What is the best antifungal cream for seborrheic dermatitis?

There are many antifungal creams that can help you treat seborrheic dermatitis. I found applying an antifungal cream twice a day when my seborrheic dermatitis flares reduces the itch and helps my skin recover faster.

There are a few topical antifungal fomulations around. Even though most of them are not marketed specifically for seborrheic dermatitis, as long as the active ingredient is an imidazole antifungal, it is probably effective to treat seborrheic dermatitis.

You can watch the video here if you prefer:

Otherwise let’s take a deep dive:

The best antifungal creams for seborrheic dermatitis

Best antifungal cream overall: Ketoconazole

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Ketoconazole is one of the most widely studied topical antifungal medication for seborrheic dermatitis. Ketoconazole creams, shampoos, foams and other formulations were all found to be effective in reducing levels of Malassezia yeast.

In fact, a Cochrane meta-analysis (highest level of research) found that people who used ketoconazole were 31% less likely to have seborrheic dermatitis symptoms persisting at 4 weeks of use.

Studies also found that the Ketoconazole 2% was more effective than 1% formulations so make sure you buy a cream that is strong enough.

Ketoconazole is well tolerated but common side effects include temporary increased skin redness, itching, bursing sensation and hair loss.

You can buy Ketoconazole 1% shampoo over-the-counter to treat dandruff. Unfortunately, Ketoconazole creams are prescription only in the United States. 

Read Is Nizoral shampoo good for dandruff?

Best OTC antifungal cream: Clotrimazole cream

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All is not lost if it’s too hard for you to get a prescription. There are plenty of over-the-counter antifungal medications. Clotrimazole is one that is easily available, well tolerated and kills a range of yeast, including Candida. There are various clotrimazole brands but a popular one is Lotrimin. 

There are quite a few studies showing that Clotrimazole is effective against Malassezia. Personally, I’ve found the cream works very well to reduce the severity and duration of symptoms of an SD flare. I use clotrimazole on my face, neck, torso, armpits and groin when seborrheic dermatitis (or candida) rears its ugly head.

Clotrimazole is well tolerated but on occasion you might experience irritation or a burning sensation. It’s also a Category B drug for pregnancy, i.e if there is a clinical need for it, it’s considered safe to use in pregnancy.

Further reading: Is clotrimazole effective against seborrheic dermatitis?

Best antifungal cream for severe seborrheic dermatitis: Ciclopirox

Ciclopirox possesses broad-spectrum antibacterial, anti-inflammatory and anti-fungal properties. Besides Ketoconazole, it’s one of the most widely studied topical drugs for seborrheic dermatitis.

Studies show people who used Ciclopirox gel to treata SD of the scalp achieved 75% improvement in symptoms after 3 weeks.

If you have moderate to severe seborrheic dermatitis, there is usually a lot of inflammation happening. There might also be superimposed bacterial infection. Ciclopirox, with its broad spectrum action, is the best choice in this situation, especially if you have used other antifungal creams and found them ineffective.

Ciclopirox is well-tolerated. As with other antifungals, it can rarely cause a burning sensation or eye stinging. It’s classified as a pregnancy category B drug.

Unfortunately, Ciclopirox cream is prescription-only.

Best antifungal cream for pregnancy: Miconazole

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Miconazole is available in a wide array of formulations including cream, gel and shampoo. A Swiss study showed that regular use of a miconazole shampoo is at least as effective and safe as ketoconazole shampoo.

Miconazole is a Category B drug and is safe to use in pregnancy.

How to treat seborrheic dermatitis using antifungal cream?

Even though seborrheic dermatitis is not a fungal infection, antifungal creams are one of the mainstays of treatment during an SD flare. As seborrheic dermatitis occurs due to an abnormal immune reaction to the metabolites of Malassezia, it makes sense that when we reduce the number of Malassezia yeast on our skin, its byproducts will reduce as well.

To treat seborrheic dermatitis using an antifungal cream:

• Apply your antifungal cream of choice liberally over affected skin areas twice a day.
• There is no need to massage the cream in as antifungal creams are very absorbent.
• After applying the antifungal cream, I usually apply my moisturizer on top.
• Do this twice a day until your seborrheic dermatitis flare settles.
• You can apply antifungal cream on the hairline, face, neck, chest and back areas. You can also use it in your armpits and groin region.

Antifungal cream formulations don’t work well on the scalp. For scalp seborrheic dermatitis or dandruff, you can use an antifungal shampoo or scalp oil:

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Further reading: Is Head and Shoulders good for seborrheic dermatitis?

Which is better: ciclopirox or ketoconazole?

Both ciclopirox and ketoconazole are two of the most studied antifungal agents in seborrheic dermatitis. Both are effective to treat SD.

Comparison studies have found that Ciclopirox is better than ketoconazole. One study found that ciclopirox 1% cream is better than ketoconazole 2% foam gel in mild to moderate facial SD. This study found that treatment response to ciclopirox was higher than ketoconazole. However, in this study, ketoconazole was only used twice a week in the initial phase while ciclopirox was used twice daily.

Another study found that ciclopirox shampoo was at least as effective as ketoconazole. However, patients rated ciclopirox as superior to ketoconazole based on their observation of overall signs and symptoms.

To wrap up

While ketoconazole and ciclopirox creams might be the most studied and most effective topical antifungal agents for seborrheic dermatitis, you need a prescription to buy either. OTC clotrimazole and miconazole can potentially work just as well and is easily available. You can also try natural antifungal agents like tea tree oil. You can easily start with one of these antifungal creams first and if they are not effective, get a prescription for ketoconazole or ciclopirox.