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.

Medication

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Ford GP, Farr PM, Ive FA, Shuster S. The response of seborrhoeic dermatitis to ketoconazole. Br J Dermatol. 1984 Nov. 111(5):603-7. [QxMD MEDLINE Link].
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. 1987 Feb. 116(2):217-21. [QxMD MEDLINE Link].
Skinner RB Jr, Noah PW, Taylor RM, et al. Double-blind treatment of seborrheic dermatitis with 2% ketoconazole cream. J Am Acad Dermatol. 1985 May. 12(5 Pt 1):852-6. [QxMD MEDLINE Link].
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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. [QxMD MEDLINE Link].
Cunha PR. Pimecrolimus cream 1% is effective in seborrhoeic dermatitis refractory to treatment with topical corticosteroids. Acta Derm Venereol. 2006. 86(1):69-70. [QxMD MEDLINE Link].
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. 2006 Aug. 142(8):1066-7. [QxMD MEDLINE Link].
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. 2006 Jun. 54(6):1083-8. [QxMD MEDLINE Link].
Schwartz RA, Janusz CA, Janniger CK. Seborrheic dermatitis: an overview. Am Fam Physician. 2006 Jul 1. 74(1):125-30. [QxMD MEDLINE Link].
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Zisova LG. Fluconazole and its place in the treatment of seborrheic dermatitis--new therapeutic possibilities. Folia Med (Plovdiv). 2006. 48(1):39-45. [QxMD MEDLINE Link].
Kligman AM, Marples RR, Lantis LR, McGinley KJ. Appraisal of efficacy of antidandruff formulations. J Soc Cosmet Chem. 1974. 225:73-91.
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. 2009 Jan. 48(1):79-85. [QxMD MEDLINE Link].
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. 1987 Feb. 116(2):213-6. [QxMD MEDLINE Link].
Waldroup W, Scheinfeld N. Medicated shampoos for the treatment of seborrheic dermatitis. J Drugs Dermatol. 2008 Jul. 7(7):699-703. [QxMD MEDLINE Link].
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. 2009 Dec. 8(4):249-53. [QxMD MEDLINE Link].
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. 1989 May. 20(5 Pt 1):770-3. [QxMD MEDLINE Link].
Odom RB. Seborrheic dermatitis in AIDS. J Int Postgrad Med. 1990. 2:18-20.
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Belew PW, Rosenberg EW, Jennings BR. Activation of the alternative pathway of complement by Malassezia ovalis (Pityrosporum ovale). Mycopathologia. 1980 Mar 31. 70(3):187-91. [QxMD MEDLINE Link].
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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 Treatment & Management

Medical Care

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