What is the treatment for sebhorreic dermatitis?

Treatment of Seborrheic Dermatitis

The most effective treatment for seborrheic dermatitis combines topical antifungal agents (primarily ketoconazole 2%) to reduce Malassezia yeast with short-term topical corticosteroids to control inflammation, followed by maintenance therapy with antifungals alone. 1

First-Line Treatment Approach

For Facial and Body Seborrheic Dermatitis

• Apply ketoconazole 2% cream or gel to affected areas twice daily for 4 weeks or until clinical clearing 2, 3
• Ketoconazole gel formulations are nearly invisible after application and may improve adherence compared to cream 4
• Avoid alcohol-containing preparations on the face as they increase skin dryness 1

For Scalp Seborrheic Dermatitis

• Begin with over-the-counter antifungal shampoos as initial therapy 3
• For moderate to severe cases, use clobetasol propionate 0.05% shampoo twice weekly alternating with ketoconazole 2% shampoo twice weekly for 4 weeks 5
• This combination regimen provides significantly greater efficacy than ketoconazole alone and sustains improvement during maintenance 5

Role of Topical Corticosteroids

• Use topical corticosteroids only for short durations (2-4 weeks maximum) due to risk of skin atrophy, telangiectasia, and tachyphylaxis 1
• Hydrocortisone 1% can be used for temporary relief of itching and inflammation 6, 7
• The least potent preparation required to control symptoms should be used 1
• Once inflammation is controlled, transition to antifungal monotherapy for maintenance 3

Adjunctive Measures for Mild Disease

• Use gentle, non-soap cleansers (dispersible creams as soap substitutes) to avoid removing natural skin lipids 1
• Apply non-greasy emollients with urea or glycerin after bathing to maintain skin hydration 1
• Use lukewarm rather than hot water to prevent facial dryness 1

Management of Symptoms

• Oral antihistamines (cetirizine, loratadina, fexofenadina) can be used for moderate to severe pruritus 1
• Sedating antihistamines may be useful as short-term adjuvants during severe flares with intense itching 1
• Avoid overuse of non-sedating antihistamines, which have little value in seborrheic dermatitis 1

Alternative Treatments for Resistant Cases

• Coal tar preparations (1% strength preferred) can reduce inflammation and scaling in scalp seborrheic dermatitis 1
• Narrowband UVB phototherapy has shown efficacy in open studies 1
• If secondary bacterial infection occurs (evidenced by crusting, weeping, or punched-out erosions), treat with appropriate antibiotics 1

Critical Pitfalls to Avoid

• Never use neomycin in topical preparations due to high risk of sensitization 1
• Avoid long-term corticosteroid use, especially on the face 1
• Do not use greasy products as they inhibit wound exudate absorption and promote superinfection 1
• Avoid undertreatment due to steroid phobia—use appropriate potency for adequate duration then taper 1
• Distinguish seborrheic dermatitis from psoriasis, atopic dermatitis, and contact dermatitis, which require different treatment approaches 1

Maintenance Strategy

• After initial clearance with combination therapy, maintain control with ketoconazole shampoo once weekly for scalp involvement 5
• For facial/body disease, continue ketoconazole applications as needed to prevent recurrence 3
• If no clinical improvement occurs after 4 weeks of treatment, redetermine the diagnosis 2