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Chapter 5: Seborrheic Dermatitis

Dae Hun Suh; Jun Hyo Lee

SEBORRHEIC DERMATITIS

Therapeutic Approach

Seborrheic dermatitis is a common, chronic inflammatory skin disease characterized by erythematous, scaly patches on sebaceous gland-rich sites. Patients can suffer from various symptoms such as itching and burning, and also cosmetic problems leading to psychosocial distress. Treatment is based on symptomatic control due to chronic and recurrent relapsing disease course. For mild or limited disease, topical agents are considered as primary treatment while severe or extensive disease may require systemic treatment. Systemic treatment may be also tried in refractory cases to topical agents. Intermittent application of pimecrolimus or tacrolimus when symptoms are recurrent may be considered for maintenance. Long-term use of topical steroids for maintenance is not recommended for fear of adverse effects. See Table 5-1.

Table 5-1Seborrheic Dermatitis Treatment Table
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Table 5-1 Seborrheic Dermatitis Treatment Table
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MEDICATION NAME INDICATION MECHANISM OF ACTION DOSING ADVERSE EFFECTS SUGGESTED MONITORING LEVEL OF EVIDENCE (REFERENCE)
Topical Therapy
Keratolyticsa Scalp/hairy areas, thick scaly lesions, dandruff Alleviate scaling or curst formation, help improve the penetration of other topical treatments Salicyclic acid 3% shampoo, Tar 1-4% shampoo, QIW-TIW Coal tar: Skin irritation, risk of squamous cell carcinoma with prolonged use   IIA1
Ketoconazolea Dandruff, folliculitis, erythematous area Antifungal 1-2% shampoo, cream, gel, or foam, BIW-TIW Skin irritation (<1%)   IA1-6
Ciclopirox olamine Dandruff, folliculitis, erythematous area Antifungal 1-1.5% shampoo, cream, gel, or lotion, QD-BIW Skin irritation (<1%)   IA1,4-6
Zinc pyrithionea Scalp/hairy areas, dandruff Antifungal

1% shampoo

BIW

 Skin irritation (<10%) Check whether irritation occurs. IB1,5,7,8
Miconazole Dandruff, folliculitis, erythematous area Antifungal 2% shampoo, cream, BIW-TIW Skin irritation   IB9-10
Hydrocortisone Erythematous area, itching Anti-inflammatory, antipruritic 1% cream, QD-BID Risk of skin atrophy, telangiectasias, hypertrichosis, and hypopigmentation with prolonged use Be careful of adverse effects of topical steroid. IA1,5,11
Betamethasone dipropionate Erythematous area, itching Anti-inflammatory, antipruritic 0.05-0.1% lotion, QD-BID IA1
Desonide Erythematous area, itching Anti-inflammatory, antipruritic 0.05% lotion, gel, QD-BID     IA1,5
Pimecrolimus Erythematous area Anti-inflammatory 1% cream, BID Risk of skin malignancy and lymphoma with prolonged use (blackbox warning) Check the possibility of cancer, although it is very low. IA1,4,5
Tacrolimus Erythematous area Anti-inflammatory 0.1% ointment, BID IA1,4,5
Selenium sulfidea Scalp/hairy areas, dandruff Antifungal, antikeratotic 2.5% shampoo, BIW Skin irritation (<3%), hyperpigmentation   IB12
Lithium gluconate/succinate Erythematous area, scaly area, itching Anti-inflammatory, antifungal 8% ointment or gel, BID for 4-8 wk Skin irritation (<10%) Check whether irritation occurs. IA6,13
Metronidazole Erythematous area Anti-inflammatory, antimicrobial 0.75% gel, BID for 8 wk Skin irritation   IA7,14
Benzoyl peroxide Erythematous, non-hairy area Antifungal, sebostatic 2.5-10% wash Skin irritation (<10%), bleaching Check whether irritation occurs. IV15
Systemic Therapy
Itraconazole Moderate-to-severe seborrheic dermatitis

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