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BMJ Clin Evid. 2007; 2007: 1713.
Published online 2007 July 1.
PMCID: PMC2943817

Seborrhoeic dermatitis

Abstract

Introduction

Seborrhoeic dermatitis affects at least 1-3% of the population. Malassezia (Pityrosporum) ovale is thought to be the causative organism, and causes inflammation involving T cells and complement. Seborrhoeic dermatitis tends to relapse after treatment.

Methods and outcomes

We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of topical treatments for seborrhoeic dermatitis of the scalp in adults? What are the effects of topical treatments for seborrhoeic dermatitis of the face and body in adults? We searched: Medline, Embase, The Cochrane Library and other important databases up to February 2006 (BMJ Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).

Results

We found nine systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.

Conclusions

In this systematic review we present information relating to the effectiveness and safety of the following interventions: bifonazole, emollients, ketoconazole, lithium succinate, selenium sulphide, tar shampoo, terbinafine, and topical steroids (betamethasone valerate, clobetasol propionate, clobetasone butyrate, hydrocortisone, mometasone furate).

Key Points

Seborrhoeic dermatitis affects at least 1-3% of the population and causes red patches with greasy scales on the face, chest, skin flexures, and scalp.

  • The cause of seborrhoeic dermatitis is unknown. Malassezia yeasts are considered to have an important role producing an inflammatory reaction involving T cells and complement.
  • Known risk factors include immunodeficiency, neurological or cardiac disease, and alcoholic pancreatitis. In this review, however, we deal with treatment in immunocompetent adults who have no known predisposing conditions.
  • Seborrhoeic dermatitis tends to relapse after treatment.

In adults with seborrhoeic dermatitis of the scalp, antifungal preparations containing ketoconazole improve symptoms compared with placebo.

  • Bifonazole and selenium sulphide are also likely to be effective, but we don't know whether terbinafine is beneficial as no studies have been found.
  • There is consensus that topical corticosteroids are effective in treating seborrhoeic dermatitis of the scalp in adults, although no studies have been found.
  • Tar shampoo may reduce scalp dandruff and redness compared with placebo.

In adults with seborrhoeic dermatitis of the face and body, short courses of topical corticosteroids are considered to be effective if used episodically, although no studies have been found that assessed this.

About this condition

Definition

Seborrhoeic dermatitis occurs in areas of the skin with a rich supply of sebaceous glands and manifests as red, sharply marginated lesions with greasy looking scales. On the face it mainly affects the medial aspect of the eyebrows, the area between the eyebrows, and the nasolabial folds. It may also affect the skin on the chest (commonly presternal) and the flexures. On the scalp it manifests as dry, flaking desquamation (dandruff) or yellow, greasy scaling with erythema. Dandruff is a lay term commonly used in the context of mild seborrhoeic dermatitis of the scalp. However, any scalp condition that produces scales could be labelled as dandruff. There is also an infantile variant, commonly affecting the scalp, flexures, and genital area, but this infantile variant seems to have a different pathogenesis than adult seborrhoeic dermatitis. Common differential diagnoses for seborrhoeic dermatitis of the scalp are psoriasis, eczema (see review on atopic eczema), and tinea capitis (see table 1 ).

Table 1
Differential diagnoses for seborrhoeic dermatitis of the scalp (see text).

Incidence/ Prevalence

Seborrhoeic dermatitis is estimated to affect around 1-3% of the general population. However, this is likely to be an underestimate because people do not tend to seek medical advice for mild dandruff.

Aetiology/ Risk factors

The cause of seborrhoeic dermatitis is unknown and seems to be a multifactorial disease. Malassezia yeasts, a genus classified in seven species, are considered to have an important role in seborrhoeic dermatitis producing an inflammatory reaction involving T cells and complement. Conditions that have been reported to predispose to seborrhoeic dermatitis include human immunodeficiency virus, neurological conditions such as Parkinson's disease, neuronal damage such as facial nerve palsy, spinal injury, ischaemic heart disease, and alcoholic pancreatitis. In this review, we deal with treatment in immunocompetent adults who have no known predisposing conditions.

Prognosis

Seborrhoeic dermatitis is a chronic condition that tends to flare and remit spontaneously, and is prone to recurrence after treatment.

Aims of intervention

To reduce the symptoms and signs of seborrhoeic dermatitis with minimal adverse effects. Most therapeutic options aim to reduce colonisation with Malassezia spp and reduce inflammation, although they tend to palliate rather than cure.

Outcomes

Severity of symptoms, including itching, scale, and erythema; adverse effects of treatment.

