Seborrheic Dermatitis Treatment & Management

Updated: Nov 13, 2020
  • Author: Marc Zachary Handler, MD; Chief Editor: William D James, MD  more...
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Medical Care

Early treatment of flares is encouraged. Behavior modification techniques in reducing excoriations are especially helpful with scalp involvement.

Low-potency topical corticosteroids, such as hydrocortisone, desonide, and mometasone furoate, have shown to be efficacious on the face. [30] Topical steroids have been associated with the development of telangiectasias and thinning of the skin. [30] Although the levels of Malassezia yeast does not correlate with the severity of seborrheic dermatitis, antifungal therapies are first-line therapies. [23] Ketoconazole, naftifine, or ciclopirox creams and gels are effective therapies. [4, 5, 6] Alternatives include calcineurin inhibitors (ie, pimecrolimus, tacrolimus), [7, 8, 9] sulfur or sulfonamide combinations, or propylene glycol. [10, 11, 12, 13, 14, 31] Class IV or lower corticosteroid creams, lotions, or solutions can be used for acute flares. [32] Tea tree oil has been reported to benefit the condition. [33, 34] Systemic fluconazole may help if seborrheic dermatitis is severe or unresponsive. [15] Combination therapy has been recommended. [35]

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, 17]  An alternative to a shampoo with zinc is a conditioner rinse with zinc, 0.01% fluocinolone, and acetonide topical oil. 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. [18, 19, 20] Shampoos may be used on truncal lesions or in beards but may cause inflammation in the intertriginous or facial areas.

Systemic low-dose isotretinoin taken by mouth has been reported to benefit severe seborrheic dermatitis. [36] Metronidazole 1% gel has been evaluated, with inconclusive results for the treatment of seborrheic dermatitis of the face. [37, 38] Some suggest using a nonsteroidal cream such as pimecrolimus; patients have reported improvement of up to 80%. [32, 39] Bikowski recommends azelaic acid. [40] 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.