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 Treatment Options

For Facial Seborrheic Dermatitis

• Apply topical antifungal agents such as ketoconazole cream 2% to affected areas twice daily for four weeks or until clinical clearing 2
• Use mild, non-soap cleansers and avoid alcohol-containing preparations which may increase skin dryness 1
• For mild cases, gentle skin care with moisturizers to reduce dryness and scaling is recommended 1
• Short-term use of low-potency topical corticosteroids like hydrocortisone can help manage inflammation and itching 3, 4

For Scalp Seborrheic Dermatitis

• Antifungal shampoos containing ketoconazole, zinc pyrithione, or selenium sulfide are effective first-line treatments 4, 5
• For thick, scaly areas, use keratolytic shampoos containing salicylic acid or coal tar preparations 1, 4
• Apply emollients after bathing to provide a surface lipid film that retards evaporative water loss 1

Second-Line Treatment Options

• For resistant cases, consider prescription-strength corticosteroid solutions, foams, or oils for short-term use 4, 5
• Calcineurin inhibitors (tacrolimus, pimecrolimus) can be used as steroid-sparing agents, especially for facial involvement 5, 6
• Narrowband UVB phototherapy has shown efficacy in seborrheic dermatitis in open, uncontrolled studies 7, 1
• For widespread or severe cases, oral antifungal therapy such as ketoconazole or itraconazole may be considered 6

Treatment Duration and Monitoring

• Facial seborrheic dermatitis: Apply ketoconazole cream 2% twice daily for four weeks; if no improvement is seen after this period, the diagnosis should be reconsidered 2
• Scalp seborrheic dermatitis: Long-term maintenance with antifungal shampoos may be necessary to prevent recurrence 5, 8
• Monitor for secondary bacterial infection (crusting, weeping, or grouped, punched-out erosions) which should be treated with appropriate antibiotics 1

Important Cautions and Considerations

• Avoid long-term use of topical corticosteroids, especially on the face, due to risk of skin atrophy, telangiectasia, and tachyphylaxis 1, 5
• Avoid neomycin in topical preparations due to risk of sensitization 1
• Distinguish seborrheic dermatitis from similar conditions like psoriasis, atopic dermatitis, and contact dermatitis, which may require different treatment approaches 1
• In people with darker skin, erythema may be less apparent, and postinflammatory pigmentary changes might present as hypopigmented, slightly scaly areas 4
• Undertreatment due to fear of steroid side effects should be avoided 1
• Non-pharmacological products with antimicrobial and anti-inflammatory ingredients such as zinc, piroctone olamine, and stearyl glycyrrhetinate may help maintain remission 9

Neonatal Seborrheic Dermatitis (Cradle Cap)

• Typically self-resolves by 6 months of age 4
• Mild cases may be treated conservatively with mineral oil to loosen scale and gentle combing 4
• More severe cases that overlap with atopic dermatitis can be treated with topical antifungals or low-potency topical corticosteroids 4