In people with seborrheic dermatitis of the face or scalp, short-term use of topical steroids reduces symptoms

Kastarinen H, Oksanen T, Okokon EO, et al. Topical anti-inflammatory agents for seborrhoeic dermatitis of the face or scalp. Cochrane Database Syst Rev. 2014;5:CD009446.

Review question

In adults with seborrheic dermatitis of the scalp or face, do anti-inflammatory drugs that are used topically (applied to the skin) reduce symptoms?

Background

Seborrheic dermatitis is a fairly common rash, an inflammation of the skin that causes redness, scaling or flaking, or itching. It mostly affects skin on the scalp (as dandruff), face, chest and at joints (e.g., armpits).

Treatments include topical drugs that are applied to affected areas of skin (e.g., creams, lotions, shampoos).

How the review was done

The reviewers did a systematic review, searching for studies that were published up to September 2013. They found 36 randomized controlled trials with 2706 people.

People in the trials had seborrheic dermatitis of the scalp or face.

Topical anti-inflammatory drugs included mild steroids (hydrocortisone), strong steroids (methylprednisolone, betamethasone, clobetasol, amcinonide, mometasone and fluocinolone), and calcineurin inhibitors (pimecrolimus and tacrolimus). People were treated for 4 weeks or less.

These drugs were compared with placebo, each other, or other treatments, including azoles (ketoconazole, metronidazole and miconazole).

What the researchers found

Compared with placebo:

• steroids completely resolved symptoms in more people;
• strong steroids reduced skin redness and scaling in 3 trials;
• strong steroids reduced itching in 2 trials but not in a 3^rd trial; and
• steroids had similar adverse effect rates across 3 trials (e.g., burning, itching).

Compared with calcineurin inhibitors, steroids:

• completely resolved symptoms in a similar proportion of people; and
• had fewer adverse effects (e.g., skin redness, burning, prickling sensations) in 2 short-term trials, with effects in about 25 fewer people out of 100, and similar adverse effect rates across 2 longer-term trials.

Compared with azoles, steroids:

• completely resolved symptoms in a similar proportion of people;
• reduced skin redness, scaling and itching in some trials but not in others; and
• had similar rates of adverse effects (e.g., dry skin, burning, dandruff).

Strong and mild steroids did not differ for completely resolving symptoms, reducing scaling and itching, or for adverse effect rates in 2 to 3 trials.

Conclusions

In people with seborrheic dermatitis of the face or scalp, use of topical steroids for 4 weeks or less reduces symptoms more than placebo but has a similar effect to calcineurin inhibitors or azoles. We don’t have enough information to evaluate other drugs.

Topical anti-inflammatory drugs (TADs) for completely resolving symptoms of seborrheic dermatitis

*Although the rates for the 2 groups look a little different, the differences were not statistically significant. This means that the differences could simply be due to chance rather than due to the different treatments.