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Am Fam Physician. 2007 May 1;75(9):1375-1376.
What are the effects of topical treatments for seborrheic dermatitis of the scalp in adults?
Five randomized controlled trials (RCTs) found that ketoconazole 2% shampoo improved scalp symptoms (including scaling, itching, redness, and dandruff) compared with placebo over four weeks.
One RCT found that selenium sulfide shampoo reduced dandruff compared with placebo.
LIKELY TO BE BENEFICIAL
Topical Steroids (Hydrocortisone, Betamethasone Valerate, Clobetasone Butyrate, Mometasone Furoate, Clobetasol Propionate)
We found no RCTs comparing topical steroids versus placebo. There is consensus that topical steroids are effective in treating seborrheic dermatitis of the scalp in adults.
One small RCT found that bifonazole shampoo improved scalp symptoms compared with placebo.
One RCT found that tar shampoo was more effective at reducing scalp dandruff and redness than placebo.
We found no RCTs comparing terbinafine versus placebo in adults with seborrheic dermatitis of the scalp.
What are the effects of topical treatments for seborrheic dermatitis of the face and body in adults?
LIKELY TO BE BENEFICIAL
Topical Steroids (Hydrocortisone, Betamethasone Valerate, Clobetasone Butyrate, Mometasone Furoate, Clobetasol Propionate; Short-term Episodic Treatment in Adults)
We found no RCTs comparing topical steroids versus placebo. There is consensus that short courses of topical steroids used episodically are effective in treating seborrheic dermatitis of the face and body in adults.
One RCT found that bifonazole improved symptoms compared with placebo after four weeks.
We found no RCTs of sufficient quality comparing emollients versus no treatment in adults with seborrheic dermatitis of the face and body.
Two small RCTs found that ketoconazole 2% cream improved symptoms (erythema, scaling, papules, and pruritus) compared with placebo after four weeks, although the significance of the differences between groups was not clear.
We found no RCTs of sufficient quality comparing selenium sulfide versus placebo in adults with seborrheic dermatitis of the face and body.
We found no RCTs of sufficient quality comparing terbinafine versus placebo in adults with seborrheic dermatitis of the face and body.
We found no RCTs of sufficient quality comparing lithium succinate versus placebo in adults with seborrheic dermatitis of the face and body.
Seborrheic dermatitis occurs in areas of the skin with a rich supply of sebaceous glands. It manifests as red, sharply marginated lesions with greasy looking scales. On the face, it mainly affects the medial aspect of the eyebrows, the area between the eyebrows, and the nasolabial folds. It also affects skin on the chest (commonly presternal) and the flexures. On the scalp, it manifests as dry, flaking desquamation (e.g., dandruff) or yellow, greasy scaling with erythema. Dandruff is a lay term commonly used in the context of mild seborrheic dermatitis of the scalp. However, any scalp condition that produces scales could be labelled dandruff. Common differential diagnoses for seborrheic dermatitis of the scalp are psoriasis, eczema, and tinea capitis.
Incidence and Prevalence
Seborrheic dermatitis is estimated to affect around 1 to 3 percent of the general population.1 However, this is likely an underestimate because people do not tend to seek medical advice for mild dandruff.
Malassezia furfur (i.e.,Pityrosporum orbiculare) is considered to be the causative organism of seborrheic dermatitis and is responsible for producing an inflammatory reaction involving T cells and the complement system. Conditions that have been reported to predispose to seborrheic dermatitis include human immunodeficiency virus2; neurologic conditions, such as Parkinson's disease3; neuronal damage such as facial nerve palsy3; spinal injury4; ischemic heart disease5; and alcoholic pancreatitis.6 In this Clinical Evidence chapter, treatment in immunocompetent adults who have no known predisposing conditions is reviewed.
editor's note: Bifonazole and lithium succinate are not available in the United States.
search date: February 2006
Adapted with permission from Manríquez JJ, Uribe P. Seborrhoeic dermatitis. Clin Evid 2006;16:670–2.
1. Gupta AK, Bluhm R, Cooper EA. Seborrhoeic dermatitis. Dermatol Clin. 2003;21:401–12.
2. Berger RS. Cutaneous manifestations of early human immunodeficiency virus exposure. J Am Acad Dermatol. 1988;19:298–303.
3. Bettley FR, Marten RH. Unilateral seborrhoeic dermatitis following a nerve lesion. Arch Dermatol. 1956;73:110–5.
4. Wilson CL, Walshe M. Incidence of seborrhoeic dermatitis in spinal injury patients. Br J Dermatol. 1988;119:(suppl 33)48.
5. Tager A. Seborrhoeic dermatitis in acute cardiac disease. Br J Dermatol. 1964;76:367–9.
6. Barba A, Piubello W, Vantini I, et al. Skin lesions in chronic alcoholic pancreatitis. Dermatologica. 1982;164:322–6.
7. Rook A, et al. Textbook of Dermatology, 6th ed. Oxford, U.K.: Blackwell and Synergy, 1998:639–43.
This is one in a series of chapters excerpted from Clinical Evidence, published by the BMJ Publishing Group, London, U.K. The medical information contained herein is the most accurate available at the date of publication. More updated and comprehensive information on this topic may be available in future print editions of Clinical Evidence, as well as online at http://www.clinicalevidence.com (subscription required). Those who receive a complimentary print copy of Clinical Evidence from United Health Foundation can gain complimentary online access by registering on the Web site using the ISBN number of their book.
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