Seborrheic Dermatitis Treatment & Management

  • Author: Samuel T Selden; Chief Editor: William D James, MD   more...
 
Updated: Mar 23, 2012
 

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.[11, 12, 13] Alternatives include calcineurin inhibitors (ie, pimecrolimus, tacrolimus),[14, 15, 16] sulfur or sulfonamide combinations, or propylene glycol.[17, 18, 19, 20, 21] 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.[22] Combination therapy has been recommended.[23]

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.[24, 25] 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.[26, 27, 28] 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 is effective for seborrheic dermatitis of the face.[29] Some suggest using a nonsteroidal cream.[30] Bikowski recommends azelaic acid.[31] 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.

Proceed to Medication
 
 
Contributor Information and Disclosures
Author

Samuel T Selden  MD, Assistant Professor, Department of Dermatology, Eastern Virginia Medical School; Consulting Staff, Chesapeake General Hospital; Private Practice

Samuel T Selden is a member of the following medical societies: American Academy of Dermatology and International Society of Geriatric Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Robin Travers, MD  Assistant Professor of Medicine (Dermatology), Dartmouth University School of Medicine; Staff Dermatologist, New England Baptist Hospital; Private Practice, SkinCare Physicians

Robin Travers, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Informatics Association, Massachusetts Medical Society, Medical Dermatology Society, and Women's Dermatologic Society

Disclosure: Nothing to disclose.

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Jeffrey Meffert, MD  Assistant Clinical Professor of Dermatology, University of Texas School of Medicine at San Antonio

Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, and Texas Dermatological Society

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD  Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology

Disclosure: Elsevier Royalty Other

References

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  2. Groisser D, Bottone EJ, Lebwohl M. Association of Pityrosporum orbiculare (Malassezia furfur) with seborrheic dermatitis in patients with acquired immunodeficiency syndrome (AIDS). J Am Acad Dermatol. May 1989;20(5 Pt 1):770-3. [Medline].

  3. Odom RB. Seborrheic dermatitis in AIDS. J Int Postgrad Med. 1990;2:18-20.

  4. Belew PW, Rosenberg EW, Jennings BR. Activation of the alternative pathway of complement by Malassezia ovalis (Pityrosporum ovale). Mycopathologia. Mar 31 1980;70(3):187-91. [Medline].

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  7. Prohic A, Kasumagic-Halilovic E. Identification of Malassezia species from immunocompetent and immunocompromised patients with seborrheic dermatitis. Eur Rev Med Pharmacol Science. Dec 2010;14(12):1019-23. [Medline].

  8. Litt JZ, Powlak WA. Drug Eruption Reference Manual. 5th ed. Cleveland, Ohio: Wal-Zac Enterprises; 1966:465.

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  10. Pontasch MJ, Kyanko ME, Brodell RT. Tinea versicolor of the face in black children in a temperate region. Cutis. Jan 1989;43(1):81-4. [Medline].

  11. Ford GP, Farr PM, Ive FA, Shuster S. The response of seborrhoeic dermatitis to ketoconazole. Br J Dermatol. Nov 1984;111(5):603-7. [Medline].

  12. Green CA, Farr PM, Shuster S. Treatment of seborrhoeic dermatitis with ketoconazole: II. Response of seborrhoeic dermatitis of the face, scalp and trunk to topical ketoconazole. Br J Dermatol. Feb 1987;116(2):217-21. [Medline].

  13. Skinner RB Jr, Noah PW, Taylor RM, et al. Double-blind treatment of seborrheic dermatitis with 2% ketoconazole cream. J Am Acad Dermatol. May 1985;12(5 Pt 1):852-6. [Medline].

  14. Tatlican S, Eren C, Eskioglu F. Insight into pimecrolimus experience in seborrheic dermatitis: close follow-up with exact mean cure and remission times and side-effect profile. J Dermatolog Treat. 2009;20(4):198-202. [Medline].

  15. Cook BA, Warshaw EM. Role of topical calcineurin inhibitors in the treatment of seborrheic dermatitis: a review of pathophysiology, safety, and efficacy. Am J Clin Dermatol. 2009;10(2):103-18. [Medline].

  16. Ozden MG, Tekin NS, Ilter N, Ankarali H. Topical pimecrolimus 1% cream for resistant seborrheic dermatitis of the face: an open-label study. Am J Clin Dermatol. 2010;11(1):51-4. [Medline].

