What is the treatment for seborrhic 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 antifungal agents are the mainstay of therapy for seborrheic dermatitis of the face and body 2:

  • Ketoconazole 2% cream applied to affected areas twice daily for four weeks is FDA-approved for seborrheic dermatitis 3
  • Treatment should be continued until clinical clearing; if no improvement is seen after the treatment period, the diagnosis should be reconsidered 3

• Gentle skin care with mild, non-soap cleansers and moisturizers to reduce dryness and scaling for mild cases 1:

  • Use dispersible creams as soap substitutes to cleanse the skin, as soaps and detergents remove natural lipids 1
  • Apply emollients after bathing to provide a surface lipid film that retards evaporative water loss 1

• Topical corticosteroids for short-term use to control inflammation 2:

  • Hydrocortisone is FDA-approved for temporarily relieving itching associated with seborrheic dermatitis 4
  • Should be used only for short durations due to risk of skin atrophy, telangiectasia, and tachyphylaxis, especially on the face 1, 2

Second-Line Treatments

• Calcineurin inhibitors (pimecrolimus, tacrolimus) when corticosteroids are contraindicated or for long-term management 2, 5:

  • Pimecrolimus 1% cream has comparable efficacy to topical corticosteroids and antimycotics in reducing erythema, scaling, and pruritus 6
  • Well-tolerated option for long-term maintenance therapy 6

• Narrowband UVB phototherapy for severe cases resistant to conventional treatments 7:

  • Has shown efficacy in seborrheic dermatitis in open, uncontrolled studies 7, 8
  • All patients in one study responded favorably to treatment, with complete clearance or marked improvement 8
  • Relapses occurred after a median of 21 days, suggesting need for maintenance therapy 8

Scalp Seborrheic Dermatitis Treatment

• Antifungal shampoos containing ingredients such as ketoconazole, selenium sulfide, zinc pyrithione, or ciclopirox as first-line therapy 2, 5
• Coal tar preparations can be used to reduce inflammation and scaling 1
• Topical corticosteroid solutions or foams for short-term use in more severe cases 2

Special Considerations

• Avoid alcohol-containing preparations on facial seborrheic dermatitis as they may increase skin dryness 1
• Avoid greasy topical products as they inhibit absorption of wound exudate and promote superinfection 1
• Treat secondary bacterial infections with appropriate antibiotics if present 1
• Distinguish seborrheic dermatitis from similar conditions like psoriasis, atopic dermatitis, and contact dermatitis, which require different treatment approaches 1

Treatment Algorithm

1. Mild disease: Start with gentle cleansing and moisturizing, plus ketoconazole 2% cream twice daily 1, 3
2. Moderate disease: Add short-term (1-2 weeks) low-potency topical corticosteroid 1, 2
3. Persistent/recurrent disease: Consider calcineurin inhibitors for maintenance 6, 5
4. Severe/refractory disease: Consider narrowband UVB phototherapy 7, 8

Common Pitfalls to Avoid

• Undertreatment due to fear of steroid side effects 1
• Overuse of topical corticosteroids, especially on the face 1, 2
• Using greasy products that can promote superinfection 1
• Overuse of non-sedating antihistamines, which have little value in seborrheic dermatitis 1
• Failing to recognize and treat secondary infections 1