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
- Note: If a patient shows no clinical improvement after the treatment period, the diagnosis should be redetermined 1
For treatment of dandruff and seborrheic dermatitis: Usually two applications each week for two weeks will afford control.
- Treatment duration: 2 weeks
- Application frequency: 2 times a week
- Note: After this, the lotion may be used at less frequent intervals – weekly, every two weeks, or every 3 or 4 weeks in some cases 2
From the Research
Seborrheic dermatitis in pediatric patients should be treated with gentle cleansing and topical antifungal agents, such as ketoconazole 2% shampoo or cream, for children over 12 years with more resistant cases, applied 2-3 times weekly for 2-4 weeks, as this approach has been shown to be effective in reducing inflammation and controlling yeast overgrowth 3.
Treatment Approach
For mild cases, initial treatment involves gentle cleansing with a mild, non-medicated shampoo applied to affected areas, gently massaged, and thoroughly rinsed off.
- For infants with cradle cap, applying mineral oil or petroleum jelly to the scalp 15-30 minutes before shampooing can help loosen scales.
- For more persistent cases, low-potency topical corticosteroids like 1% hydrocortisone cream can be used for short periods (5-7 days) on affected areas.
Medication Options
- Ketoconazole 2% shampoo or cream may be used in children over 12 years with more resistant cases, applied 2-3 times weekly for 2-4 weeks.
- Selenium sulfide shampoos (1%) can be effective for older children, used twice weekly.
Disease Management
These treatments work by reducing inflammation, controlling yeast overgrowth (particularly Malassezia species), and managing excess sebum production.