From the Guidelines
Facial seborrheic dermatitis should be treated with topical antifungal medications and anti-inflammatory agents to reduce yeast presence and inflammation. The condition is characterized by greasy yellowish scaling, itching, and secondary inflammation from Malassezia yeast, and is more pronounced in patients with certain conditions such as Down syndrome, HIV infection, and Parkinson's disease 1. Key aspects of management include:
- Gentle skin care
- Application of emollients
- Prevention of secondary skin infection
- Use of topical corticosteroids and other antipruritics
- Topical antifungal medications to reduce yeast presence
- Topical anti-inflammatory medications to reduce inflammation and itch. It's essential to note that while the provided study 1 focuses on otitis externa, the information on seborrheic dermatitis is relevant and applicable to facial seborrheic dermatitis, highlighting the importance of managing the condition to prevent complications and improve quality of life.
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.
- Treatment for facial seborrheic dermatitis with ketoconazole cream 2% involves applying it to the affected area twice daily for four weeks or until clinical clearing 2.
- Hydrocortisone can be used to temporarily relieve itching associated with seborrheic dermatitis 3.
From the Research
Causes and Symptoms of Facial Seborrheic Dermatitis
- Facial seborrheic dermatitis (FSD) is a chronic, recurrent, inflammatory skin disorder occurring in areas rich in sebaceous glands 4, 5.
- It manifests clinically as erythematous macules or plaques with varying levels of scaling and associated pruritus 4, 5.
- The pathogenesis of FSD has yet to be fully understood, but Malassezia yeasts, hormones, sebum levels, and immune response are known to play important roles 4, 5.
- Additional factors including drugs, winter temperatures, and stress may exacerbate FSD 4, 5.
Treatment Options for Facial Seborrheic Dermatitis
- Current available treatments include antifungal agents, topical low-potency steroids, and calcineurin inhibitors 4, 6, 7, 8.
- Topical non-steroidal creams and gels, such as those containing zinc PCA, piroctone olamine, and hydroxyphenyl propamidobenzoic acid, have shown effectiveness in treating FSD 4, 5.
- Ketoconazole gel 2% has been developed for the once-daily treatment of seborrheic dermatitis and has shown to be an effective treatment option 8.
- Sertaconazole 2% cream has also been shown to be effective in treating FSD, with similar efficacy to hydrocortisone 1% cream 7.
Efficacy and Safety of Treatment Options
- A study found that 81.8% of patients with FSD showed an excellent response to a topical non-steroidal cream, while 18.1% showed a good response 4.
- Another study found that ketoconazole gel 2% was effective in treating moderate to severe seborrheic dermatitis, with a significant reduction in erythema and scaling scores 8.
- A double-blind, randomized clinical trial found that sertaconazole 2% cream and hydrocortisone 1% cream had similar efficacy in treating FSD, with a significant improvement in SD lesions and a low rate of adverse events 7.