  17. Cunha PR. Pimecrolimus cream 1% is effective in seborrhoeic dermatitis refractory to treatment with topical corticosteroids. Acta Derm Venereol. 2006;86(1):69-70. [Medline].

  18. Firooz A, Solhpour A, Gorouhi F, et al. Pimecrolimus cream, 1%, vs hydrocortisone acetate cream, 1%, in the treatment of facial seborrheic dermatitis: a randomized, investigator-blind, clinical trial. Arch Dermatol. Aug 2006;142(8):1066-7. [Medline].

  19. High WA, Pandya AG. Pilot trial of 1% pimecrolimus cream in the treatment of seborrheic dermatitis in African American adults with associated hypopigmentation. J Am Acad Dermatol. Jun 2006;54(6):1083-8. [Medline].

  20. Schwartz RA, Janusz CA, Janniger CK. Seborrheic dermatitis: an overview. Am Fam Physician. Jul 1 2006;74(1):125-30. [Medline].

  21. Cook BA, Warshaw EM. Role of topical calcineurin inhibitors in the treatment of seborrheic dermatitis: a review of pathophysiology, safety, and efficacy. Am J Clin Dermatol. 2009;10(2):103-18. [Medline].

  22. Zisova LG. Fluconazole and its place in the treatment of seborrheic dermatitis--new therapeutic possibilities. Folia Med (Plovdiv). 2006;48(1):39-45. [Medline].

  23. Shin H, Kwon OS, Won CH, et al. Clinical efficacies of topical agents for the treatment of seborrheic dermatitis of the scalp: a comparative study. J Dermatol. Mar 2009;36(3):131-7. [Medline].

  24. Kligman AM, Marples RR, Lantis LR, McGinley KJ. Appraisal of efficacy of antidandruff formulations. J Soc Cosmet Chem. 1974;225:73-91.

  25. Schwartz JR, Rocchetta H, Asawanonda P, Luo F, Thomas JH. Does tachyphylaxis occur in long-term management of scalp seborrheic dermatitis with pyrithione zinc-based treatments?. Int J Dermatol. Jan 2009;48(1):79-85. [Medline].

  26. Carr MM, Pryce DM, Ive FA. Treatment of seborrhoeic dermatitis with ketoconazole: I. Response of seborrhoeic dermatitis of the scalp to topical ketoconazole. Br J Dermatol. Feb 1987;116(2):213-6. [Medline].

  27. Waldroup W, Scheinfeld N. Medicated shampoos for the treatment of seborrheic dermatitis. J Drugs Dermatol. Jul 2008;7(7):699-703. [Medline].

  28. Seite S, Rougier A, Talarico S. Randomized study comparing the efficacy and tolerance of a lipohydroxy acid shampoo to a ciclopiroxolamine shampoo in the treatment of scalp seborrheic dermatitis. J Cosmet Dermatol. Dec 2009;8(4):249-53. [Medline].

  29. Siadat AH, Iraji F, Shahmoradi Z, Enshaieh S, Taheri A. The efficacy of 1% metronidazole gel in facial seborrheic dermatitis: a double blind study. Indian J Dermatol Venereol Leprol. Jul-Aug 2006;72(4):266-9. [Medline].

  30. Elewski B. An investigator-blind, randomized, 4-week, parallel-group, multicenter pilot study to compare the safety and efficacy of a nonsteroidal cream (Promiseb Topical Cream) and desonide cream 0.05% in the twice-daily treatment of mild to moderate seborrheic dermatitis of the face. Clin Dermatol. Nov-Dec 2009;27(6 Suppl):S48-53. [Medline].

  31. Bikowski J. Facial seborrheic dermatitis: a report on current status and therapeutic horizons. J Drugs Dermatol. Feb 2009;8(2):125-33. [Medline].

 
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Seborrheic dermatitis affecting the scalp line and the eyebrows with red skin and scaling. Courtesy of Wilford Hall Medical Center Dermatology slide files.
Seborrheic dermatitis may affect any hair-bearing area, and the chest is frequently involved. Courtesy of Wilford Hall Medical Center Dermatology Teaching slides.
African Americans and persons from other darker-skinned races are susceptible to annular seborrheic dermatitis, also called petaloid seborrheic dermatitis or seborrhea petaloides. Sarcoidosis, secondary syphilis, and even discoid lupus may be in the differential in such cases. Courtesy of Jeffrey J. Meffert, MD.
 
 
 
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