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, with the most recent evidence suggesting the use of topical antifungal medications and anti-inflammatory agents to reduce inflammation and control the Malassezia yeast that contributes to the condition 1.

Treatment Options

• For mild cases, start with anti-dandruff shampoos containing ketoconazole 1-2% (like Nizoral), selenium sulfide (like Selsun Blue), or zinc pyrithione (like Head & Shoulders), used 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).
• Topical calcineurin inhibitors such as tacrolimus 0.1% or pimecrolimus 1% are steroid-free alternatives for facial application.

Lifestyle Modifications

• Maintaining good skin hygiene, reducing stress, and avoiding harsh skin products can help prevent flare-ups.
• Regular maintenance therapy is often necessary to keep symptoms under control, as seborrheic dermatitis is a chronic condition.

Evidence-Based Recommendations

The most recent study on seborrheic dermatitis treatment, published in 2020, suggests the use of topical coal tar as an antiproliferative and anti-inflammatory agent, although its exact mechanism of action is unclear 1. However, the use of coal tar and phototherapy in combination has a theoretical increased risk of carcinogenicity with prolonged use, and should be considered on an individual basis. In contrast, the use of topical antifungal medications and anti-inflammatory agents is a safer and more effective option for managing seborrheic dermatitis, with fewer side effects and a lower risk of carcinogenicity 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

Treatment options for seborrheic dermatitis include:

• Ketoconazole Cream 2% applied twice daily for four weeks or until clinical clearing 2
• Hydrocortisone to temporarily relieve itching associated with 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.
• Systemic therapy is reserved only for widespread lesions or in cases that are refractory to topical treatment 4.

Specific Treatment Approaches

• For seborrheic dermatitis of the face and body, treatment with antifungal agents such as topical ketoconazole is the mainstay of therapy 5.
• For seborrheic dermatitis of the scalp, several over-the-counter shampoos are available, and patients should be directed to initiate therapy with one of these agents 5.
• Antifungal shampoos (long-term) and topical corticosteroids (short-term) can be used as second-line agents for treatment of scalp seborrheic dermatitis 5.
• Oral therapies, such as itraconazole, terbinafine, fluconazole, ketoconazole, pramiconazole, prednisone, isotretinoin, and homeopathic mineral therapy, can be prescribed in severe or unresponsive cases 6.

Clinical Trials and Studies

• A double-blind, randomized clinical trial compared the efficacy and safety of treatment with sertaconazole 2% cream and hydrocortisone 1% cream to treat facial seborrheic dermatitis, and found that both treatments resulted in significant improvement of SD lesions and similar rates of adverse events 7.
• A systematic review of oral treatments for seborrheic dermatitis found that most publications investigated oral antifungals and the quality of the evidence was generally low, but ketoconazole therapy was associated with more relapses compared with other treatments 6.
• A study on the treatment of seborrheic dermatitis found that treatment options include application of selenium sulfide, pyrithione zinc or ketoconazole-containing shampoos, topical ketoconazole cream or terbinafine solution, topical sodium sulfacetamide, and topical corticosteroids 8.