Methods

BMJ Clinical Evidence search and appraisal February 2007. Most authors have used the term "dandruff" to mean seborrhoeic dermatitis of the scalp. If there was any doubt about the diagnosis the study was excluded. The following databases were used to identify studies for this systematic review: Medline 1966 to February 2007, Embase 1980 to February 2007, and The Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Clinical Trials 2007, Issue 1. Additional searches were carried out using these websites: NHS Centre for Reviews and Dissemination (CRD) — for Database of Abstracts of Reviews of Effects (DARE) and Health Technology Assessment (HTA), Turning Research into Practice (TRIP), and National Institute for Health and Clinical Excellence (NICE). Abstracts of the studies retrieved from the initial search were assessed by an information specialist. Selected studies were then sent to the author for additional assessment, using predetermined criteria to identify relevant studies. Study design criteria for evaluation in this review were: published systematic reviews and RCTs in any language. RCTs had to be double blinded and contain 20 or more individuals. Trials of less than 4 weeks' duration had to have at least 90% follow up; trials lasting 4 weeks or longer had to have at least 80% follow up. Trials of less than 1 week were excluded. We use a regular surveillance protocol to capture harms alerts from organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA), which are added to the reviews as required. We have performed a GRADE evaluation of the quality of evidence for interventions included in this review (see table ).

Table
GRADE evaluation of interventions for seborrhoeic dermatitis

Glossary

Low-quality evidence
Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Moderate-quality evidence
Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Very low-quality evidence
Any estimate of effect is very uncertain.

Notes

Disclaimer

The information contained in this publication is intended for medical professionals. Categories presented in Clinical Evidence indicate a judgement about the strength of the evidence available to our contributors prior to publication and the relevant importance of benefit and harms. We rely on our contributors to confirm the accuracy of the information presented and to adhere to describe accepted practices. Readers should be aware that professionals in the field may have different opinions. Because of this and regular advances in medical research we strongly recommend that readers' independently verify specified treatments and drugs including manufacturers' guidance. Also, the categories do not indicate whether a particular treatment is generally appropriate or whether it is suitable for a particular individual. Ultimately it is the readers' responsibility to make their own professional judgements, so to appropriately advise and treat their patients.To the fullest extent permitted by law, BMJ Publishing Group Limited and its editors are not responsible for any losses, injury or damage caused to any person or property (including under contract, by negligence, products liability or otherwise) whether they be direct or indirect, special, incidental or consequential, resulting from the application of the information in this publication.

Contributor Information

Juan Jorge Manríquez, Unidad Docente Asociada de Dermatologia, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile.

Pablo Uribe, Unidad Docente Asociada de Dermatologia, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile.

References

1. Gupta AK, Bluhm R, Cooper EA. Seborrhoeic dermatitis. Dermatol Clin 2003;21:401–412. [PubMed]
2. Berger RS. Cutaneous manifestations of early human immunodeficiency virus exposure. J Am Acad Dermatol 1988;19:298–303. [PubMed]
3. Bettley FR, Marten RH. Unilateral seborrhoeic dermatitis following a nerve lesion. Arch Dermatol 1956;73:110–115. [PubMed]
4. Wilson CL, Walshe M. Incidence of seborrhoeic dermatitis in spinal injury patients. Br J Dermatol 1988;119(suppl 33):48.
5. Tager A. Seborrhoeic dermatitis in acute cardiac disease. Br J Dermatol 1964;76:367–369. [PubMed]
6. Barba A, Piubello W, Vantini I, et al. Skin lesions in chronic alcoholic pancreatitis. Dermatologica 1982;164:322–326. [PubMed]
7. Rook et al. Textbook of Dermatology, 6th ed. Blackwell and Synergy: 639–643.
8. Green CA, Farr PM, Shuster S. Treatment of seborrhoeic dermatitis with ketoconazole: II. Response of seborrhoeic dermatitis of the face, scalp and trunk to topical ketoconazole. Br J Dermatol 1987;116:217–221. [PubMed]
9. Carr MM, Pryce DM, Ive FA. Treatment of seborrhoeic dermatitis with ketoconazole: I. Response of seborrhoeic dermatitis of the scalp to topical ketoconazole. Br J Dermatol 1987;116:213–216. [PubMed]
10. Berger R, Mills OH. Double blind placebo-controlled trial of ketoconazole 2% shampoo in the treatment of moderate to severe dandruff. Adv Ther 1990;7:247–255.
11. Danby FW, Maddin WS, Margesson LJ. A randomised, double-blind, placebo-controlled trial of ketoconazole 2% shampoo versus selenium sulfide 2.5% shampoo in the treatment of moderate to severe dandruff. J Am Acad Dermatol 1993;29:1008–1012. [PubMed]
12. Davies DB, Boorman GC, Shuttleworth D. Comparative efficacy of shampoos containing coal tar (4.0% w/w; TarmedTM ), coal tar (4.0% w/w) plus ciclopirox olamine (1.0% w/w; TarmedTM AF) and ketoconazole (2.0% w/w; Nizoral® ) for the treatment of dandruff/seborrhoeic dermatitis. J Dermatol Treat 1999;10:177–183.
13. Segal R, David A, Ingber R, et al. Treatment with bifonazole shampoo for seborrhoea and seborrhoeic dermatitis: a randomised, double blind study. Acta Derm Venereol (Stockh) 1992;72:454–455. [PubMed]
14. Skinner RB, Noah PW, Taylor RM, et al. Double-blind treatment of seborrheic dermatitis cream with 2% ketoconazole cream. J Am Acad Dermatol 1985;12:852–856. [PubMed]
15. Elewski B, Ling MR, Phillips TJ. Efficacy and safety of a new once-daily topical ketoconazole 2% gel in the treatment of seborrheic dermatitis: a phase III trial. J Drugs Dermatol 2006;5:646–650. [PubMed]
16. Zienicke H, Korting HC, Braun-Falco O, et al. Comparative efficacy and safety of bifonazole 1% cream and the corresponding base preparation in the treatment of seborrhoeic dermatitis. Mycoses 1993;36:325–331. [PubMed]
17. Cuelenaere C, De Bersaques J, Kint A. Use of topical lithium succinate in the treatment of seborrhoeic dermatitis. Dermatology 1992;184:194–197. [PubMed]
2007; 2007: 1713.
Published online 2007 July 1.

