Since this chronic inflammatory disease occurs in response to the presence of Malassezia species on the scalp, the amount of lipid on the skin, nutritional deficiencies and secondary bacterial infection. The objective of treatment consists of reducing the oiliness on the scalp, controlling inflammation and reducing the potential aggravation of a secondary bacterial infection.
Various types of therapeutic agents and medication are used to combat seborrheic dermatitis. Due to the chronic and relapsing nature of the disease, it is important the patient remain compliant with treatment even if the condition appears to resolve before the treatment period has elapsed.
Anti-inflammatory agents | Conventional treatment for adult seborrheic dermatitis often starts with topical steroids or a calcineurin inhibitor. These topical therapies can be administered as a shampoo, topical steroid solutions, lotions applied to the scalp or creams applied to the skin. Adults with the condition will typically use topical steroids once or twice daily in addition to a medicated shampoo. These conventional treatments have fungicidal and anti-inflammatory properties. Topical corticosteroids result in rapid improvement in symptoms of seborrheic dermatitis; however, relapses are frequent. Corticosteroids can only be used for short periods as side effects will occur with prolonged use. Calcineurin inhibitors exert an effect equal to low potency corticosteroids, are well tolerated and induce a more prolonged remission than corticosteroids.
Keratolytics | Keratolytics based on salicylic acid and sometimes sulphur, help with the softening and removal of the scalps adhered to the hair and scalp. More traditional methods for treating seborrheic dermatitis have keratolytic but not specific antifungal properties. Popular keratolytic that are widely used to treat seborrheic dermatitis include salicylic acid, tar and zinc pyrithione shampoos. Zinc pyrithione is a non-specific keratolytic with antifungal properties.
Antifungals | Antifungals work by targeting Malassezia directly. When treatment stops, and the normal flora is restored, the condition will appear again. Antifungals do not generally deal with any secondary bacterial infection that may be aggravating the condition.
Laser therapy | Combination treatments with lasers (e.g., pulsed-dye laser, 755-nm alexandrite laser, 810-nm diode laser, 1064-nm Nd:YAG laser) and microdermabrasion are non-invasive techniques currently under approval for different hyperkeratotic diseases.
Nutritional therapies | Most of the mechanisms involved in seborrheic dermatitis are related to the function of zinc. Zinc in the skin acts as a natural bactericide reducing the potential for secondary bacterial infection that worsens the condition. Zinc has antifungal properties, regulates cell replication, immune activity and wound repair. Zinc improves immune activity by preserving natural killer cell function and has anti-inflammatory effects. A 2019 study showed patients with seborrheic dermatitis had significantly lower levels of zinc than healthy controls .
Low levels of zinc lead to metabolic alterations that reduce sulphur availability, enzyme function, B-complex vitamin capacity and affect iron use in the body. Patients with seborrheic will need to address the secondary nutritional deficiencies that may be present for long term disease remission.
Topical therapies | The hair follicle is an ideal delivery route for topical agents. Topical formulations that incorporate red clover and caffeine can help in the management of seborrheic dermatitis. Red clover contains phytoestrogens that help to modulate skin physiology, targeting skin cells, sebaceous glands and improving immune responses. Caffeine is a powerful antioxidant that acts in several ways to improve symptoms of inflammation. Caffeine plays a supportive role in cell death preventing inflammatory triggers to cell injury or infection.