Sections

Medication

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and to prevent complications.

Class Summary

The mechanism of action may involve alteration of RNA and DNA metabolism or an intracellular accumulation of peroxide that is toxic to fungal cells.

Ketoconazole topical

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Ketoconazole topical is available as ketoconazole cream 2% (Nizoral), ketoconazole foam (Extina), ketoconazole shampoo 2% (Nizoral 2%; prescription only in United States), and ketoconazole shampoo 1% (Nizoral A-D Shampoo; over-the-counter in United States). It is an imidazole broad-spectrum antifungal agent. It inhibits the synthesis of ergosterol, causing cellular components to leak, resulting in fungal cell death.

Class Summary

Corticosteroids have anti-inflammatory properties and cause profound and varied metabolic effects. They also modify the body's immune response to diverse stimuli.

Betamethasone topical (Valisone)

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Betamethasone is a medium-strength topical corticosteroid for body areas. It decreases inflammation by suppressing the migration of polymorphonuclear leukocytes and reversing capillary permeability. Betamethasone affects the production of lymphokines and has inhibitory effects on Langerhans cells.

Desonide

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Desonide is used for inflammatory dermatoses responsive to steroids. It decreases inflammation by suppressing the migration of polymorphonuclear leukocytes and reversing capillary permeability.

Class Summary

Keratolytics cause cornified epithelium to swell, soften, macerate, and then desquamate.

Coal tar shampoo (DHS Tar, MG217, Theraplex T, Psoriasin); Scytera foam

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Coal tar shampoo inhibits deregulated epidermal proliferation and dermal infiltration; it is antipruritic and antibacterial.

Class Summary

Immunosuppressants exert anti-inflammatory affects by inhibiting T-lymphocyte activation. They are safer than topical steroids for prolonged use or in skin folds.

Tacrolimus ointment (Protopic)

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Tacrolimus ointment is a nonsteroidal anti-inflammatory agent. It should not cause steroid-type skin atrophy. It is currently indicated only for atopic dermatitis in immunocompetent patients aged 2 years and older.

Pimecrolimus (Elidel cream 1%)

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Pimecrolimus is a nonsteroidal anti-inflammatory agent. It should not cause steroid-type skin atrophy. It is currently indicated only for atopic dermatitis in immunocompetent patients aged 2 years and older. Use cream sparingly to avoid maceration in skin folds.

Questions

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Media Gallery

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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Author

Marc Zachary Handler, MD Fellow in Mohs Micrographic Surgery, Skin Laser and Surgery Specialists of NY and NJ

Marc Zachary Handler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, European Society for Pediatric Dermatology, International Society of Dermatology, New York Academy of Medicine, Sigma Xi, The Scientific Research Honor Society, Society for Pediatric Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

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, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society

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, Society for Investigative Dermatology

Disclosure: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD<br/>Served as a speaker for various universities, dermatology societies, and dermatology departments.

Additional Contributors

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, Women's Dermatologic Society, Medical Dermatology Society

Disclosure: Nothing to disclose.

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

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

Disclosure: Nothing to disclose.

Seborrheic Dermatitis Medication

Medication Summary

Antifungals

Class Summary

Ketoconazole topical

Ketoconazole topical

Corticosteroids

Class Summary

Betamethasone topical (Valisone)

Betamethasone topical (Valisone)

Desonide

Desonide

Keratolytics

Class Summary

Coal tar shampoo (DHS Tar, MG217, Theraplex T, Psoriasin); Scytera foam

Coal tar shampoo (DHS Tar, MG217, Theraplex T, Psoriasin); Scytera foam

Immunosuppressants

Class Summary

Tacrolimus ointment (Protopic)

Tacrolimus ointment (Protopic)

Pimecrolimus (Elidel cream 1%)

Pimecrolimus (Elidel cream 1%)

Seborrheic Dermatitis Medication

Medication Summary

Antifungals

Class Summary

Ketoconazole topical

Ketoconazole topical

Corticosteroids

Class Summary

Betamethasone topical (Valisone)

Betamethasone topical (Valisone)

Desonide

Desonide

Keratolytics

Class Summary

Coal tar shampoo (DHS Tar, MG217, Theraplex T, Psoriasin); Scytera foam

Coal tar shampoo (DHS Tar, MG217, Theraplex T, Psoriasin); Scytera foam

Immunosuppressants

Class Summary

Tacrolimus ointment (Protopic)

Tacrolimus ointment (Protopic)

Pimecrolimus (Elidel cream 1%)

Pimecrolimus (Elidel cream 1%)

References

Tables

Contributor Information and Disclosures

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