Topical corticosteroids may hasten recurrences, foster dependence because of a rebound effect, and are discouraged except for short-term use. Skin involvement responds to ketoconazole or naftinine creams. Alternatives include sulphur or sulfonamide combinations or propylene glycol. Class IV or lower corticosteroid creams, lotions or solutions can be used in acute flares. Systemic ketoconazole may help if seborrheic dermatitis is severe or unresponsive.
Dandruff responds to more frequent shampooing or a longer period of lathering.
Hair spray or hair pomades should be stopped. Salicylic acid, tar, selenium, sulphur and zinc are all effective in shampoos and may be alternated. Shampoos may be used on truncal lesions or in beards but may inflame intertriginous or facial involvement. Seborrheic blepharitis may respond to gentle cleaning of eyelashes with baby shampoo and cotton applicators. The use of ketoconazole cream in this anatomic region is controversial.