How is seborrheic dermatitis treated?

The treatment of seborrheic dermatitis depends on its location on the body. Treatment also
depends on your age.

Seborrheic dermatitis of the scalp (dandruff) in adults and adolescents. Dandruff is usually
treated with a shampoo that contains salicylic acid (some brand names: Scalpicin, X-Seb),
selenium sulfide (brand names: Exsel, Selsun Blue) or zinc pyrithione (some brand names: DHS
Zinc, Head & Shoulders). These shampoos can be used 2 times a week. Shampoos that contain
coal tar (some brand names: DHS Tar, Neutrogena T/Gel, Polytar) may be used 3 times a week.
If you have dandruff, you might start by using one of these shampoos daily until your dandruff is
controlled, and then use it 2 or 3 times a week.

When you use a dandruff shampoo, rub the shampoo into your hair thoroughly and let it stay on
your hair and scalp for at least 5 minutes before rinsing. This will give it time to work.

If the shampoo alone doesn't help, your doctor might want you to use a prescription steroid lotion
once or twice daily, in addition to the shampoo.

Self-Care Guidelines
Most cases of seborrheic dermatitis are easy to control with non-prescription home measures.
These include:

 Frequent (daily) shampooing or a longer lather time.

 Use of shampoos containing ketoconazole, selenium sulfide, 2% pyrithione zinc, salicylic
acid, or tar-based shampoos.
 Discontinuation of hairspray, gel, mousse, and other hairstyling products.
 Stress reduction and a healthy diet, especially with adequate B vitamins, zinc, omega-3
fatty acids, and reduction of sugar- and yeast-containing foods such as bread, beer, and
wine.
 A little (not too much!) sun – this seems to suppress the growth of Pityrosporum.
 Managing any eyelid changes (blepharitis) by gentle cleaning of the skin around the eye
lashes (eyelid margins) with a Q-Tip® and baby shampoo.

If a regular daily shampoo fails, consider an over-the-counter dandruff shampoo. There are
several types and one may work better than another. Sometimes one will work well for a time
and then become less helpful; then it may help to switch to a different type.

If the scalp is covered with widespread, dense scale, the scale may first be removed by applying
warm mineral oil or olive oil to the scalp and washing several hours later with a detergent, such
as a dishwashing liquid or a tar shampoo.

Some over-the-counter creams will help if the medicated shampoo is not working well enough.
These are often added to the shampoo use until you notice improvement and then can be
discontinued, to be used again temporarily when needed. These include:

 Creams that reduce the Pityrosporum yeast (clotrimazole, miconazole, terbinafine).

 Hydrocortisone cream, which may work rapidly but may be less helpful if used for a long
time.

Treatment Options

The original panel assigned to review OTC products for dandruff and seborrheic dermatitis
produced a document in 1982, which was mostly affirmed (with few changes) in the final rule
published by the FDA in 1991.[7] Several ingredients were found to be safe and effective for self-
treatment of dandruff and seborrheic dermatitis in the 1991 final rule. Salicylic acid, selenium
sulfide, zinc pyrithione and coal tar are effective in treating both conditions while sulfur and
ketoconzole are effective in treating dandruff only and hydrocortisone is effective for seborrheic
dermatitis only. These products can treat patients aged 2 years and older except for ketoconazole,
which is not to be used to treat patients under the age of 12.

Salicylic Acid 1.8%-3%

Salicylic acid is available in the form of shampoo and foam. It functions by increasing the
hydration of skin. Its mechanism may be lowering of the epidermal pH, producing an
inflammation that allows skin to retain water. This artificially produced maceration causes the
upper layer of the epidermis to shed. The keratolytic action removes the scales of dandruff and
seborrheic dermatitis.

Selenium Sulfide 1%

Selenium sulfide is highly active in inhibiting the growth of P. ovale. It is also a proven
cytostatic agent, slowing the growth of both hyperproliferative and normal cells in dandruff and
seborrheic dermatitis. A 0.6% micronized form of selenium sulfide is also safe and effective for
dandruff.

Zinc Pyrithione

Zinc pyrithione is safe and effective for dandruff in a 0.3%-2% concentration shampoo, and for
seborrheic dermatitis in a 0.95%-2% concentration shampoo.
Hydrocortisone 0.25%-1%

Hydrocortisone cream is safe and effective for treatment of seborrheic dermatitis, but is not to be
used to treat dandruff. This is because seborrheic dermatitis has an inflammatory component,
while dandruff does not.

Coal Tar 0.5%-5%

Coal tar in its various forms (e.g., coal tar distillate, coal tar extract, coal tar solution) is effective
for both conditions, but is perhaps not the best choice. In addition to its unpleasant odor, it can
stain the skin and hair (especially if the patient's hair color is naturally light [gray or blond]) or
has been artificially bleached. It also can cause folliculitis, irritant dermatitis, and allergic
dermatitis. Coal tar may cause photosensitivity reactions, and patients should be cautioned to
avoid sun exposure for up to 24 hours after using it. It is also potentially carcinogenic. This was
demonstrated in a 1775 landmark study of chimney sweeps and their high incidence of scrotal
cancer being induced by exposure to soot and coal tar. Coal tar has caused a rash of cancers in
the anogenital area, leading to a precaution against application to the rectum, genital area or
groin for creams, ointments and lotions. If the product is labeled for seborrheic dermatitis, the
patient should be cautioned to consult a physician before use if the condition covers a large part
of the body.

Sulfur 2%-5%

Sulfur, which is available in shampoo form, may function through a keratolytic action. It is
approved for dandruff in a 2%-5% concentration. It may also be combined with salicylic acid for
dandruff. The combination product is also a shampoo.

Ketoconazole 1%

Ketoconazole 1% shampoo was recently switched from prescription to nonprescription status. Its
antifungal activity has been found to control the flaking, scaling, and itching of dandruff safely
in patients over the age of 12 years. The patient is directed to use the shampoo every three to four
days for up to eight weeks, then as needed to control dandruff. If the condition worsens or fails to
improve in two to four weeks, the patient should see a physician. If the scalp is broken or
inflamed, the patient should not use the product.