What is the treatment for seborrheic dermatitis of the scalp?

From the Guidelines

To treat seborrheic dermatitis of the scalp, use topical coal tar shampoo as an antiproliferative and anti-inflammatory agent, as it has been identified as effective in managing seborrheic dermatitis, among other conditions, as stated in the joint American Academy of Dermatology guidelines 1. The treatment approach for seborrheic dermatitis of the scalp involves using topical agents that reduce inflammation and prevent overgrowth of Malassezia yeast.

• Topical coal tar shampoo is a viable option, given its antiproliferative and anti-inflammatory properties, which can help in managing the symptoms of seborrheic dermatitis, as noted in the guidelines for the management of psoriasis and other dermatological conditions 1.
• The exact mechanism of action of coal tar is unclear, but it has been shown to be effective in treating various skin conditions, including seborrheic dermatitis, making it a potential treatment option for scalp involvement 1.
• It is essential to consider the potential adverse effects of coal tar application, such as folliculitis, irritation, contact dermatitis, and photosensitivity/phototoxicity, and weigh these against the benefits of treatment 1.
• Given the chronic and recurrent nature of seborrheic dermatitis, maintaining a consistent treatment regimen is crucial to manage symptoms effectively and prevent recurrence.
• If symptoms persist despite consistent treatment, consulting a dermatologist for further evaluation and prescription-strength options may be necessary to achieve optimal outcomes.

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 2. Alternatively, Clobetasol propionate topical solution can be used for short-term treatment of inflammatory and pruritic manifestations of moderate to severe corticosteroid-responsive dermatoses of the scalp, for up to 2 consecutive weeks 3.

From the Research

Treatment Options for Seborrheic Dermatitis of the Scalp

• Topical antifungals and corticosteroids are the mainstay of treatment for seborrhoeic dermatitis 4
• Ketoconazole shampoo is an effective treatment for seborrhoeic dermatitis of the scalp, with a response rate of 89% in one study 5
• Combination therapy of clobetasol propionate shampoo and ketoconazole shampoo is also effective in treating moderate to severe scalp seborrhoeic dermatitis 4
• Other treatment options include selenium sulfide, pyrithione zinc, and terbinafine solution 6
• A new-formula shampoo containing extract of Rosa centifolia petals and epigallocatechin gallate has been shown to be comparable in efficacy to ketoconazole and zinc-pyrithione shampoos 7

Efficacy of Ketoconazole Shampoo

• Ketoconazole 2% shampoo has been shown to be highly effective in clearing scalp seborrhoeic dermatitis and dandruff, with an excellent response in 88% of patients 8
• Prophylactic use of ketoconazole 2% shampoo once weekly can prevent relapse of the disease in 81% of patients 8

Safety and Tolerability

• All treatment regimens, including ketoconazole shampoo and combination therapy, have been shown to be well tolerated and safe, with low incidences of adverse events 4, 5, 8