eMedicine Specialties > Dermatology > Papulosquamous Diseases
Seborrheic Dermatitis: Treatment & Medication
Updated: Mar 10, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Treatment
Medical Care
Early treatment of flares is encouraged. Behavior modification techniques in reducing excoriations are especially helpful with scalp involvement.
- Topical corticosteroids may hasten recurrences, may foster dependence because of a rebound effect, and are discouraged except for short-term use. Skin involvement responds to ketoconazole, naftifine, or ciclopirox creams and gels.7,8,9 Alternatives include calcineurin inhibitors (ie, pimecrolimus, tacrolimus), sulfur or sulfonamide combinations, or propylene glycol.10,11,12,13,14 Class IV or lower corticosteroid creams, lotions, or solutions can be used for acute flares. Systemic ketoconazole or fluconazole may help if seborrheic dermatitis is severe or unresponsive.15
- Dandruff responds to more frequent shampooing or a longer period of lathering. Use of hair spray or hair pomades should be stopped. Shampoos containing salicylic acid, tar, selenium, sulfur, or zinc are effective and may be used in an alternating schedule.16 Overnight occlusion of tar, bath oil, or Baker's P&S solution may help to soften thick scalp plaques. Derma-Smoothe F/S oil is especially helpful when widespread scalp plaques are present. Selenium sulfide (2.5%), ketoconazole, and ciclopirox shampoos may help by reducing Malassezia yeast scalp reservoirs.17,18 Shampoos may be used on truncal lesions or in beards but may cause inflammation in the intertriginous or facial areas.
- Siadat et al reported that 1% metronidazole gel 1% is effective for seborrheic dermatitis of the face.19
- Seborrheic blepharitis may respond to gentle cleaning of eyelashes with baby shampoo and cotton applicators. The use of ketoconazole cream in this anatomical region is controversial.
Medication
The goals of pharmacotherapy are to reduce morbidity and to prevent complications.
Antifungals
Mechanism of action may involve alteration of RNA and DNA metabolism or an intracellular accumulation of peroxide that is toxic to fungal cells.
Ketoconazole
Available as ketoconazole cream 2% (Nizoral), ketoconazole foam (Extina), ketoconazole shampoo 2% (Nizoral 2%; prescription only in United States), ketoconazole shampoo 1% (Nizoral A-D Shampoo; over-the-counter in United States)
Imidazole broad-spectrum antifungal agent. Inhibits synthesis of ergosterol, causing cellular components to leak, resulting in fungal cell death.
Adult
Topical: Rub gently into affected area qd/bid prn
Shampoo: After lathering, let soak in for 10 min prior to rinsing
Pediatric
Administer as in adults
None reported
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
If sensitivity or irritation develops, discontinue use; for external use only; avoid contact with eyes
Corticosteroids
Have anti-inflammatory properties and cause profound and varied metabolic effects. Also modify body's immune response to diverse stimuli.
Betamethasone valerate 0.1% (Valisone) solution or lotion
Medium-strength topical corticosteroid for body areas. Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing capillary permeability. Affects production of lymphokines and has inhibitory effect on Langerhans cells.
Adult
Apply to affected areas qd/bid; solutions and lotions tend to be thin and good for scalp application
Pediatric
Administer as in adults
None reported
Documented hypersensitivity; viral or fungal skin infections
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
May suppress adrenal function in prolonged therapy over large body surface areas; if infection present, discontinue use until under control
Desonide cream 0.05%
For inflammatory dermatosis responsive to steroids. Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing capillary permeability.
Adult
Apply thin film qd/bid
Pediatric
Administer as in adults
None reported
Documented hypersensitivity; viral or fungal skin infections
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
May suppress adrenal function in prolonged therapy over large body surface areas; if infection present, discontinue use until under control
Keratolytics
Cause cornified epithelium to swell, soften, macerate, and then desquamate.
Coal tar (DHS Tar, MG217, Theraplex T, Psoriasin)
Inhibits deregulated epidermal proliferation and dermal infiltration; antipruritic and antibacterial.
Adult
Rub copious amounts of shampoo into wet hair and scalp or skin and rinse thoroughly; repeat, leave on for 5 min and rinse thoroughly.
Pediatric
Administer as in adults
None reported
Documented hypersensitivity; acute inflammation or open lesions
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Do not apply to eyes; if irritation or unsatisfactory response occurs, discontinue use
Immunosuppressants
Exert anti-inflammatory affect by inhibiting T-lymphocyte activation. Safer than topical steroids for prolonged use or in skin folds.
Tacrolimus (Protopic) ointment 0.03% and 0.1%
Nonsteroidal anti-inflammatory agent. Should not cause steroid-type skin atrophy. Currently indicated only for atopic dermatitis in immunocompetent patients >2 y.
Adult
0.1% ointment: Apply to affected areas bid for 2-6 wk
Pediatric
0.03% ointment: Apply as in adults
None reported; use with caution if using oral treatments with CYP3A4 inhibitors
Documented hypersensitivity; ointments can lead to maceration in skin folds, use with caution; not recommended in immunocompromised persons
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Use may aggravate superficial bacterial, fungal, or viral infections; monitor for localized lymphadenopathy; local reactions include itching or burning sensation of short duration first 1-3 d of use
Pimecrolimus (Elidel cream 1%)
Nonsteroidal anti-inflammatory agent. Should not cause steroid-type skin atrophy. Currently indicated only for atopic dermatitis in immunocompetent patients >2 y. Use cream sparingly to avoid maceration in skin folds.
Adult
Apply to affected areas bid for 2-6 wk
Pediatric
<2 years: Not recommended
>2 years: Apply as in adults
None reported; use with caution if using oral treatments with CYP3A4 inhibitors
Documented hypersensitivity; not indicated in immunocompromised patients; efficacy and safety in geriatric patients not tested
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Discontinue if sensitivity or chemical irritation occurs; for external use only; may aggravate superficial bacterial, fungal, or viral infections; monitor for localized lymphadenopathy; local reactions include itching or burning sensation of short duration first 1-3 d of use
More on Seborrheic Dermatitis |
| Overview: Seborrheic Dermatitis |
| Differential Diagnoses & Workup: Seborrheic Dermatitis |
 Treatment & Medication: Seborrheic Dermatitis |
| Follow-up: Seborrheic Dermatitis |
| Multimedia: Seborrheic Dermatitis |
| References |
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References
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Further Reading
Keywords
seborrheic dermatitis, seborrhea, seborrheic blepharitis, dandruff, Pityrosporum ovale , P ovale, Malassezia, Malassezia ovalis, M ovalis, psoriasis, cradle cap, infantile napkin dermatitis, diaper dermatitis, fungal infection, drug-induced dermatitis, drug-induced seborrhea
