Is ketoconazole an effective treatment for seborrheic dermatitis?

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Seborrheic dermatitis is a skin condition that can be both embarrassing and uncomfortable. It can cause the skin to become red, itchy, and flaky. There are many treatments available for seborrheic dermatitis, but ketoconazole is one of the most effective. Ketoconazole is a medication that is available in both cream and shampoo form. It works by preventing the growth of yeast on the skin.

Let’s take a deep dive:

What is ketoconazole?

Ketoconazole is an antifungal medicine that is used to treat seborrheic dermatitis and other skin infections caused by fungus. Brand names include Daktarin, Dandrazol and Nizoral.

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Check out Is Nizoral shampoo good for dandruff?

It’s also used to treat other skin conditions including:

• Athlete’s foot
• Jock itch
• Intertrigo
• Pityriasis versicolor (which is caussed by Malassezia, the same yeast that causes seborrheic dermatitis)
• Fungal acne (also caused by Malassezia)

Is ketoconazole an effective treatment for seborrheic dermatitis?

Ketoconazole is applied topically as an antifungal cream or shampoo. It attacks the fungus by creating holes in the yeast cell membrane that allow the cell’s contents to leak out. This kills the fungus, which reduces skin inflammation.

To understand how Malassezia causes seborrheic dermatitis read Malassezia and seborrheic dermatitis: Getting to know the yeast.

Ketoconazole is the most tested antifungal treatment for seborrheic dermatitis and is found to be one of the most effective. There are numerous studies comparing ketoconazole and other anti-fungals, and ketoconazole trumps all except Ciclopirox, which was found to be just as effective.

Using ketoconazole for seborrheic dermatitis

You can buy ketoconazole 1% shampoo as an over-the-counter anti-dandruff shampoo. However, ketoconazole cream and 2% shampoo is available via prescription only. It also exists in tablet form but the oral option was found to be so toxic that it’s only very rarely prescribed.

Using ketoconazole cream

When using the creams you should observe the following:

• Wash and dry your affected area.

• Gently rub the cream into the area affected by seborrheic dermatitis.

• Avoid getting the cream in your eyes or mouth.

• Wash your hands thoroughly after as the cream is not safe for ingestion.

• Let the cream absorb fully first before applying your moisturizer or cream on top.

Using ketoconazole shampoo

When using the shampoo you should observe the following:

• Before applying, rinse your hair and the affected area with clean water.

• Shake the shampoo bottle and squeeze some onto the palm of your hand.

• Massage the shampoo gently into your scalp until it lathers.

• Let the shampoo soak in for at least 10 minutes before rinsing it off.

• Condition your hair as usual after.

Are antifungals effective against Malassezia?

Malassezia is one of many yeast fungus species. Seborrheic dermatitis is just one of several skin conditions caused by Malassezia.

Malassezia species inhabit the skin of 90% of adults without any harmful infections. However, diseases can develop in the presence of high humidity, sweating, oily skin, acne, and immune deficiency. The yeast can proliferate to unhealthy levels resulting in various skin disorders.

Malassezia-related skin disorders, including seborrheic dermatitis, are all treated with antifungals like Ketoconazole. Other antifungal medications like miconazole and clotrimazole are over-the-counter and have been found to be inhibit Malassezia as well. Sometimes antifungals are combined with anti-inflammatory medications like steroids.

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Is ketoconazole shampoo effective for dandruff?

The shampoo is proven to be an effective treatment for dandruff. Several controlled studies have compared it to other treatments and placebos and found it helpful.

A 1987 study compared the shampoo with a placebo for the treatment of 20 subjects with dandruff. Topical ketoconazole was an effective therapy while the placebo had no effect.

A 1995 study of 575 patients suffering from dandruff tested ketoconazole 2% shampoo against a placebo. The placebo patients all suffered a relapse of dandruff. Of those who used ketoconazole shampoo, 88% of the patients had an excellent response when they used the shampoo twice weekly for 2 to 4 weeks.

The study concluded that the “2% shampoo is highly effective, not only in clearing scalp seborrhoeic dermatitis and dandruff but also in preventing relapse of the disease when used prophylactically once weekly”.

How long does ketoconazole take to treat seborrheic dermatitis?

For dandruff, Mayo Clinic recommends treatment with the shampoo once a day or 2 to 3 times a week for several weeks. You should let the shampoo stay on your scalp then rinse.

It will probably take several weeks for your dandruff condition to clear up. After the symptoms subside you should continue the shampoo once a week or once every 2 to 3 weeks for relapse prevention.

Side effects of ketoconazole

The side effects of the antifungal cream and shampoo are minor and occur in only 1% of users. Side effects are more likely with creams rather than shampoo. They usually consist of irritated or red skin.

However, some people can have allergic reactions. Serious allergic reactions (anaphylaxis) are rare but can happen with creams or shampoos.

If you experience itching, redness, or burning sensation use less cream. Sweat can exacerbate reactions so try wearing loose clothing or take other steps to minimize sweating.

To wrap up

Ketoconazole is an effective treatment for seborrheic dermatitis. It’s safe and well-tolerated, with few side effects. Unfortunately, most ketoconazole products are prescription-only.