Antifungal shampoos
Over-the-counter dandruff shampoos have been the mainstay of therapy for seborrhea of the scalp. These products often contain selenium (ie, Selsun Blue) or zinc (ie, Head and Shoulders), both of which are toxic to Pityrosporum. Often patients have both seborrhea on the scalp and the face, and using these shampoos can cut down the amount of Pityrosporumon both. Instruct patients with facial hair to lather their beards and moustache with shampoo as well.
Both ketoconazole (Nizoral) 2% shampoo and selenium sulfide 2.5% shampoo are effective in the treatment of moderate to severe dandruff (level of evidence [LOE]: 1b).1 Ketoconazole 2% shampoo is highly effective not only for clearing seborrheic dermatitis on the scalp but also for preventing relapse when used prophylactically once weekly (LOE: 1b).2 Ketoconazole has become available in a 1% over-the-counter dandruff shampoo, but the 2% shampoo still requires a prescription.
Treating severe cases
When seborrhea of the scalp becomes more severe, add a higher-potency steroid solution or lotion to the treatment until the exacerbation is under control. Ketoconazole cream is also a good treatment for seborrheic dermatitis in areas other than the scalp. Other antifungal creams such as miconazole can be used to treat seborrhea of the face.