What is the treatment for seborrheic dermatitis?

Treatment of 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

• Ketoconazole cream 2% is the mainstay of therapy and should be applied to affected areas twice daily for four weeks or until clinical clearing 2, 3
• If no clinical improvement is seen after the treatment period, the diagnosis should be reconsidered 2

Gentle Skin Care

• Use dispersible creams as soap substitutes to cleanse the skin, as soaps and detergents remove natural lipids from skin surface 4
• Apply emollients after bathing to provide a surface lipid film that retards evaporative water loss 4, 1
• Avoid alcohol-containing preparations on facial seborrheic dermatitis as they may increase skin dryness 1

Scalp Seborrheic Dermatitis

Antifungal Shampoos

• Over-the-counter antifungal shampoos should be used as first-line therapy for scalp involvement 3, 5
• For thick, scaly areas, keratolytic shampoos can be beneficial 5

Coal Tar Preparations

• Coal tar products can effectively reduce inflammation and scaling in scalp seborrheic dermatitis 1, 6
• Coal tar solution in 1% strength is generally preferred to crude coal tar 4

Second-Line and Adjunctive Treatments

Topical Corticosteroids

• Should be used only for short durations due to risk of skin atrophy, telangiectasia, and tachyphylaxis 1, 3
• Use the least potent preparation required to keep the eczema under control 4
• For facial application, low-potency corticosteroids are preferred 5

Calcineurin Inhibitors

• Can be used as an alternative to corticosteroids, especially for facial involvement 3, 5
• Beneficial for short-term use to avoid steroid-related side effects 7

Treatment for Resistant Cases

Alternative Topical Options

• Ichthammol (1% in zinc ointment) or paste bandages may be useful for lichenified areas 4
• Tea tree oil, honey, and products containing zinc, piroctone olamine, or stearyl glycyrrhetinate have shown efficacy 7, 8

Systemic Treatments

• For widespread or resistant seborrheic dermatitis, oral antifungals like ketoconazole, itraconazole, or terbinafine may be considered 8, 9
• Antihistamines with sedative properties can be useful as short-term adjuvants during severe flares with intense pruritus 4

Important Considerations

Infection Management

• Secondary bacterial infection may occur and should be treated with appropriate antibiotics if present 4, 1
• Look for evidence of clinical infection such as crusting, weeping, or grouped, punched-out erosions (suggesting herpes simplex infection) 4

Common Pitfalls to Avoid

• Long-term use of topical corticosteroids, especially on the face 1
• Failure to distinguish seborrheic dermatitis from similar conditions like psoriasis, atopic dermatitis, and contact dermatitis 1
• Undertreatment due to fear of steroid side effects 4
• Overuse of non-sedating antihistamines, which have little value in seborrheic dermatitis 4

Maintenance Therapy

• Due to the chronic, relapsing nature of seborrheic dermatitis, maintenance therapy with non-pharmacological products may be beneficial after acute treatment 7, 9
• Specific cleansers, moisturizers, and sunscreens formulated as light creams or gel/creams should be recommended to all patients 7