Antifungal treatment Treatment options include:

• topical imidazole antifungals such as ketoconazole cream may be useful in the removal of yeast commensals such as Pityrosporum; however it does not work in all patients with seborrhoeic dermatitis (1)
  • ketoconazole 2% shampoo (twice a week application, for 2-4 weeks) is prescribed for seborrhoeic dermatitis of the scalp and beard areas. Selenium sulphide shampoo is an alternative. Use of antifungal shampoos once a week, or once every other week will help maintain remission (2)
  • ketoconazole 2% cream (or other topical imidazoles) can be considered for face or body seborrhoeic dermatitis. Apply to the affected area once or twice a day. Continue for a few days after the affected area has healed
  • if ketoconazole and selenium sulphide containing shampoos aren't acceptable, other options such as anti-dandruff shampoos containing salicylic acid (2), zinc pyrithione and tar shampoos are also available
  • other options include pimecrolimus and ciclopiroxolamine applications (3)

If more extensive or recalcitrant symptoms then consider systemic itraconazole 100 mg per day for 14 days (4)

Reference:

• (1) Update (24/9/97), 338-44
• (2) Clinical Knowledge Summaries (July 2008). Seborrhoeic dermatitis
• (3) Naldi L, Rebora A. Seborrheic dermatitis. N Engl J Med.2009;360:387-396
• (4) Primary Care Dermatological Society. Seborrhoeic dermatitis (Accessed 30/7/14)