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Seborrheic Dermatitis - Old and New Treatments

- In: Clinical Practice

As one of the most common diagnoses in dermatology, one doesn’t have to practice very long to become familiar with seborrheic dermatitis. Despite the diagnostic familiarity, treatments that offer patients complete, rapid, and long-term clearance are still needed–and what works well for one may not work for another! Having environmental and lifestyle triggers and complex pathophysiology, treatments seek to modulate sebum production, reduce skin colonization of Malassezia spp., and control inflammation. So it's important to have a variety of treatment options in mind to discuss with patients. The treatments listed below have been around for many years.


  • Salicylic acid (eg, Neutrogena T/Sal shampoo)
  • Selenium sulfide (eg, Selsun Blue)
  • Tar shampoos (eg, Neutrogena T/Gel shampoo, coal tar shampoo)
  • Salicylic acid / sulfur (Sebulex)
  • Pyrithione zinc (eg, Head and Shoulders shampoo)
  • Topical antifungals (ketoconazole cream and shampoo; ciclopirox cream and shampoo; miconazole or econazole cream)
  • Topical calcineurin inhibitors (off-label, Elidel and Protopic)
  • Promiseb cream
  • Topical corticosteroids
  • Systemic antifungal drugs (severe cases, terbinafine & itraconazole)
  • UVB therapy

The newest treatment for seborrheic dermatitis is Roflumilast foam 0.3%. This foam is the first FDA drug approved for seborrheic dermatitis with a new mechanism of action in over two decades. Used once daily, and can be used anywhere on the body, and is indicated for ages 9 years and older. Roflumilast is a selective phosphodiesterase-4 (PDE-4) inhibitor, which is an intracellular enzyme that increases the production of proinflammatory mediators and decreases the production of anti-inflammatory mediators. Phase 3 trial showed that 79.5% of patients achieved clear or almost clear results after 8 weeks. Roflumilast was well tolerated and had a low rate of treatment-emergent adverse events. This novel foam may finally simplify and offer complete relief for our patients suffering from this skin disorder.


Reference:


Blauvelt, A., Draelos, Z. D., Stein Gold, L., Alonso-Llamazares, J., Bhatia, N., DuBois, J., Forman, S. B., Gooderham, M., Green, L., Guenthner, S. T., Hebert, A. A., Lain, E., Moore, A. Y., Papp, K. A., Zirwas, M., Kato, S., Snyder, S., Krupa, D., Burnett, P., Berk, D. R., … Chu, D. H. (2024). Roflumilast foam 0.3% for adolescent and adult patients with seborrheic dermatitis: A randomized, double-blinded, vehicle-controlled, phase 3 trial. Journal of the American Academy of Dermatology, 90(5), 986–993. https://doi.org/10.1016/j.jaad.2023.12.065



Madeline June APRN-CNP is a dermatology nurse practitioner at Cleveland Clinic, in Cleveland Ohio. Madeline grew up on a farm in Michigan and is passionate about skin cancer prevention, especially within the farming community.