Treatment of seborrhoeic dermatitis generally involves the use of topical steroids and/or antifungals such as ketoconazole. Topical antifungal agents are the mainstay of treatment. Topical steroids are useful in the short term mainly to control erythema and itching (1)
The scalp
- ketoconazole 2% shampoo
- initially use two to four times a week then once every two weeks for maintenance. an alternative is selenium sulphide shampoo
- for itch and erythema - a topical steroid scalp application or mousse
- for scale and crusts - olive oil for mild crusting. Sebco ® ointment massaged in and left on for two to four hours can be very useful for thicker scale / crust
Topical treatments for the skin
- topical ketoconazole cream - some patients find this causes too much skin irritation, in which case use either miconazole or clomitrazole cream
- topical steroids can be added in for flare-ups but should only be used for one to two days at a time on facial skin
- for adults who are affected by face and/or body seborrhoeic dermatitis, a mild topical corticosteroid cream, such as hydrocortisone 1% (or a combined imidazole and hydrocortisone preparation) can be considered to settle inflammation more quickly (4)
- if there are concerns about how much topical steroid is being used on the face consider the off-label use of topical calcineurin inhibitors eg pimecrolimus cream or tracrolimus ointment (3)
More extensive or recalcitrant symptoms
- consider systemic itraconazole 100 mg per day for 14 days
- if symptoms relapse frequently then consider six to eight week courses of a systemic tetracycline (off-label), which have an anti-inflammatory effect on the skin
- consider HIV in patients with more severe symptoms
- patients responding inadequately to treatment should be referred to Secondary Care
- in such cases a prolonged course of low dose isotretinoin, used off-label, may be considered (3)
Ocular symptoms
- lid hygiene - clean eyelids using cotton wool soaked in cooled boiled water
- artificial tears - should be applied liberally through the day if the eyes are dry or sore. If necessary a lubricating ointment, sometimes containing an antibiotic preparation may be used at night
- as with rosacea, systemic tetracyclines given for six to eight weeks at a time can be useful for more troublesome symptoms such as blepharitis (3)
- erythromycin can be used in patients unable to take tetracyclines (3)
Reference: