Safe and effective treatment of seborrheic dermatitis.

Seborrheic dermatitis is a common chronic inflammatory skin disorder that can vary in presentation from mild dandruff to dense, diffuse, adherent scale. The disorder occurs throughout the world without racial or geographic predominance; it is more common in males than females. Its precise etiology remains unknown, but the condition is strongly associated with lipophilic Malassezia yeasts found among the normal skin flora and represents a cofactor linked to several risk factors, including T-cell depression, increased sebum levels, and activation of the alternative complement pathway. The goal of treatment is symptom control, with an emphasis on the importance of maintaining patient adherence to therapy to achieve low rates of recurrence. Available therapies include corticosteroids, antifungal agents, immunomodulators, and medicated keratolytic shampoos. Although corticosteroids are associated with recurrence, they sometimes may be recommended in combination with antifungal agents. Antifungal therapy is considered primary, but some agents are more effective than others because of their favorable pharmacokinetic profiles, high rates of absorption, anti-inflammatory and antipruritic properties, and vehicle.