Treating Seborrheic Dermatitis with Anti-Fungals

The majority of medical literature attributes seborrheic dermatitis to the malassezia fungi. As a result, antifungals are currently the most common treatment approach as defined in recent medical and dermatological text-books.

The main focus of all topical anti-fungal products is to inhibit fungi on the skin’s surface. However, recent advances in the understanding of skin biology question their effectiveness [1].

Many of the most popular anti-fungals appear to exhibit a variety of other beneficial effects on seborrheic dermatitis. Here are just a few examples:

  • Ketoconazole has been shown to alter gene expression and suppress the skins inflammatory response [2]
  • Zinc Pyrithione can up-regulate stress response gene expression in keratinocytes and effect genomic stability [3]
  • Selenium sulfide may have a toxic effect on keratinocytes, reducing the rate of cell division [4]

In addition to this, a recent small-scale study failed to demonstrate ketoconazole’s (shown to have some of the strongest anti-malassezia activity in a lab) effectiveness on malassezia reduction outside of the lab [].

These facts considered together cast some uncertainty on the actual role these antifungals play in seborrheic dermatitis relief.

What about internal anti-fungals?

Some researchers have also examined the usage of internal anti-fungals. This approach has a greater possibility of complications and is discussed in later in the section.

Nonetheless, anti-fungals are currently the most recommended approach to seborrheic dermatitis by the medical community. As a result, it helps to understand how they work and what we can expect from treatment.

Section Outline

This section will examine each anti-fungal agent in significant detail. How they work, possible complications, and an overview of the latest research. Examined anti-fungals include:

  1. Ketoconazole
    Shown to have some of the strongest anti-malassezia activity
  2. Clotrimazole
    Less potent then ketoconazole, but very commonly prescribed
  3. Zinc Pyrithione
    Popular over the counter treatment choice for dandruff
  4. Selenium Sulfide
    Commercially developed alternative to sulfur
  5. Nystatin
    One of the most common broad anti-fungals available today
  6. Coal Tar
    Long history of use for various skin conditions

Even if you are not considering treating seborrheic dermatitis with anti-fungals it may still be worthwhile to quickly scan through each one’s summary to further build your overall knowledge of the skin condition.

This section can be read in any order you wish and can serve as great reference material.


  1. Kim Lewis "Persister cells, dormancy and infectious disease." Nature reviews. Microbiology 5.1 (2006): 48-56. PubMed
  2. Zrinka Bukviu Mokos, Martina Kralj, Aleksandra Basta-Juzbauiu, Ines Lakou Jukiu "Seborrheic dermatitis: an update." Acta dermatovenerologica Croatica : ADC 20.2 (2012): 98-104. PubMed
  3. Sarah D Lamore, Georg T Wondrak "Zinc pyrithione impairs zinc homeostasis and upregulates stress response gene expression in reconstructed human epidermis." Biometals : an international journal on the role of metal ions in biology, biochemistry, and medicine 24.5 (2011): 875-90. PubMed
  4. Kenneth Gilbertson, Robert Jarrett, Susan J Bayliss, David R Berk "Scalp discoloration from selenium sulfide shampoo: a case series and review of the literature." Pediatric dermatology 29.1 (2012): 84-8. PubMed
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About Michael Anders

After being affected by seborrheic dermatitis, I have made it my goal to gather and organize all the information that has helped me in my journey.

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