Ketoconazole scalp preparations

Summary

SYMPTOM SEVERITY Compared with placebo: Ketoconazole shampoo is more effective than placebo at improving scalp symptoms such as scaling, itching, redness, and dandruff at 4 weeks in people with seborrhoeic dermatitis of the scalp ( moderate-quality evidence ).

Benefits

Ketoconazole shampoo versus placebo:

We found no systematic reviews. We found five RCTs ranging in size from 20 to 246 participants. All found improvements in symptoms with ketoconazole 2% shampoo after 4 weeks compared with placebo (see table 2 ).

Table 2
RCTs comparing ketoconazole shampoo versus placebo for seborrhoeic dermatitis of the scalp (see antifungal scalp preparations).

Harms

Ketoconazole shampoo versus placebo:

Four of the five RCTs reported that there were no adverse effects of treatment. The fifth RCT reported one instance of scalp tenderness that was probably related to ketoconazole treatment.

Comment

None.

Substantive changes

No new evidence

2007; 2007: 1713.
Published online 2007 July 1.

Bifonazole scalp preparations

Summary

SYMPTOM SEVERITY Compared with placebo: Bifonazole shampoo may be more effective than placebo at improving symptoms such as scaling and pruritus, and overall symptom severity at six weeks in people with seborrhoea or seborrhoeic dermatitis of the scalp ( low-quality evidence ).

Benefits

Bifonazole shampoo versus placebo:

We found no systematic review. We found one RCT which compared bifonazole 1% shampoo versus placebo. It found that bifonazole 1% shampoo significantly improved scalp symptoms (severity of scaling, pruritus, and overall severity graded by a clinician on a 3 point scale from 0 = none to 3 = severe) compared with placebo after 6 weeks (51 people with seborrhoea or seborrhoeic dermatitis of the scalp; scaling: P = 0.01; pruritus: P = 0.008; overall severity: P = 0.012).

Harms

Bifonazole shampoo versus placebo:

The RCT reported no major side effects.

Comment

None.

Substantive changes

No new evidence

2007; 2007: 1713.
Published online 2007 July 1.

Selenium sulphide scalp preparations

Summary

SYMPTOM SEVERITY Compared with placebo: Selenium sulphide shampoo is more effective than placebo at reducing dandruff, and at increasing response to treatment at 29 days, in people with moderate to severe dandruff ( moderate-quality evidence ).

