Practical approach for an adult

1. Scalp
   • Use an anti-dandruff shampoo containing ketoconazole, selenium sulfide, zinc pyrithione, or ciclopirox 2-3 times weekly.
   • Leave the lather on the scalp for about 5 minutes, then rinse.
   • Once improved, use it once weekly or every 1-2 weeks to prevent recurrence.
   • Avoid scratching and harsh hair oils or fragranced products if they irritate the scalp.
2. Face, ears, chest
   • Wash gently with a fragrance-free cleanser and apply a plain moisturizer.
   • A clinician may prescribe an antifungal cream such as ketoconazole or ciclopirox.
   • If very red or itchy, a low-potency steroid such as hydrocortisone can be used only briefly and preferably under medical advice. Do not use stronger steroid creams on the face, eyelids, or skin folds without a clinician because they can thin the skin and cause other adverse effects.
   • For recurrent facial disease, a clinician may instead use non-steroid anti-inflammatory creams such as pimecrolimus or tacrolimus.
3. General measures
   • Stress, cold/dry weather, illness, and fatigue can worsen flares.
   • Continue maintenance treatment even after the skin clears.
   • It is not caused by poor hygiene and is not contagious.

When to arrange medical review

• diagnosis is uncertain, or there are thick plaques that might be psoriasis, fungal infection, eczema, or contact dermatitis
• there is pain, pus, crusting, fever, or spreading redness, which can indicate infection
• it is widespread, severe, sudden in onset, or does not improve after 4-6 weeks of appropriate treatment
• it occurs in an infant, especially with extensive rash, poor feeding, or failure to thrive
• the patient is immunocompromised or has severe recurrent disease.

Ketoconazole + zinc pyrithione shampoo

• Use 2-3 times a week during a flare.
• Massage into the scalp and leave for 3-5 minutes, then rinse.
• After control, reduce to once weekly or every 1-2 weeks for maintenance.

Does cutting the hair cure it?

Get a dermatologist review soon if

• hair loss is in distinct patches, there are broken hairs, pus, painful swelling, or thick adherent scales
• the scalp is scarred/shiny or follicle openings appear lost
• shedding continues for more than 2-3 months after the dermatitis is controlled
• there is a strong family history of progressive thinning.

Recent guidance and consensus on seborrheic dermatitis

Most relevant recent publications

1. International expert consensus for adult scalp disease, 2024
   Vano-Galvan et al. reviewed 131 papers and proposed a severity-based algorithm using topical antifungal and anti-inflammatory treatment. Note that this article has a published erratum. PubMed record
   [Expert consensus/review . 2024 . PMID: 38919137]
2. Practical recommendations for acute treatment and maintenance, 2025
   This consensus-driven paper prioritizes combined topical antifungal and anti-inflammatory approaches during flares, followed by maintenance therapy to reduce relapse. Practical recommendations
3. Recent child and adult treatment review, 2025
   Confirms topical antifungals, short courses of topical corticosteroids, and topical calcineurin inhibitors as standard first-line options. It also covers newer roflumilast foam and specialist options for resistant disease. Current treatment review
   [Review . 2025 . PMID: 39953371]
4. Primary-care review, 2025
   A practical summary for scalp, face/body, and cradle cap treatment. [Clinical review . 2025 . PMID: 40834373]

Consensus treatment algorithm for adults

Important prescribing points

• Antifungals are the usual foundation of treatment because reducing Malassezia yeast and inflammation helps control disease.
• Steroids help quickly for inflammation, but should be used only briefly, especially on the face, eyelids, and folds. Long-term use can cause skin thinning, visible vessels, acne-like eruptions, and rebound flares.
• Do not use oral ketoconazole for seborrheic dermatitis because of liver toxicity and drug-interaction risk. WHO guidance supports topical ketoconazole and short, limited steroid use when appropriate. WHO evidence review
• A diagnosis review is needed if there is patchy hair loss, pustules, pain, broken hairs, scalp scarring, or failure to improve. Psoriasis, tinea capitis, allergic contact dermatitis, and other disorders can mimic seborrheic dermatitis.