From the Guidelines
Facial seborrheic dermatitis can be effectively treated with a combination of antifungal and anti-inflammatory medications, prioritizing topical antifungal medications to reduce the amount of yeast present and topical anti-inflammatory medications to reduce inflammation and itch. For mild cases, start with over-the-counter antifungal shampoos containing ketoconazole 1%, selenium sulfide, or zinc pyrithione, applied to affected areas for 5-10 minutes before rinsing off, used 2-3 times weekly 1. Some key points to consider when treating facial seborrheic dermatitis include:
- Daily gentle cleansing with a mild, fragrance-free cleanser is important, avoiding harsh soaps that can trigger flares
- For more persistent cases, prescription-strength ketoconazole 2% cream or hydrocortisone 1% cream can be applied to affected areas twice daily for 1-2 weeks
- For moderate to severe cases, a dermatologist may prescribe stronger topical corticosteroids like desonide or fluocinolone for short-term use (7-10 days), or non-steroidal alternatives like pimecrolimus or tacrolimus
- Oral antifungals such as fluconazole may be prescribed for severe cases
- Maintenance therapy with weekly antifungal shampoo may be necessary to prevent recurrence, as seborrheic dermatitis is believed to result from an inflammatory reaction to Malassezia yeast that naturally lives on the skin 1. Additionally, general skin care measures such as moisturizing regularly, protecting against excessive exposure to sunlight, and using emollients or soap substitutes can help prevent flares and improve overall skin health 1.
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. Uses temporarily relieves itching associated with minor skin irritations, inflammation, and rashes due to: ... seborrheic dermatitis For facial seborrheic dermatitis treatment,
- Ketoconazole Cream 2% can be applied 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
Treatment Options for Facial Seborrheic Dermatitis
- Topical non-pharmacological products such as cosmetics or medical devices may improve clinical outcomes, with ingredients like zinc, piroctone olamine, dihydroavenanthramide, biosaccharide gum-2, and stearyl glycyrrhetinate potentially speeding up recovery and avoiding flare-ups 4
- Antifungal agents, keratolytics, topical low-potency steroids, and calcineurin inhibitors are available pharmacological treatments, but they have potential side effects 4
- Topical treatments are the first line of defense in treating facial seborrheic dermatitis, with options including antifungal agents, keratolytics, and corticosteroids 5
Effective Topical Treatments
- Pimecrolimus, Promiseb®, desonide, mometasone furoate, and pimecrolimus have been found to be effective topical treatments for facial seborrheic dermatitis, with low recurrence rates and high clearance rates 5
- Ciclopirox olamine, ketoconazole, lithium (gluconate and succinate), and tacrolimus are also strongly recommended topical treatments for facial seborrheic dermatitis 5
- Topical steroids, such as mild and strong steroids, are effective treatments for seborrheic dermatitis of the face and scalp, with no differences between mild and strong steroids in the short-term 6
- Calcineurin inhibitors, such as pimecrolimus, and lithium salts may also be effective treatments for seborrheic dermatitis 6
Antifungal Agents
- Ketoconazole and ciclopirox are more effective than placebo in treating seborrheic dermatitis, with ketoconazole showing a 31% lower risk of failed clearance of rashes compared to placebo 7
- Ketoconazole treatment resulted in a remission rate similar to that of steroids, but with fewer side effects 7
- Ciclopirox 1% led to a lower failed remission rate than placebo at four weeks of follow-up, with similar rates of side effects 7
Treatment Considerations
- Treatment with antifungal agents, such as ketoconazole, may be comparable to treatment with steroids, but with fewer side effects 8, 7
- The use of specific cleansers, moisturizers, and sunscreens formulated as light creams or gel/creams should be strongly recommended to all patients with facial seborrheic dermatitis 4
- Treatment outcomes may be influenced by factors such as dose, mode of delivery, and treatment compliance, but more research is needed to fully understand these relationships 7