American Family Physician (AFP) Journal:

Seborrheic dermatitis is a common skin condition in infants, adolescents, and adults.

Seborrheic dermatitis is a chronic inflammatory dermatologic condition that usually appears on areas of the body with a large density of sebaceous glands, such as the scalp, face, chest, back, axilla, and groin.

KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendation

Treatment with antifungal agents such as topical ketoconazole is the mainstay first-line therapy for acute and long-term treatment of seborrheic dermatitis of the face and body.

Several shampoos are available for treatment of seborrheic dermatitis of the scalp. Antifungal shampoos (long-term) and topical corticosteroids (short-term) can be used as second-line agents for treatment of scalp seborrheic dermatitis.

Diagnosis

Seborrheic dermatitis is a clinical diagnosis based on the location and appearance of lesions. In adolescents and adults, seborrheic dermatitis typically presents as flaky, greasy, erythematous patches on the scalp, nasolabial folds, ears, eyebrows, anterior chest, or upper back.

Treatment

SCALP

For mild seborrheic dermatitis of the scalp, shampoos containing selenium sulfide, zinc pyrithione, or coal tar can control symptoms.

For long-term control of seborrheic dermatitis of the scalp, antifungal shampoos containing ketoconazole 2% or ciclopirox 1% can be used daily or at least two or three times per week for several weeks, until remission is achieved. Once-weekly use of these medicated shampoos can prevent relapse. These shampoos should remain on the hair for at least five minutes to guarantee adequate exposure to the scalp.

Severe scalp inflammation, topical corticosteroids can be beneficial, but long-term use is associated with adverse effects and can be expensive.

For moderate to severe cases, clobetasol 0.05% shampoo twice weekly alternating with ketoconazole 2% shampoo twice weekly can reduce acute symptoms more quickly and maintain control longer after discontinuing use, compared with ketoconazole alone.