One trial demonstrated the effectiveness of topical 1% metronidazole gel in seborrheic dermatitis (LOE: 1b). At the 8-week follow-up, 14 patients in the metronidazole group showed a marked to complete improvement compared with 2 in the placebo group (P<.001; number needed to treat=2).3 This is not an approved indication for metronidazole gel, but it may be considered when other topical medications fail. In a randomized controlled trial using crossover design, treatment with a low-dose homeopathic preparation provided significant improvement in seborrheic dermatitis and dandruff after 10 weeks of dosing (LOE: 2b).4
Most seborrheic dermatitis is fully treatable with topical agents. When topical medications are not providing adequate results, oral antifungal agents may be considered. In 1 study, oral terbinafine was found to be effective in the treatment of moderate to severe seborrheic dermatitis. Clinical improvement following 4 weeks treatment with terbinafine was maintained 8 weeks after completing treatment (LOE: 1b).5
Conclusion of visit
The patient was given a prescription for 1% hydrocortisone lotion and 2% ketoconazole cream, both to be applied twice daily to the affected areas. He also planned to investigate the homeopathy option for the future. It was explained to the patient that these treatments may not be curative, and seborrhea may come back when he is under stress.