From the FDA Drug Label
Seborrheic dermatitis: Ketoconazole Cream 2% should be applied to the affected area twice daily for four weeks or until clinical clearing. The treatment for seborrheic dermatitis of the scalp is Ketoconazole Cream 2% applied twice daily for four weeks or until clinical clearing 1.
- Key points:
- Apply twice daily
- For four weeks or until clinical clearing
- If no clinical improvement after the treatment period, the diagnosis should be redetermined Note that hydrocortisone may also provide temporary relief from itching associated with seborrheic dermatitis, but the provided label does not specify its use for the scalp 2.
From the Research
Seborrheic dermatitis of the scalp is most effectively treated with ketoconazole shampoo 2%, as evidenced by the most recent and highest quality study 3.
Treatment Approach
The treatment approach for seborrheic dermatitis of the scalp involves a combination of medicated shampoos and topical anti-inflammatory medications.
- Start with antifungal shampoos containing ketoconazole 2% (like Nizoral), used 2-3 times weekly.
- Apply the shampoo to the scalp, leave on for 5-10 minutes before rinsing, and continue for several weeks even after symptoms improve.
Additional Therapies for Moderate to Severe Cases
For moderate to severe cases, consider adding:
- Topical corticosteroids such as fluocinolone 0.01% solution or clobetasol 0.05% solution applied directly to affected areas once or twice daily for 1-2 weeks.
- Topical calcineurin inhibitors like tacrolimus 0.1% ointment can be used for maintenance therapy without the side effects of long-term steroid use.
Prevention of Flare-Ups
To prevent flare-ups, it is essential to:
- Keep the scalp clean
- Manage stress
- Avoid harsh hair products This condition is caused by an inflammatory reaction to Malassezia yeast that naturally lives on the skin, which explains why antifungal treatments are effective 4, 3. While seborrheic dermatitis is chronic and may require ongoing management, these treatments typically provide good symptom control, as supported by the latest research 3.