From the Guidelines
Seborrhea infection should be treated with a combination of topical antifungal medications to reduce the amount of yeast present and topical anti-inflammatory medications to reduce inflammation and itch. According to the clinical practice guideline for acute otitis externa 1, seborrheic dermatitis is a common condition affecting the ears, scalp, central face, and other sebaceous areas of the skin, and its treatment includes the use of topical antifungal medications and topical anti-inflammatory medications. Some key points to consider when treating seborrhea infection include:
- The use of topical antifungal medications, such as ketoconazole, to reduce the amount of yeast present
- The use of topical anti-inflammatory medications, such as hydrocortisone, to reduce inflammation and itch
- The importance of gentle skin care and the application of emollients to prevent secondary skin infection
- The potential for other skin disorders, such as psoriasis and discoid lupus erythematosus, to mimic seborrhea infection, and the need for careful diagnosis and treatment. As noted in the study 1, seborrheic dermatitis is more pronounced in patients with certain conditions, such as Down syndrome, HIV infection, and Parkinson's disease, and treatment should be tailored to the individual patient's needs.
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 seborrhea infection: Ketoconazole Cream 2% applied twice daily for four weeks or until clinical clearing 2.
- Alternative treatment: Hydrocortisone can temporarily relieve itching associated with seborrheic dermatitis, but its use should be under the advice and supervision of a doctor 3.
From the Research
Treatment Options for Seborrhea Infection
- Topical antifungal agents, such as ketoconazole, are the mainstay of therapy for seborrheic dermatitis of the face and body 4, 5
- Anti-inflammatory agents, such as topical corticosteroids and calcineurin inhibitors, can be used for short durations due to possible adverse effects 4
- Over-the-counter shampoos are available for treatment of seborrheic dermatitis of the scalp, and antifungal shampoos and topical corticosteroids can be used as second-line agents 4
- Other topical antifungal agents, such as allylamines, benzylamines, hydroxypyridones, and immunomodulators, have also been effective in treating seborrheic dermatitis 5
- Oral therapies, such as ketoconazole, itraconazole, and terbinafine, may be preferred in cases where seborrheic dermatitis is widespread 5, 6
Alternative Therapies
- Tea tree oil, honey, and cinnamic acid have antifungal activity against Malassezia species and may be of benefit in the treatment of seborrheic dermatitis 5
- Lithium gluconate/succinate, coal tar, salicylic acid, selenium sulfide, sodium sulfacetamide, glycerin, benzoyl peroxide, and aloe vera are also used in the treatment of seborrheic dermatitis 7
- Alternative therapies, such as Quassia amara and Solanum chrysotrichum, have also been reported 7
Comparison of Treatments
- A double-blind comparative study found no significant difference between ketoconazole 2% cream and hydrocortisone 1% cream in the treatment of seborrheic dermatitis 8
- A systematic review of oral treatments for seborrheic dermatitis found that the quality of the evidence was generally low, but ketoconazole therapy was associated with more relapses compared to other treatments 6