• Seborrhoeic dermatitis of the scalp

Feedback

Please complete the form below.

First Name*

Surname*

Occupation*

Email*

Phone

Company

BMJ Clinical Evidence - Seborrhoeic dermatitis of the scalp

Message*

Please wait

General background

Seborrhoeic dermatitis is a chronic condition and one of the most common skin complaints. The scalp is one of the areas most frequently involved. Seborrhoeic dermatitis of the scalp can cause distress for patients in terms of itching and scaling, and also social embarrassment since the scalp is a visible area. The condition can have a major influence on a patient's life. Several treatment options are available.

Focus of the review

This review focuses on the topical treatment for seborrhoeic dermatitis of the scalp. It aims to discuss the suitable treatments in the acute phase as well as in the maintenance phase to try to prevent a relapse.

Comments on evidence

There is limited evidence available on the effectiveness of the different topical treatment agents for seborrhoeic dermatitis of the scalp. Only ketoconazole and ciclopirox have been studied in multiple RCTs. However, in several trials of ketoconazole, the focus is on dandruff rather than more specifically on seborrhoeic dermatitis. Moreover, long-term outcomes and prevention of relapse are scarcely studied and are areas for future research. This review deals with scalp treatment only. No RCTs are available on pimecrolimus or tacrolimus since no vehicle is available for the scalp.

Search and appraisal summary

The update literature search for this review was carried out from the date of the last search, April 2010 to November 2013. Searches for new options added to the scope at this update were carried out from 1966 to November 2013. For more information on the electronic databases searched and criteria applied during assessment of studies for potential relevance to the review, please see the Methods section. Searching of electronic databases retrieved 75 studies. After deduplication and removal of conference abstracts, 59 records were screened for inclusion in the review. Appraisal of titles and abstracts led to the exclusion of 45 studies and the further review of 14 full publications. Of the 14 full articles evaluated, six RCTs were added at this update.

Additional information

In this version of the review we have only looked for effectiveness versus placebo to establish for which agents there is evidence of benefit. In the next update we will look for RCTs that compare the different active topical agents directly.

Substantive changes at this update

Ketoconazole scalp preparations versus placebo One RCT added.[14] Categorisation unchanged (beneficial).

Ciclopirox/ciclopirox olamine scalp preparations versus placebo New option. Five RCTs added.[14][18][19][20][21] Categorised as 'beneficial'.

Pyrithione zinc scalp preparations versus placebo New option. One RCT added.[22] Categorised as 'unknown effectiveness'.

Tar shampoo versus placebo Existing evidence re-evaluated. Categorisation unchanged (likely to be beneficial).

Abstract

INTRODUCTION: Seborrhoeic dermatitis affects a variable proportion of the general population, ranging from 3% to 10%. Malassezia yeast species (previously referred to as Pityrosporum) are thought to be the responsible organisms, and cause inflammation by still poorly defined mechanisms. Seborrhoeic dermatitis tends to relapse after treatment. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical question: What are the effects of topical treatments for seborrhoeic dermatitis of the scalp in adults? We searched: Medline, Embase, The Cochrane Library, and other important databases up to November 2013 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 14 studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: bifonazole, ciclopirox, ketoconazole, pyrithione zinc, selenium sulfide, tar shampoo, terbinafine, and topical corticosteroids (betamethasone valerate, clobetasol propionate, clobetasone butyrate, hydrocortisone, mometasone furoate).

Cite as

Naldi L, Diphoorn J. Seborrhoeic dermatitis of the scalp. Systematic review 1713. BMJ Clinical Evidence. . 2015 May. Accessed [date].