What are the treatment options for Seborrheic Dermatitis?

Treatment Options for Seborrheic Dermatitis

The most effective treatment for seborrheic dermatitis combines topical antifungal medications to reduce Malassezia yeast with topical anti-inflammatory agents to control inflammation and itching. 1

First-Line Treatments

Scalp Treatment

• Antifungal shampoos containing ketoconazole, selenium sulfide, zinc pyrithione, or coal tar are effective first-line treatments for scalp seborrheic dermatitis 2, 3
• For thick, scaly areas (including cradle cap in infants), use keratolytic shampoos or mineral oil to loosen scales before gentle combing 2
• For moderate to severe cases, prescription-strength antifungal solutions, foams, or oils may be necessary 2, 4

Face and Body Treatment

• Ketoconazole 2% cream applied twice daily for four weeks is the FDA-approved treatment for seborrheic dermatitis 5
• Topical hydrocortisone cream can temporarily relieve itching, inflammation, and rashes associated with seborrheic dermatitis 6
• For facial seborrheic dermatitis, avoid alcohol-containing preparations as they may increase skin dryness 1

Second-Line Treatments

For Persistent or Severe Cases

• Topical calcineurin inhibitors (tacrolimus, pimecrolimus) can be effective alternatives when corticosteroids are contraindicated or ineffective 2, 3
• Short-term use of higher potency topical corticosteroids may be necessary for severe flares, but should be limited due to potential adverse effects 3
• Sertaconazole 2% cream has shown excellent results (90% satisfaction) in clinical trials and may be superior to tacrolimus 0.03% cream (83.3% satisfaction) 7

Treatment Algorithm Based on Severity

Mild Seborrheic Dermatitis

• Gentle skin care with mild, non-soap cleansers 1
• Moisturizers to reduce dryness and scaling 1
• Over-the-counter antifungal shampoos for scalp involvement 2, 3
• Ketoconazole 2% cream once daily for facial/body involvement 5

Moderate Seborrheic Dermatitis

• Ketoconazole 2% cream twice daily for four weeks 5
• Short-term use of low-potency topical corticosteroids (like hydrocortisone) 6, 3
• For scalp: Prescription-strength antifungal solutions or combination products 2, 4

Severe Seborrheic Dermatitis

• Combination therapy with antifungal agents and short-term topical corticosteroids 3, 8
• Consider oral antifungal therapy (ketoconazole, itraconazole, or terbinafine) for widespread disease 8
• Calcineurin inhibitors as steroid-sparing agents for facial involvement 2, 3

Special Considerations

For Infants (Cradle Cap)

• Often self-resolves by 6 months of age 2
• Gentle application of mineral oil to loosen scales followed by soft brushing 2
• For persistent cases, mild antifungal shampoo or low-potency topical corticosteroids 2

For Patients with Darker Skin

• Erythema may be less apparent, and postinflammatory pigmentary changes with hypopigmented, slightly scaly areas might be presenting signs 2
• Treatment approach remains the same, but monitor for postinflammatory hyperpigmentation with corticosteroid use 2

Common Pitfalls and Caveats

• Avoid long-term use of topical corticosteroids, especially on the face, due to risk of skin atrophy, telangiectasia, and tachyphylaxis 3
• Neomycin, found in some topical preparations, can cause sensitization in 5-15% of patients with chronic external otitis and should be avoided if hypersensitivity is suspected 1
• Seborrheic dermatitis is chronic and relapsing; maintenance therapy may be necessary after initial clearance 4, 3
• Distinguish seborrheic dermatitis from similar conditions like psoriasis, atopic dermatitis, and contact dermatitis, which may require different treatment approaches 1