What are the treatment options for seborrheic dermatitis?

From the Guidelines

Seborrheic dermatitis can be effectively managed with a combination of medicated shampoos, topical treatments, and lifestyle modifications. For mild cases, start with anti-dandruff shampoos containing ketoconazole 2% (like Nizoral), selenium sulfide 1% (like Selsun Blue), or zinc pyrithione 1% (like Head & Shoulders) 1. Apply the shampoo to affected areas, leave on for 5-10 minutes before rinsing, and use 2-3 times weekly. For facial or body involvement, topical antifungal creams containing ketoconazole 2% or hydrocortisone 1% can be applied to affected areas twice daily for 1-2 weeks. For more severe cases, prescription-strength corticosteroids like fluocinolone 0.01% or desonide 0.05% may be needed for short-term use (7-10 days) 1. Topical calcineurin inhibitors such as tacrolimus 0.1% or pimecrolimus 1% are steroid-free alternatives for facial use. These treatments work because seborrheic dermatitis involves both inflammation and overgrowth of Malassezia yeast on oily skin. The antifungal ingredients reduce yeast populations while anti-inflammatory components reduce redness and itching. Maintaining good skin hygiene, managing stress, and avoiding harsh skin products can help prevent flare-ups. Treatment typically requires ongoing maintenance as seborrheic dermatitis tends to recur. Some key points to consider when treating seborrheic dermatitis include:

• Using gentle skin care products to avoid irritating the skin
• Applying topical treatments as directed to affected areas
• Avoiding harsh skin products that can exacerbate the condition
• Managing stress through relaxation techniques or lifestyle modifications
• Maintaining good skin hygiene to prevent flare-ups. It's also important to note that seborrheic dermatitis can be more pronounced in patients with certain conditions, such as Down syndrome, HIV infection, and Parkinson's disease 1. In these cases, treatment may need to be adjusted to accommodate the underlying condition. Overall, a combination of medicated shampoos, topical treatments, and lifestyle modifications can help effectively manage seborrheic dermatitis and reduce symptoms.

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. Mode of Action:In vitro studies suggest that ketoconazole impairs the synthesis of ergosterol, which is a vital component of fungal cell membranes. It is postulated that the therapeutic effect of ketoconazole in seborrheic dermatitis is due to the reduction of M. ovale, but this has not yet been proven.

• Ketoconazole Cream 2% is a treatment option for seborrheic dermatitis, applied twice daily for four weeks or until clinical clearing 2.
• The treatment may work by reducing M. ovale, a yeast that may be involved in seborrheic dermatitis, although this has not been proven 2.
• Another option is coal tar, which is used for anti-seborrheic dermatitis 3.

From the Research

Treatment Options for Seborrheic Dermatitis

• Topical antifungal and anti-inflammatory agents are the most commonly used treatments for seborrheic dermatitis, as the primary underlying pathogenic mechanisms comprise Malassezia proliferation and inflammation 4
• Other broadly used therapies include lithium gluconate/succinate, coal tar, salicylic acid, selenium sulfide, sodium sulfacetamide, glycerin, benzoyl peroxide, aloe vera, mud treatment, and phototherapy 4
• Alternative therapies have also been reported, such as tea tree oil, Quassia amara, and Solanum chrysotrichum 4

Specific Treatment Regimens

• A combination therapy of twice-weekly clobetasol propionate shampoo alternating with twice-weekly ketoconazole shampoo provided significantly greater efficacy than ketoconazole alone and a sustained effect in the treatment of moderate to severe scalp seborrhoeic dermatitis 5
• Antifungal shampoos (long-term) and topical corticosteroids (short-term) can be used as second-line agents for treatment of scalp seborrheic dermatitis 6
• Treatment options for seborrheic dermatitis include application of selenium sulfide, pyrithione zinc or ketoconazole-containing shampoos, topical ketoconazole cream or terbinafine solution, topical sodium sulfacetamide, and topical corticosteroids 7

Oral Treatments

• Oral therapies can be prescribed in severe or unresponsive cases of seborrheic dermatitis, with options including itraconazole, terbinafine, fluconazole, ketoconazole, pramiconazole, prednisone, isotretinoin, and homeopathic mineral therapy 8
• The quality of evidence for oral therapies is generally low, and the clinical efficacy outcome reported varies considerably between studies, preventing statistical analysis and direct comparison between treatments 8