From the Guidelines
The recommended treatment for seborrheic dermatitis includes the use of topical antifungal medications to reduce the amount of yeast present and topical anti-inflammatory medications to reduce inflammation and itch. When considering treatment options, it's essential to prioritize morbidity, mortality, and quality of life as the outcome. According to the provided evidence 1, seborrheic dermatitis is a common condition affecting the ears, scalp, central face, and other sebaceous areas of the skin, presenting with greasy yellowish scaling, itching, and secondary inflammation from Malassezia yeast. Some key points to consider when treating seborrheic dermatitis include:
- The use of topical antifungal medications to reduce the amount of yeast present
- The use of topical anti-inflammatory medications to reduce inflammation and itch
- Gentle skin care and application of emollients to prevent secondary skin infection
- The potential need for maintenance therapy with medicated shampoos once or twice weekly for long-term management. It's also important to note that seborrheic dermatitis is more pronounced in patients with certain conditions, such as Down syndrome, HIV infection, and Parkinson's disease, and may require more aggressive treatment in these cases.
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. For treatment of dandruff and seborrheic dermatitis: Usually two applications each week for two weeks will afford control.
The recommended treatments for Seborrheic dermatitis are:
- Ketoconazole Cream 2% applied twice daily for four weeks or until clinical clearing 2
- Selenium sulfide lotion applied two times a week for two weeks, then as needed to maintain control 3
From the Research
Treatment Options for Seborrheic Dermatitis
The treatment for seborrheic dermatitis focuses on clearing signs of the disease, ameliorating associated symptoms, and maintaining remission with long-term therapy 4. The primary underlying pathogenic mechanisms comprise Malassezia proliferation and inflammation, and the most commonly used treatments are topical antifungal and anti-inflammatory agents.
Topical Treatments
- Topical antifungals such as ketoconazole, ciclopirox, and miconazole are effective in managing mild-to-moderate scalp seborrheic dermatitis 5.
- Anti-inflammatory agents, such as mild-to-moderate potency corticosteroids, are also used to treat seborrheic dermatitis 5.
- Keratolytic/humectant agents, such as propylene glycol, can be used to manage scalp seborrheic dermatitis 5.
- Topical ketoconazole, ciclopirox, clotrimazole, mild-to-moderate potency corticosteroids, lithium succinate/gluconate, and topical calcineurin inhibitors are recommended for treating facial or body areas seborrheic dermatitis 5.
- Pimecrolimus, desonide, mometasone furoate, and pimecrolimus are effective topical treatments for facial seborrheic dermatitis, with low recurrence rates and high clearance rates 6.
Systemic Treatments
- Systemic antifungal drugs, such as terbinafine and itraconazole, may be considered for severe and/or resistant cases of seborrheic dermatitis 5.
- Systemic treatments, including itraconazole, terbinafine, fluconazole, ketoconazole, pramiconazole, prednisone, isotretinoin, and homeopathic mineral therapy, have been investigated for seborrheic dermatitis, but the quality of evidence is generally low 7.
Other Treatments
- Phototherapy, such as UVB phototherapy, may be considered for severe and/or resistant cases of seborrheic dermatitis 5.
- Alternative therapies, such as tea tree oil, Quassia amara, and Solanum chrysotrichum, have been reported, but their effectiveness is not well established 4.
- Baby shampoos enriched with emollient agents and vegetable oils can be used to manage "cradle cap" in infants 5.
- Medical device shampoos with anti-inflammatory and antifungal properties may be used to treat scalp seborrheic dermatitis in children 5.