What are the recommended first-line treatments for seborrhoeic dermatitis in adults?

First-Line Treatments for Seborrhoeic Dermatitis in Adults

• For Face and Body:
  • Offer ketoconazole 2% cream or another imidazole cream (such as clotrimazole or miconazole) ¹.
  • Apply once or twice a day for up to 4 weeks ¹.
  • An antifungal shampoo, such as ketoconazole 2%, can also be used as a body wash ¹.
  • Once symptoms are controlled, ketoconazole cream can be used less frequently (for example, twice a week, once a week, or once every other week) to prevent recurrence ¹.
  • For flares, a short course (up to 2 weeks) of a mild topical corticosteroid, such as hydrocortisone 1%, may be considered to help settle inflammation ¹.
• For Scalp:
  • Offer ketoconazole 2% shampoo, used twice a week for up to 4 weeks, followed by once every 1-2 weeks for maintenance ¹.
  • The shampoo should be left on for 5 minutes before rinsing ¹.
  • Scales can be removed by applying a keratolytic preparation (for example, salicylic acid) for several hours before shampooing ¹.
  • Other medicated shampoos, such as zinc pyrithione, coal tar, or salicylic acid, can be used if ketoconazole is not appropriate or acceptable to the person ¹.
  • For severe scalp inflammation, a short course of a topical corticosteroid scalp application (such as betamethasone valerate 0.1% or mometasone furoate 0.1%) can be considered once or twice daily to reduce itching and inflammation ¹. Strong topical corticosteroid scalp applications are not suitable for application to the beard area; a mild topical corticosteroid (such as hydrocortisone 1%) should be used instead ¹.

General Advice:

• Seborrhoeic dermatitis in adults is a chronic condition, and long-term maintenance treatment may be needed ¹.
• Advise using a gentle, soap-free wash on affected areas and applying a light moisturiser after washing ¹.
• If wearing makeup, use non-comedogenic products that do not block pores ¹.
• Research suggests fruit consumption may help to reduce flares ¹.
• Stress may exacerbate seborrhoeic dermatitis and lead to flares ¹.