What is the treatment for seborrheic dermatitis?

From the Guidelines

Seborrheic dermatitis should be treated with topical antifungal medications to reduce the amount of yeast present and topical anti-inflammatory medications to reduce inflammation and itch. This condition is a common chronic inflammatory skin condition that causes red, scaly, itchy patches primarily on oil-producing areas of the body, such as the ears, scalp, central face, and other sebaceous areas of the skin 1.

Key Characteristics

• Presenting with greasy yellowish scaling, itching, and secondary inflammation from Malassezia yeast
• More pronounced in patients with Down syndrome, HIV infection, and Parkinson's disease

Treatment Options

• Topical antifungal medications to reduce the amount of yeast present
• Topical anti-inflammatory medications to reduce inflammation and itch It is essential to note that seborrheic dermatitis is believed to be caused by an inflammatory reaction to Malassezia yeast that naturally lives on the skin, combined with excess oil production 1.

Management Considerations

• Gentle skin care and application of emollients can help prevent secondary skin infection
• Topical corticosteroids and other antipruritics may be used to manage symptoms While seborrheic dermatitis cannot be cured, these treatments effectively manage symptoms, and patients should avoid scratching affected areas and may benefit from reducing consumption of alcohol, spicy foods, and dairy products which can trigger flares in some individuals.

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 duration: 4 weeks or until clinical clearing
• Application frequency: Twice daily
• Drug: Ketoconazole Cream 2% 2
• Alternative treatment: Coal tar is also used for anti-seborrheic dermatitis 3

From the Research

Definition and Symptoms of Seborrheic Dermatitis

• Seborrheic dermatitis (SD) is a chronic, recurring inflammatory skin disorder that manifests as erythematous macules or plaques with varying levels of scaling associated with pruritus 4.
• The condition typically occurs as an inflammatory response to Malassezia species and tends to occur on seborrheic areas, such as the scalp, face, chest, back, axilla, and groin areas 4, 5.
• The characteristic symptoms of seborrheic dermatitis include scaling, erythema, and itching, which occur most often on the scalp, face, chest, back, axilla, and groin 5.

Treatment Options for Seborrheic Dermatitis

• Treatment of seborrheic dermatitis focuses on clearing signs of the disease, ameliorating associated symptoms, such as pruritus, and maintaining remission with long-term therapy 4.
• Topical antifungal and anti-inflammatory agents are the most commonly used treatments for seborrheic dermatitis 4, 5.
• Other treatment options include lithium gluconate/succinate, coal tar, salicylic acid, selenium sulfide, sodium sulfacetamide, glycerin, benzoyl peroxide, aloe vera, mud treatment, and phototherapy 4.
• Systemic therapy is reserved for widespread lesions or cases that are refractory to topical treatment 4, 6.
• Ketoconazole shampoo is a promising treatment option for seborrheic dermatitis of the scalp, with numerous trials displaying significant improvement in irritation and scaling 7.

Oral Treatments for Seborrheic Dermatitis

• Oral therapies can be prescribed in severe or unresponsive cases of seborrheic dermatitis 6.
• A systematic review of oral treatments for seborrheic dermatitis identified eight oral therapies, including itraconazole, terbinafine, fluconazole, ketoconazole, pramiconazole, prednisone, isotretinoin, and homeopathic mineral therapy 6.
• The quality of the evidence for oral treatments was generally low, and the clinical efficacy outcome reported varied considerably between studies 6.