What are the recommended first-line treatments for seborrhoeic dermati

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

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) .
- Apply once or twice a day for up to 4 weeks .
- An antifungal shampoo, such as ketoconazole 2%, can also be used as a body wash .
- 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 .
- 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 .
For Scalp:
- Offer ketoconazole 2% shampoo, used twice a week for up to 4 weeks, followed by once every 1-2 weeks for maintenance .
- The shampoo should be left on for 5 minutes before rinsing .
- Scales can be removed by applying a keratolytic preparation (for example, salicylic acid) for several hours before shampooing .
- 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 .
- 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 . 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 .

General Advice:

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

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