How is seborrheic dermatitis treated?

Once your doctor has clearly identified the extent and location of the symptoms, he or she can then suggest the most appropriate treatment for seborrheic dermatitis.
There are several options, ranging from prescription drugs to dermo-cosmetic treatments. The key is to find what works best for you.

So what medicines are generally recommended for treating seborrheic dermatitis of the face or scalp? Can dermo-cosmetic treatments be enough to relieve symptoms? Are there any natural treatments?
Overview of current " seborrheic dermatitis ” treatments.

How is seborrheic dermatitis, a chronic condition, treated?

The treatment of seborrheic dermatitis has three main objectives: 

• Combat excessive secretion of sebum, the skin's natural oil. 
• Reduce the growth of Malassezia yeast naturally present on the skin. 
• Calm inflammation.

All seborrheic dermatitis treatments are highly effective against the symptoms, i.e. during the flare-up phase.
However, to date, there is no treatment that can provide a definitive cure for seborrheic dermatitis. This condition is chronic and recurrent with near-invariable relapses, and treatments are therefore repeated whenever necessary.

The chronic nature of seborrheic dermatitis means that patients have to learn to live with it. It's a bit like becoming a detective: you have to be able to spot the signs of a flare-up, intervene at the right time and use the right tools. 

There are several ways of treating seborrheic dermatitis. When a medicated treatment is introduced, it is essential to have dermo-cosmetic support to prevent symptoms from returning too quickly. These same dermo-cosmetics can sometimes be sufficient on their own, depending on the severity and location of the condition. 

Several treatments are available

Seborrheic dermatitis can be treated in different ways, depending on where the symptoms appear:

• Shampoos to treat seborrheic dermatitis of the scalp, 
• Creams to treat seborrheic dermatitis of the face.
• Sachets suitable for all areas: scalp, face and chest.

If the seborrheic dermatitis is severe or resistant to treatment, oral antifungal (yeast-fighting) and anti-inflammatory (inflammation-fighting) medication will be preferred.

What medication should be used for seborrheic dermatitis?

Several families of medicines are available: 

Antifungals

Antifungals are often the first choice for treating seborrheic dermatitis. They are used: 

• first as an aggressive treatment during the flare-up phase. 
• then as a maintenance treatment to limit the risk of recurrence: only the frequency of application will be reduced.

They act locally by reducing the concentration of yeasts of the genus Malassezia on the skin. There are two main classes of antifungal agents: 

• imidazoles (including ketoconazole). 
• and pyridones (including ciclopiroxolamine).

Dermocorticoids

Dermocorticoids are cortisone-based creams used for their anti-inflammatory properties on the skin: a bit like firefighters, they quickly extinguish the " fire ” on the skin. They are applied in a thin layer using gentle massage to help penetration.

They are often prescribed as an adjunct to antifungal treatment. In a short time, they calm inflammation and redness and reduce itching.

Calcineurin inhibitors

Calcineurin is like a switch that turns on the cells responsible for inflammation. These drugs, known as calcineurin inhibitors, act by blocking this switch: they deactivate part of the immune system responsible for inflammation, thereby preventing activation of the inflammatory mechanism.

This targeted treatment is often used when cortisone-based creams are not enough. Tacrolimus and pimecrolimus are common examples. 

Gluconate

Lithium gluconate is also prescribed for its anti-inflammatory action and is also thought to have an effect on Malassezia yeasts. In other words, as a basic treatment, it prevents the spread of the condition and acts more as an inflammation regulator on the skin. 

Treatment of seborrheic dermatitis by area

When seborrheic dermatitis is diagnosed, it must be treated everywhere it occurs.
Depending on the area concerned, face or scalp, seborrheic dermatitis treatments will be adapted to make them easier to use and apply correctly.

Treatment of seborrheic dermatitis of the face

Treatments for seborrheic dermatitis of the face are adapted according to the severity of the symptoms:

Treatment of seborrheic dermatitis of the scalp

Seborrheic dermatitis is a scalp condition that causes red patches and dandruff and can be soothed with a variety of treatments, mainly in the form of shampoos: 

• If the symptoms of seborrheic dermatitis are mild to moderate, antifungal shampoos, such as those containing zinc pyrithione, selenium sulphide or ketoconazole, are often used as a first-line treatment. They help reduce inflammation and control Malassezia yeast proliferation.
• In more severe cases of scalp seborrheic dermatitis, additional treatments, such as corticosteroids in lotion or shampoo form, may be necessary. These products are sometimes combined with keratolytic agents like salicylic acid to eliminate more resistant flakes.

Natural treatments for seborrheic dermatitis

For those who prefer natural solutions, phytotherapy offers alternatives. Plant extracts such as cannabidiol(1) or glycyrrhetinic acid⁽²⁾ have been shown to be effective in treating this scalp condition. In addition, certain essential oils such as palmarosa essential oil or tea tree essential oil may be recommended ⁽³⁾.

The application of dermo-cosmetic treatments as a complement to medication

In addition to medical treatments for seborrheic dermatitis, there are a number of dermo-cosmetic treatments available in pharmacies. They provide invaluable support and are sometimes even enough on their own. 

These treatments generally consist of: 

• antifungal active ingredients: some products will contain the same molecules as medications, but in smaller quantities (lithium gluconate, selenium sulphide), while others will contain new ingredients such as zinc, piroctone olamine, climbazole, etc.
• keratolytic agents to help eliminate surface flakes (salicylic acid, keluamide, fruit acids, glycolic acid). 
• soothing and anti-inflammatory active ingredients to reduce itching and redness. 

Recent studies also suggest that strengthening the skin's protective barrier can help in the treatment of seborrheic dermatitis. In practice, this means it is important to use products that hydrate the skin (called emollients), attract water (humectants) and help repair this natural barrier. These products can effectively complement standard treatments and improve results. ⁽⁴⁾.

A few tips to keep in mind on a day-to-day basis

This advice, combined with the prescribed medical treatment, can help optimise the effectiveness of the treatment and improve the skin of people with seborrheic dermatitis ⁽⁵⁾.

1. Avoid scratching: do not scratch the scales to avoid aggravating skin inflammation.
2. Avoid wearing hats or caps too often.
3. Respect treatment times: continue to apply treatments even if the condition improves to reduce the risk of new flare-ups as much as possible.
4. Adopt an appropriate hygiene and skincare routine, specifically formulated for seborrheic dermatitis:

• To treat seborrheic dermatitis of the face, avoid harsh soaps and use foaming gels instead. Cleanse morning and evening to remove excess sebum, but avoid rubbing to keep from irritating the skin.
• To treat seborrheic dermatitis of the scalp, alternate use of mild shampoos and avoid colouring and other products that may irritate or cause allergic reactions. 

Finally, don't forget that stress, cold winters, alcohol and smoking can make seborrheic dermatitis worse. Taking care of yourself in these ways is essential if you are to manage your condition more effectively.