weeks 1
  • If no clinical improvement after the treatment period, the diagnosis should be reconsidered
  • Targets Malassezia yeast, which is believed to be a key pathogenic factor 3, 4

Anti-inflammatory Agents

• Low-potency topical corticosteroids (e.g., hydrocortisone): Use short-term to control inflammation and relieve itching 2, 4
  • Should be used cautiously, especially on the face, to avoid skin atrophy 5
  • Best used as adjunctive therapy alongside antifungal treatment

Scalp Treatment

• Medicated shampoos containing:
  • Ketoconazole
  • Selenium sulfide
  • Pyrithione zinc
  • Coal tar
  • Salicylic acid 6, 7
• Apply shampoo to affected areas, leave on for 5-10 minutes before rinsing
• Use 2-3 times weekly for maintenance after initial control 4

Treatment Algorithm Based on Severity and Location

Mild to Moderate Cases

1. Start with topical ketoconazole 2% cream twice daily 1
2. Add short-term low-potency topical corticosteroid for inflammation if needed 2
3. For scalp involvement, use medicated shampoos containing antifungal agents 7
4. Apply emollients and moisturizers to maintain skin barrier function 5

Severe or Widespread Cases

1. Consider systemic therapy with oral antifungals:
   • Oral ketoconazole
   • Itraconazole
   • Terbinafine 8
2. Refer to dermatology specialist if inadequate response to topical treatments 5, 4

Maintenance Therapy

• After clinical clearing, consider proactive maintenance therapy to prevent relapse 5
• For scalp: Continue with medicated shampoos 1-2 times weekly 7
• For face/body: Consider twice-weekly application of antifungal agents to previously affected areas 5, 3

Important Clinical Considerations

Common Pitfalls to Avoid

• Using potent topical corticosteroids on the face for prolonged periods (risk of skin atrophy) 5
• Neglecting to identify and avoid triggers 5
• Using topical antibiotics long-term (risk of resistance) 5
• Failing to reassess diagnosis if no improvement after 4 weeks of appropriate therapy 1

Treatment Duration

• Facial and body seborrheic dermatitis: 4 weeks of treatment 1
• May require ongoing maintenance therapy to prevent recurrence 3, 4

Special Considerations

• Seborrheic dermatitis is chronic and often recurrent, requiring long-term management strategies 3
• Treatment should focus on clearing signs of disease, relieving symptoms, and maintaining remission 3
• Alternative therapies such as tea tree oil may have some benefit but should be considered secondary to established treatments 8