Noncorticosteroid Combination Shampoo versus 1% Ketoconazole Shampoo for the Management of Mild-to-Moderate Seborrheic Dermatitis of the Scalp: Results from a Randomized, Investigator-Single-Blind Trial Using Clinical and Trichoscopic Evaluation

Abstract

Purpose: The aim of this study was to assess the efficacy and tolerability of a combination noncorticosteroid, antiinflammatory/antifungal shampoo versus 1% ketoconazole shampoo in the treatment of mild-to-moderate scalp seborrheic dermatitis (SD). Procedures: Twenty patients were randomized to using the combination shampoo (group A, 10 patients) or the 1% ketoconazole shampoo (group B, 10 patients) 3 times a week every other day for 8 weeks. Efficacy was evaluated by measuring the degree of scaling and pruritus by clinical and trichoscopic examination using a 4-point scale. Additionally, a physician global assessment (PGA) was assessed at the end of the study. Results: At 4 weeks, there was a significant reduction of scaling from baseline for both groups, while pruritus showed a significant reduction only for group A. After 8 weeks, there was a significant reduction of scaling and pruritus for both groups. PGA showed a complete response in 90% of the cases in both groups. Conclusions: The results of our study demonstrate that the combination noncorticosteroid, antiinflammatory/antifungal shampoo represents an alternative approach to standard topical treatment for scalp SD. A noncorticosteroid shampoo may be equally safe and effective as ketoconazole shampoo for scalp SD, and trichoscopy provides accurate and reliable quantifiable data to assist in therapeutic monitoring.

Novel Non-Steroidal Facial Cream Demonstrates Antifungal and Anti-Inflammatory Properties in Ex Vivo Model for Seborrheic Dermatitis

“…Having developed and validated our model, we sought to test its utility to screen topical agents for their antifungal activity. Topical treatment with ketoconazole 2% (a product with known antifungal properties [15]) reduced fungal CFUs by 76.3%. Petroleum jelly, however, did not decrease CFUs.…”

Diagnostic Accuracy of Trichoscopy in Inflammatory Scalp Diseases: A Systematic Review

“…Scaling. Perifollicular scaling was described in 168/365 (46%) patients, white color dominating over yellow/oily scaling [12, 17, 21, 22] (Fig. 3c).…”

“…A total of 9 original studies including 365 patients described trichoscopic features of seborrheic dermatitis of the scalp [4,10,12,14,16,17,[21][22][23].…”

“…Vessels. The most common vascular pattern present in seborrheic dermatitis lesions on the scalp were arborizing red lines (181/365 [49.6%]) [4,10,12,14,[21][22][23], twisted red loops (120/365 [32.9%]) [4,10,12,14,[21][22][23], atypical vessels (95/365 [26%], the morphology not precisely described by authors) [10,12,14], and glomerular vessels (68/365 [18.6%]) [10,12,[21][22][23] (Fig. 2c, d).…”

Treatment algorithm for seborrheic dermatitis

“…Съгласно данните от рандомизирано, единично-сляпо проучване посредством трихоскопия при общо 20 болни с леко до умерено изразен СД на капилициума комбинацията от некортикостероиден и противовъзпалителен/антимикотичен шампоан е по-ефективна от шампоана с 1%-ен кетоконазол (6).…”