Seborrheic dermatitis describes oily skin that has become red, itchy, irritated, flaky, or inflamed. It is caused by the buildup of skin oils, also known as sebum. Sebum is produced by oil glands, which are found mainly on the scalp, face, and chest. A fungus that lives on the skin, Malassezia, overgrows when there is a lot of sebum. This leads to inflammation of the skin, causing these symptoms. A very common example of seborrheic dermatitis on the scalp is dandruff. To help treat these symptoms, a doctor can prescribe a topical medication, which simply means a medication that is put on the skin’s surface.

The two main types of topical anti-inflammatory medications used to treat seborrheic dermatitis are corticosteroids and calcineurin inhibitors. Each works slightly differently to help lower inflammation. These treatments are usually combined with creams to stop the growth of fungus or yeast (called topical antifungals, including ketoconazole and ciclopirox) as well as anti-dandruff shampoos that contain salicylic acid or selenium sulfide.

1. Corticosteroids Reduce Inflammation

Corticosteroids are medications that are similar to the human hormone cortisol. In the body, cortisol helps lower inflammation. Corticosteroids work to reduce the inflammation that happens with seborrheic dermatitis. They also narrow the blood vessels in the skin, which helps relieve erythema (redness).

Topical corticosteroids are available over the counter (OTC) at grocery stores or pharmacies, or as a prescription from a doctor or dermatologist. The most common OTC topical corticosteroid is hydrocortisone cream, which is available in 0.5 percent to 1 percent strengths.

Prescription topical corticosteroids are stronger than their OTC relatives and can be used on the scalp, face, and body. Medications used to treat seborrheic dermatitis on the scalp include:

• Betamethasone valerate (Luxiq)
• Clobetasol (Clobex)
• Fluocinolone (Capex)
• Fluocinolone solution (Synalar)

These medications are usually foams, lotions, solutions, oils, or shampoos. Corticosteroid shampoos are used once to twice daily for two weeks, then are used twice per week to keep the skin clear.

Topical corticosteroids used to treat seborrheic dermatitis on the face and body include:

• Desonide (sold as Desowen, Desonate)
• Betamethasone valerate
• Fluocinolone

Topical corticosteroids typically come as lotions, creams, or ointments. They are used once to twice daily for a few days to weeks at a time. This helps prevent unwanted side effects.

2. Calcineurin Inhibitors Block Immune Cell Activity

Calcineurin inhibitors are another topical anti-inflammatory used to treat seborrheic dermatitis. They block the activity of immune cells in the skin, reducing and preventing inflammation. Dermatologists often prescribe these instead of corticosteroids because they tend to have fewer side effects, including no atrophy (thinning of the skin). Two calcineurin inhibitors used to treat seborrheic dermatitis are tacrolimus (Protopic) and pimecrolimus (Elidel). These are applied twice daily to the affected skin.

Because they are less harsh than corticosteroids and do not cause thinning of the skin, topical calcineurin inhibitors are preferred for areas with sensitive skin. This includes the eyelids, face, neck, and genitals. They can be used as both a short- and long-term treatment for seborrheic dermatitis to help clear the skin and prevent future flare-ups.

3. Topical Anti-Inflammatories Come in Different Forms

There are many different types of topical anti-inflammatories for treating seborrheic dermatitis. Some medications only come in certain forms to help them better absorb into the skin and be more effective. These include:

• Lotions — Usually water-, oil-, or alcohol-based. They need to be shaken if they separate and also tend to be less greasy.
• Creams — Thicker than lotions and don’t leave residue, making them ideal for treating seborrheic dermatitis in skin folds
• Ointments — Better for areas with thick skin (like the palms of the hands or the soles of the feet). They contain high oil levels, so they’re not typically used on the scalp because they can cause folliculitis (inflammation of the hair follicles).
• Foams — Ideal for scalp treatment but can be expensive
• Shampoos — Ideal for scalp treatment because they deliver medication to the skin without leaving it greasy
• Oils — Helpful on the scalp to soften the scales of seborrheic dermatitis

Topical corticosteroids are prescribed as lotions, creams, foams, ointments, or shampoos. Regarding topical calcineurin inhibitors, tacrolimus comes as an ointment, and pimecrolimus is available as a cream.

4. Topical Anti-Inflammatories Are Effective at Treating Seborrheic Dermatitis

Studies show that both topical corticosteroids and calcineurin inhibitors are effective at treating seborrheic dermatitis. One report found that both corticosteroids and calcineurin inhibitors reduce seborrheic dermatitis symptoms when compared to placebo (something that appears to be a medical treatment but isn’t). Strong prescription steroids are more effective than antifungal medications when it comes to reducing itching, redness, and skin scaling.

Other studies found that low- to mid-dose corticosteroids are better at improving symptoms than other treatments. Researchers have also found that calcineurin inhibitors offer longer-lasting relief from seborrheic dermatitis than corticosteroids.

5. Anti-Inflammatory Topical Medications Have Side Effects

Although topical anti-inflammatories work well for treating seborrheic dermatitis, they come with side effects. Your doctor or dermatologist will prescribe the lowest but most effective dose possible for the shortest amount of time to help prevent these unwanted effects.

Topical corticosteroids are generally safe when used for a short time, and they are best used to manage intense flare-ups. Long-term use can cause skin damage, such as:

• Atrophy, making the skin more see-through
• Easier bleeding and bruising
• Enlarged blood vessels
• Formation of stretch marks
• Thickening and lengthening of hair
• Fungal skin infections (such as tinea or Malassezia folliculitis)
• Steroid rosacea (reddening of the skin)
• Symptom flare-ups after stopping corticosteroid use (called withdrawal)

After starting a topical calcineurin inhibitor, you may notice a burning, irritating, or itching sensation on your skin. This is common in around 50 percent of people who use these medications, and it typically goes away after a week or so. Other side effects of calcineurin inhibitors include:

• Skin color changes, including redness or darkening
• “Pins and needles” sensation where the medication was applied
• Skin warmth
• Viral skin infections, such as warts or cold sores
• Clogged pores and folliculitis

Unlike topical corticosteroids, calcineurin inhibitors don’t cause skin thinning, making them an ideal choice for treating seborrheic dermatitis on thin-skinned or sensitive areas of the body.

6. You Can Manage the Side Effects of Topical Anti-Inflammatories

To help prevent skin thinning while using topical corticosteroids, avoid putting bandages or wraps over the treated skin. Use the medications only as directed by your doctor or dermatologist. Do not use them for longer than the prescribed time or on areas of the body for which they are not designed. If your seborrheic dermatitis symptoms haven’t improved after using the treatment, talk to your doctor or dermatologist.

Calcineurin inhibitors make your skin more sensitive to the sun, so be sure to avoid direct sunlight for long periods of time. If you do go outside, use sunscreen with a sun protection factor of 30 to 50 and cover any affected skin that is being treated. Some people may also notice that their skin becomes more irritated or red when they drink alcohol. Talk to your doctor or dermatologist if you notice these symptoms, and try to limit alcohol consumption while using calcineurin inhibitors. For red or warm skin, use a cold compress, but be sure to wrap any ice or frozen items in a towel before applying them to your skin.

Talk With Others Who Understand

MySebDermTeam is the social network for people with seborrheic dermatitis and their loved ones. On MySebDermTeam, members come together to ask questions, give advice, and share their stories with others who understand life with seborrheic dermatitis.

Do you use a topical anti-inflammatory treatment to manage your seborrheic dermatitis? Share your experiences in the comments below, or start a conversation by posting on your Activities page.