What is the prescription for seborrheic dermatitis?

From the Guidelines

Seborrheic dermatitis can be effectively managed with a combination of medicated shampoos and topical treatments, prioritizing ketoconazole 2% shampoo and hydrocortisone 1% cream for mild to moderate cases. For mild to moderate cases, start with ketoconazole 2% shampoo applied to affected areas twice weekly for 4 weeks, then once weekly for maintenance. For facial involvement, use ketoconazole 2% cream or hydrocortisone 1% cream twice daily for 7-14 days. For more severe cases, prescription options include fluocinolone 0.01% solution for the scalp applied daily for 2-3 weeks, or tacrolimus 0.1% ointment for facial areas twice daily for 2 weeks, then as needed for flares. Selenium sulfide 2.5% shampoo is another effective option used 2-3 times weekly. These medications work by reducing Malassezia yeast overgrowth and controlling inflammation. Maintaining a regular treatment schedule is important as seborrheic dermatitis is chronic and tends to recur. Patients should avoid triggers like stress and harsh skin products, and should cleanse affected areas gently without scrubbing, which can worsen inflammation, as suggested by general skin care principles 1.

Key Considerations

• Avoid greasy creams for basic care, as they might facilitate the development of folliculitis due to their occlusive properties 1
• Avoid manipulation of skin, hot blow-drying of the hair, wearing of tight shoes, and topical acne medications, as they may irritate and worsen skin reactions 1
• Use topical moisturizers, gels, emulsions, and dressings to offer symptomatic relief and help skin healing, but avoid applying them shortly before radiation treatment 1
• Limit the use of corticosteroids to avoid promoting superinfection and skin atrophy 1

Treatment Approach

• For seborrhoeic areas, gels can be useful 1
• For areas outside skin folds and seborrhoeic areas, creams can be used 1
• Hydrophilic dressings may be useful in moist areas to absorb wound exudate and promote skin healing 1

Patient Education

• Advise patients to avoid sun exposure, skin irritants, and scratching of the skin in the affected area 1
• Instruct patients to gently clean and dry the skin in the radiation field before each irradiation session 1

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 prescription for seborrheic dermatitis is to apply Ketoconazole Cream 2% to the affected area twice daily for four weeks or until clinical clearing 2.

• Apply to the affected area
• Twice daily
• For four weeks or until clinical clearing If a patient shows no clinical improvement after the treatment period, the diagnosis should be redetermined.

From the Research

Treatment Options for Seborrheic Dermatitis

• The treatment of seborrheic dermatitis should be directed towards eradication of Malassezia spp., reduction of the skin lipids, and suppression of the inflammatory response 3.
• A wide variety of agents presented in different forms--ointments, shampoos and drugs--can offer quick, safe and effective treatment alternatives 3.
• Topical antifungal agents such as ketoconazole and ciclopirox are effective in treating seborrheic dermatitis 4, 5.
• Ketoconazole treatment resulted in a remission rate similar to that of steroids, but occurrence of side effects was 44% lower in the ketoconazole group than in the steroid group 5.
• Ciclopirox 1% led to a lower failed remission rate than placebo at four weeks of follow-up 5.

Prescription Medications

• Fluconazole, an anti-fungal drug, has been shown to be successful, effective and safe in treating seborrheic dermatitis 3.
• Itraconazole, terbinafine, and ketoconazole are oral antifungal therapies that can be prescribed in severe or unresponsive cases of seborrheic dermatitis 6.
• The dosing regimen for itraconazole is generally 200 mg/day for the first week of the month followed by 200 mg/day for the first 2 days for 2-11 months 6.
• Terbinafine is prescribed at 250 mg/day either as a continuous (4-6 weeks) or as an intermittent regimen (12 days per month) for 3 months 6.

Topical Treatments

• Pimecrolimus, desonide, mometasone furoate, and pimecrolimus are effective topical treatments for facial seborrheic dermatitis 7.
• Ciclopirox olamine, ketoconazole, lithium (gluconate and succinate), and tacrolimus are also strongly recommended topical treatments for facial seborrheic dermatitis 7.
• Topical corticosteroids and calcineurin inhibitors should be used only for short durations due to possible adverse effects 4.