Treatment for Seborrheic Dermatitis

Effective therapies for seborrheic dermatitis include anti-inflammatory (immunomodulatory) agents, keratolytic agents, antifungals, and alternative medications.

The conventional treatment for adult seborrheic dermatitis of the scalp starts with topical steroids or a calcineurin inhibitor. These therapies may be administered as a shampoo, such as fluocinolone (Synalar), topical steroid solutions, lotions applied to the scalp, or creams applied to the skin. Adults with seborrheic dermatitis typically use topical steroids once or twice daily, often in addition to a shampoo. Low-potency topical steroids may effectively treat infantile or adult seborrheic dermatitis of the flexural areas or persistent recalcitrant seborrheic dermatitis in adults. A topical azole preparation may be combined with a desonide regimen (one dose daily for two weeks) for facial seborrheic dermatitis.

Topical calcineurin inhibitors (e.g., tacrolimus ointment [Protopic], pimecrolimus cream [Elidel]) have fungicidal and anti-inflammatory properties without the risk of cutaneous atrophy, which is associated with topical steroids. Calcineurin inhibitors also are good therapies when the face and ears are affected. However, one week of daily use is necessary before benefits are apparent.

Older modalities for treating seborrheic dermatitis may have had keratolytic but not specific antifungal properties. Keratolytics that are widely used to treat seborrheic dermatitis include tar, salicylic acid, and zinc pyrithione shampoos. Pyrithione zinc has nonspecific keratolytic and antifungal properties and can be applied two or three times per week. Patients should leave these shampoos on the hair for at least five minutes to ensure that it reaches the scalp. Patients also may use it on other affected sites, such as the face. Infantile seborrheic dermatitis of the scalp requires a gentle approach3 (e.g., a mild, nonmedicated shampoo).

Most antifungal agents attack Malassezia associated with seborrheic dermatitis. A once-daily ketoconazole gel preparation (Nizoral) combined with a two-week, once-daily regimen of desonide (Desowen), may be useful for facial seborrheic dermatitis. Shampoos containing selenium sulfide (Selsun) or an azole often are used. These shampoos can be applied two or three times per week. Ketoconazole (cream or foaming gel) and oral terbinafine (Lamisil) also may be beneficial. Other topical antifungal agents include ciclopirox (Loprox) and fluconazole (Diflucan). Patients also may use a 2 % ketoconazole or a fluconazole shampoo. Some azoles (e.g., itraconazole [Sporanox], ketoconazole) also have anti-inflammatory properties.

Natural therapies are becoming increasingly popular. Tea tree oil (Melaleuca oil) is an essential oil from a shrub native to Australia. The therapy appears to be effective and well tolerated when used daily as a 5 % shampoo.