Seborrheic Dermatitis

For adolescents and adults, the main treatments for seborrheic dermatitis are medicated shampoos, creams and lotions. If nonprescription products and self-care habits don’t help, your health care provider might suggest that you try one or more of these treatments:

• Antifungal gels, creams, lotions, foams or shampoos alternated with another medication. Your health care provider might suggest you try a product with 2% ketoconazole or 1% ciclopirox (Loprox). Or you might rotate between two or more products. Ketoconzole can worsen the dryness of tightly coiled or chemically treated hair and increase the risk of breakage. To ease this effect, use it only once a week with a moisturizing conditioner.

  How often you shampoo or apply other antifungal products will depend on your hair-grooming practices and symptoms. Medicated shampoos can be used once a day or 2 to 3 times a week for several weeks. Let the product sit on your scalp for a few minutes — see package directions — so it has time to work. Then rinse. After your symptoms clear up, use a medicated shampoo just once a week or once every two weeks. This will help prevent a relapse.

• Creams, lotions, shampoos or ointments that control inflammation. Your health care provider might prescribe a prescription-strength corticosteroid you apply to the scalp or other affected area. These include hydrocortisone, fluocinolone (Capex, Synalar), clobetasol (Clobex, Temovate) and desonide (Desowen, Desonate). They are effective and easy to use. And use them only until symptoms clear up. If used for many weeks or months without a break, they can cause side effects. These include loss of skin color, thinning skin, and skin showing streaks or lines.

  Creams or ointments with a calcineurin inhibitor such as tacrolimus (Protopic) or pimecrolimus (Elidel) may be effective. Another benefit is that they have fewer side effects than corticosteroids do. But they are not first-choice treatments because the Food and Drug Administration has concerns about a possible association with cancer. In addition, tacrolimus and pimecrolimus cost more than mild corticosteroid medications.

• Antifungal medication you take as a pill. If your condition isn’t improving with other treatments or is severe, your health care provider may prescribe an antifungal medication in pill form.