PubMed Central: BMJ Clinical Evidence

Seborrhoeic dermatitis affects at least 3% to 10% of the population and causes red patches with greasy scales on the face, chest, skin flexures, and scalp.

The cause of seborrhoeic dermatitis is unknown. Malassezia yeast species are thought to have an important role.

The inflammatory process may be mediated in susceptible people by fungal metabolites, namely free fatty acids, released from sebaceous triglycerides. The lipid layer of Malassezia can also modulate pro-inflammatory cytokine production by keratinocytes.

Known risk factors include immunodeficiency, neurological or cardiac disease, and alcoholic pancreatitis. In this review, however, we deal with treatment in immunocompetent adults who have no known predisposing conditions.

TAKE HOME MESSAGE

Seborrhoeic dermatitis tends to relapse after treatment. Treatments is usually with an anti-dandruff shampoo for the scalp.

In adults with seborrhoeic dermatitis of the scalp, topical antifungal preparations containing ketoconazole seem to improve symptoms compared with placebo and are also useful as treatment in the maintenance phase.

Ciclopirox seems to improve symptoms compared with placebo and may reduce relapse up to 12 weeks after initial treatment phase.

Selenium sulfide is also likely to be effective.

There is consensus that topical corticosteroids are effective in treating seborrhoeic dermatitis of the scalp in adults.

Tar shampoo may reduce scalp dandruff and redness compared with placebo; however, nowadays it is rarely used.

Pyrithione zinc may be more effective than vehicle shampoo at reducing dandruff severity; however, the evidence is too weak and limited to draw conclusions about the effectiveness.

Ketoconazole and Ciclopirox have both been shown to be beneficial compared to placebo.

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