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 .
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 
- Zinc Pyrithione can up-regulate stress response gene expression in keratinocytes and effect genomic stability 
- Selenium sulfide may have a toxic effect on keratinocytes, reducing the rate of cell division 
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 Treatments on the Horizon 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.
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:
Shown to have some of the strongest anti-malassezia activity
Less potent then ketoconazole, but very commonly prescribed
- Zinc Pyrithione
Popular over the counter treatment choice for dandruff
- Selenium Sulfide
Commercially developed alternative to sulfur
One of the most common broad anti-fungals available today
- 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.