From the Guidelines
Scalp seborrheic dermatitis should be treated with medicated shampoos containing active ingredients such as ketoconazole 2% (Nizoral), selenium sulfide 1% (Selsun Blue), zinc pyrithione 1% (Head & Shoulders), or coal tar (T/Gel) as the first line of treatment. The treatment of scalp seborrheic dermatitis typically involves the use of medicated shampoos, which can help reduce the symptoms of the condition.
- Medicated shampoos containing ketoconazole 2% (Nizoral) can be applied to the affected areas, massaged gently, left on for 5-10 minutes, and then rinsed thoroughly 1.
- Selenium sulfide 1% (Selsun Blue) and zinc pyrithione 1% (Head & Shoulders) are also effective options for treating scalp seborrheic dermatitis.
- Coal tar (T/Gel) can be used as an alternative treatment option, although it may have a stronger odor and potential for skin irritation 1. For more severe cases, topical corticosteroids like fluocinolone 0.01% (Capex) or clobetasol 0.05% (Clobex) solutions can be applied directly to the scalp once or twice daily for up to two weeks.
- Antifungal creams containing ketoconazole or ciclopirox may also help in reducing the symptoms of seborrheic dermatitis. Seborrheic dermatitis is believed to result from an inflammatory reaction to Malassezia yeast that naturally lives on the skin, combined with increased sebum production and individual susceptibility.
- The condition tends to be chronic with periods of flare-ups and remission, so ongoing maintenance therapy is often necessary.
- Triggers like stress, cold weather, and certain medical conditions may worsen symptoms, so identifying and managing these factors can help control the condition. The most recent and highest quality study on the treatment of scalp seborrheic dermatitis is from 2020, which recommends the use of medicated shampoos as the first line of treatment 1.
- This study provides the most up-to-date and evidence-based guidance on the treatment of scalp seborrheic dermatitis, and its recommendations should be followed in clinical practice.
From the FDA Drug Label
DOSAGE & ADMINISTRATION SECTION ... Seborrheic dermatitis: Ketoconazole Cream 2% should be applied to the affected area twice daily for four weeks or until clinical clearing. Uses temporarily relieves itching associated with minor skin irritations, inflammation, and rashes due to: ... seborrheic dermatitis The treatment options for scalp seborrheic dermatitis are:
- Ketoconazole Cream 2%: applied twice daily for four weeks or until clinical clearing 2
- Hydrocortisone: for temporary relief of itching associated with seborrheic dermatitis 3
From the Research
Treatment Options for Scalp Seborrheic Dermatitis
- Topical corticosteroids are a mainstay of treatment for many scalp dermatoses, including seborrheic dermatitis, and can significantly reduce erythema, scaling, and pruritus 4
- Medicated shampoos, such as those containing fluocinolone acetonide or clobetasol propionate, provide a convenient alternative for patients who require topical administration of corticosteroids for scalp conditions 4, 5, 6
- Antifungal shampoos, such as those containing ketoconazole, are effective for the treatment of seborrheic dermatitis and other mycotic conditions 4, 5, 7, 8
- Combination therapy of corticosteroid shampoos and antifungal shampoos may provide greater efficacy than using either treatment alone 5
- Over-the-counter shampoos, including those containing selenium sulfide, pyrithione zinc, or ketoconazole, can be used as first-line agents for treatment of scalp seborrheic dermatitis 7, 8
Specific Treatment Regimens
- Clobetasol propionate shampoo 0.05% has been shown to be effective in the treatment of seborrheic dermatitis of the scalp, with or without combination with ketoconazole shampoo 2% 5, 6
- Twice-weekly application of clobetasol propionate shampoo alternating with twice-weekly ketoconazole shampoo may provide sustained efficacy in the treatment of moderate to severe scalp seborrhoeic dermatitis 5