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

• Topical antifungals are the mainstay of therapy for seborrheic dermatitis of the face and body, with ketoconazole 2% cream being FDA-approved for this indication 2

  • Apply ketoconazole cream 2% to affected areas twice daily for four weeks or until clinical clearing 2
  • Ketoconazole works by impairing the synthesis of ergosterol, a vital component of fungal cell membranes, reducing Malassezia ovale colonization 2

• Topical corticosteroids provide anti-inflammatory effects and reduce itching 1, 3

  • Low-potency formulations like hydrocortisone are appropriate for facial seborrheic dermatitis 3
  • Should be used only for short durations to avoid skin atrophy, telangiectasia, and tachyphylaxis, especially on the face 1, 4

• Topical calcineurin inhibitors (tacrolimus, pimecrolimus) can be used as steroid-sparing agents for facial seborrheic dermatitis 5, 4

  • Particularly useful for long-term management as they don't cause skin atrophy 6

Scalp Seborrheic Dermatitis

• Medicated shampoos containing one or more of the following ingredients:

  • Antifungal agents (ketoconazole, ciclopirox, piroctone olamine) 5, 7
  • Keratolytic agents (salicylic acid, selenium sulfide) to remove scales 8, 7
  • Coal tar preparations to reduce inflammation and scaling 9, 8
  • Use these shampoos 2-3 times weekly initially, then reduce to maintenance frequency 4

• For thick, scaly areas (severe cases):

  • Apply mineral oil or olive oil to loosen scales before shampooing 7
  • Consider prescription-strength solutions, foams, or oils containing antifungals or corticosteroids 7

For Moderate to Severe or Resistant Cases

• Combination therapy with both antifungal and anti-inflammatory agents often yields better results than monotherapy 1, 4

• Systemic antifungals (terbinafine, itraconazole) may be considered for widespread or refractory cases 5

• Narrowband UVB phototherapy has shown efficacy in seborrheic dermatitis as demonstrated in open, uncontrolled studies 9

Gentle Skin Care Recommendations

• Use mild, non-soap cleansers to avoid stripping natural oils 1
• Apply moisturizers to reduce dryness and scaling 1
• Avoid alcohol-containing preparations on the face as they may increase skin dryness 1

Important Considerations and Pitfalls

• Distinguish seborrheic dermatitis from similar conditions like psoriasis, atopic dermatitis, and contact dermatitis, which require different treatment approaches 1

• If no clinical improvement is seen after the treatment period, reconsider the diagnosis 2

• Secondary bacterial infection may occur and should be treated with appropriate antibiotics if present 9

• Newer treatments like roflumilast foam show promise as first-line treatments with potentially fewer side effects than traditional options 6

• For infantile seborrheic dermatitis ("cradle cap"), gentle approaches with baby shampoos enriched with emollient agents and vegetable oils are usually sufficient, as the condition typically self-resolves by 6 months of age 5, 7