Treatments and drugs

By Mayo Clinic Staff

Seborrheic dermatitis tends to be chronic, and there's usually no strategy that stops it permanently. But treatments — including many you can try at home — may control your signs and symptoms during a flare-up. The best approach for you depends on your skin type, the severity of your condition, and whether your symptoms affect your scalp or other areas of your body.

Creams and lotions that you apply to affected body areas and medicated shampoos are all mainstays of treatment. In very severe cases, physicians may prescribe oral medications with whole-body effects. Products are available with several kinds of active ingredients. Some preparations include active ingredients from more than one category.

Antifungal agents

These agents seem to work by reducing numbers of Malassezia yeast in affected areas of your body. Antifungal agents commonly used to treat seborrheic dermatitis include:

  • Ketoconazole is found in shampoos, foams, gels and creams. It's available in over-the-counter products in a 1 percent concentration and prescription products at a 2 percent strength. Some studies show that the 2 percent strength may be more effective. In a small percentage of people, ketoconazole can cause irritation, itching and burning.
  • Ciclopirox is found in prescription shampoos and skin products. It may cause irritation, itching and burning in a small number of people.
  • Terbinafine (Lamisil) is sometimes prescribed in tablet form to treat severe episodes, but studies of its effectiveness are limited. Most doctors are cautious about prescribing oral antifungal agents for seborrheic dermatitis because these drugs can have serious side effects, and seborrheic dermatitis tends to be a chronic condition. Side effects of terbinafine include severe allergic reactions and liver problems.

Corticosteroids

These agents help symptoms by reducing inflammation, itching and discomfort. They're generally recommended for short-term, occasional use because long-term use over large areas of your body can cause significant side effects. These include local effects, such as skin damage and excessive hair growth, and whole-body effects such as increased susceptibility to infection, high blood sugar and suppression of certain hormones.

Examples of corticosteroids include:

  • Hydrocortisone is available over the counter in a 1 percent strength cream that can be used on body areas other than your scalp. It's available in higher strength creams by prescription.
  • Desonide (Desowen, Desonate) is available by prescription as a gel or ointment for application to your scalp and other body areas.
  • Betamethasone (Beta-Val) is also available by prescription as a cream or lotion for use on your scalp and other parts of your body. It's a stronger category of steroid, and its use is usually limited to a few weeks at a time.

Calcineurin inhibitors

These prescription creams are derived whole-body medications that lower the activity of your immune system. Research and clinical experience suggest they're about as effective as antifungal and corticosteroid creams and lotions. Because more extensive exposure to the whole-body drugs may increase risk of skin cancer or lymphoma, the Food and Drug Administration (FDA) recommends that these creams be used only after other treatments haven't helped you, or if you can't tolerate other treatments. The FDA also advises against long-term use of these medications.

Calcineurin inhibitors include:

  • Tacrolimus (Protopic)
  • Pimecrolimus (Elidel)

Other shampoo ingredients

Additional active ingredients in some shampoos include:

  • Selenium sulfide is found in products available by prescription. Some people who use selenium sulfide experience scalp irritation or lightening of their hair color.
  • Zinc pyrithione is available in over-the-counter products. It may cause irritation.
  • Coal tar is the active ingredient in Neutrogena T/Gel and products marketed by other manufacturers.
  • Salacylic acid is a mild compound that loosens up scale in the scalp.

It's important to use treatments for seborrheic dermatitis exactly as the package directs or as your physician prescribes. If one type of shampoo works for a time and then seems to lose its effectiveness, try alternating between two types. Be sure to leave your shampoo on for the full recommended time — this allows its ingredients time to work.

If you've shampooed faithfully for several weeks and you're still experiencing an itchy, flaky scalp, talk to your doctor. You may need a prescription-strength shampoo or lotion.

Jun. 16, 2011