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. For severe seborrhic dermatitis, the treatment is Ketoconazole Cream 2% applied to the affected area twice daily for four weeks or until clinical clearing 1.
- Key points:
- Drug: Ketoconazole Cream 2%
- Frequency: Twice daily
- Duration: Four weeks or until clinical clearing If a patient shows no clinical improvement after the treatment period, the diagnosis should be redetermined 1.
From the Research
Treatment for severe seborrheic dermatitis should involve a combination of antifungal and anti-inflammatory medications, with the most recent and highest quality study suggesting the use of topical antifungals such as ketoconazole, ciclopirox, or miconazole, along with mild-to-moderate potency corticosteroids 2.
Key Considerations
- The condition is believed to result from an inflammatory reaction to Malassezia yeasts naturally present on the skin, which explains why antifungal treatments are effective 2.
- Seborrheic dermatitis tends to be chronic with periods of flares and remission, so long-term maintenance therapy with antifungal products is often required to prevent recurrence 2.
- For mild-to-moderate scalp seborrheic dermatitis, topical antifungals or anti-inflammatory agents can be used, while severe and/or resistant cases may require systemic antifungal drugs or UVB phototherapy 2.
Treatment Options
- Topical ketoconazole 2% shampoo can be used as a wash, leaving it on affected areas for 5 minutes before rinsing, used 2-3 times weekly 3, 4.
- Topical corticosteroids such as clobetasol propionate 0.05% shampoo can be used for short-contact application, with studies showing efficacy and safety in the treatment of seborrheic dermatitis of the scalp 3, 4.
- Combination therapy of topical antifungals and corticosteroids may provide greater efficacy than monotherapy, with a study showing that the combination of clobetasol propionate and ketoconazole shampoo was more effective than ketoconazole alone 4.
Maintenance Therapy
- After initial control, maintenance therapy with less potent steroids and regular use of antifungal shampoo can help prevent recurrence 2.
- Long-term maintenance therapy with antifungal products is often required to prevent recurrence, with studies suggesting the use of topical antifungals such as ketoconazole or ciclopirox 2.