Topical therapy is the mainstay for most cases. The goal is to reduce yeast overgrowth, calm inflammation, and loosen scale while supporting the skin barrier.
Antifungal shampoos (ketoconazole, ciclopirox, selenium sulfide, zinc pyrithione)
Medicated shampoos work by reducing Malassezia yeast and the downstream inflammation that contributes to flaking and redness. Ketoconazole and ciclopirox are prescription options, while selenium sulfide and zinc pyrithione are widely available and often used for maintenance. Many people notice improvement in 1–3 weeks with consistent use, though ongoing maintenance is commonly needed to prevent relapse. Side effects can include dryness, irritation, or hair texture changes; selenium sulfide may cause discoloration if not rinsed thoroughly.
Antifungal creams (ketoconazole, ciclopirox)
For facial or body involvement, antifungal creams help decrease yeast levels and reduce inflammation in affected areas. They are often used during flares and then tapered to intermittent use as symptoms improve. Improvement is commonly seen in 2–4 weeks, with earlier relief of itching possible. Side effects are typically mild and may include stinging, dryness, or irritation.
Low-potency topical corticosteroids (hydrocortisone, desonide)
Topical corticosteroids reduce redness and itching by suppressing inflammatory signaling in the skin. They can be helpful for short bursts during flares, particularly on the face or ears where symptoms can be uncomfortable. Symptom relief may begin within 1–3 days, and visible redness often improves within 1–2 weeks. Common side effects include burning or irritation; with prolonged or frequent use, especially on the face, steroids can thin the skin, trigger visible blood vessels, or cause steroid-induced acne-like breakouts, so careful guidance is important.
Topical calcineurin inhibitors (tacrolimus, pimecrolimus)
Calcineurin inhibitors reduce inflammation without the skin-thinning risks associated with long-term steroid use, making them useful for sensitive areas such as the face, eyelids, and skin folds. They are thought to work by blocking T-cell activation and inflammatory cytokines involved in redness and scaling. Improvement often occurs in 1–3 weeks, with continued stabilization over several weeks. Common side effects include temporary burning or stinging at application, especially during the first few days.
Roflumilast topical foam (PDE-4 inhibitor)
Topical roflumilast foam 0.3% is a non-steroidal prescription option for seborrheic dermatitis that works by inhibiting phosphodiesterase-4 (PDE-4), which helps reduce inflammatory signaling in the skin and, in turn, can lessen redness, scaling, and itch. Roflumilast is the first FDA-approved medication with a new mechanism of action for seborrheic dermatitis in over 20 years. In clinical studies, itch improvement was reported as early as 2 days for some people, with broader clearance outcomes assessed at 8 weeks. The most commonly reported side effects (≥1%) included nasopharyngitis, nausea, and headache.
Keratolytics to lift scale (salicylic acid, sulfur, urea)
Keratolytic ingredients help loosen and remove thick scale by breaking down the bonds between dead skin cells, which can improve the penetration of antifungals and anti-inflammatory medications. They can be especially useful on the scalp or in areas with heavier buildup. Many people see benefits in 1–2 weeks when used regularly. Side effects may include dryness, irritation, or sensitivity if overapplied, particularly on facial skin.
Coal tar shampoos (selected cases)
Coal tar can reduce scaling and slow excess skin cell turnover, which may help persistent dandruff or scalp scale. It is thought to work through anti-proliferative and anti-inflammatory effects in the outer layer of skin. Improvement is often noticed in 2–4 weeks. Common drawbacks include odor, potential irritation, increased sun sensitivity on treated areas, and possible staining of light-colored hair or fabrics.