Benefits

Selenium sulphide shampoo versus placebo:

We found no systematic reviews. We found one RCT which compared three treatments randomised in a 2 : 2 : 1 ratio: selenium sulphide 2.5% shampoo (100 people); ketoconazole 2% shampoo (97 people); and placebo (49 people). It found significantly greater reductions in mean adherent dandruff scores (determined by visual examination of six scalp areas, in which 0 = none and 9–10 = severe/heavy) with selenium sulphide shampoo compared with placebo over 29 days (people with moderate to severe dandruff; percentage reduction in adherent dandruff scores from baseline: 66.7% with selenium sulphide v 44.5% with placebo; P value not reported). It also found that significantly more people responded to treatment (global improvement of completely cleared, excellent, or good) with selenium sulphide shampoo than with placebo at 29 days (AR for responding to treatment: 54.7% with selenium sulphide v 28.6% with placebo; P = 0.004).

Harms

Selenium sulphide shampoo versus placebo:

The RCT reported infrequent adverse events with selenium sulphide shampoo, including pruritus or burning sensation of the scalp (3 people), eruption near the hair line (1 person), psoriasis (1 person), lightening/bleaching of hair colour (2 people), orange staining of the scalp (1 person), and a chemical taste during shampooing (1 person).

Comment

None.

Substantive changes

Selenium sulphide (under question on topical treatments for seborrhoeic dermatitis of the scalp in adults) Evidence re-evaluated, recategorised from Beneficial to Likely to be beneficial.

2007; 2007: 1713.
Published online 2007 July 1.

Tar shampoo

Summary

SYMPTOM SEVERITY Compared with placebo: Tar shampoo is more effective than placebo at improving dandruff and redness at 29 days in people with seborrhoeic dermatitis or dandruff ( moderate-quality evidence ).

Benefits

Tar shampoo versus placebo:

We found no systematic reviews. We found one RCT which compared tar shampoo (4% coal tar) versus placebo. It found that, compared with placebo, tar shampoo significantly improved both dandruff (dandruff score, assessed by a technician by multiplying size of affected area by severity; size of affected area scored from 0 = 10% to 4 = > 70%; severity scored from 1 = small flakes resembling a white powder to 5 = flakes adhering to the scalp as white or yellow plates) and redness (graded by a clinician on a 5 point scale from 0 = none to 4 = very severe) after 29 days (111 people with seborrhoeic dermatitis or dandruff; mean reduction in dandruff score from baseline: 31 with tar shampoo v 19 with placebo, P < 0.01; mean difference in redness from baseline: 1.2 with tar shampoo v 0.6 with placebo, P < 0.05). There was no significant difference in scaling or area of seborrhoeic dermatitis after 29 days between tar shampoo and placebo.

Harms

Tar shampoo versus placebo:

The RCT reported no major adverse events.

Comment

None.

Substantive changes

No new evidence

2007; 2007: 1713.
Published online 2007 July 1.

Topical corticosteroids (hydrocortisone, betamethasone valerate, clobetasone butyrate, mometasone furoate, clobetasol propionate)

Summary

We found no direct information about whether topical corticosteroids (hydrocortisone, betamethasone valerate, clobetasone butyrate, mometasone furoate, or clobetasol propionate) are better than no active treatment for seborrhoeic dermatitis of the scalp in adults. There is consensus that topical corticosteroids are effective in treating seborrhoeic dermatitis of the scalp in adults.

Benefits

Topical corticosteroids versus placebo:

We found no systematic review or RCTs comparing topical corticosteroids (hydrocortisone, betamethasone valerate, clobetasone butyrate, mometasone furoate, or clobetasol propionate) versus placebo for seborrhoeic dermatitis of the scalp in adults.

Harms

Topical corticosteroids versus placebo:

We found no RCTs.

Comment

Although no systematic reviews or RCTs were identified, there is consensus that topical corticosteroids are effective in treating seborrhoeic dermatitis of the scalp in adults. Betamethasone valerate scalp application in a lotion or mousse is routinely used in practice by dermatologists.

Substantive changes

No new evidence

2007; 2007: 1713.
Published online 2007 July 1.

Terbinafine scalp preparations

Summary

We found no direct information about whether terbinafine is better than no active treatment in adults with seborrhoeic dermatitis of the scalp.

Benefits

Terbinafine versus placebo:

We found no systematic review or RCTs (see comment below).

Harms

Terbinafine versus placebo:

We found no RCTs (see comment below).

Comment

Terbinafine versus placebo:

Terbinafine is not manufactured as a scalp preparation in the UK and is not known to be available worldwide.

Substantive changes

No new evidence

2007; 2007: 1713.
Published online 2007 July 1.

Ketoconazole

Summary

SYMPTOM SEVERITY Compared with placebo: Ketoconazole may be more effective than placebo at increasing the number of people successfully treated, and at improving symptoms such as erythema, scaling, papules, and pruritus, at 4 weeks ( low-quality evidence ).

Benefits

Ketoconazole versus placebo:

We found no systematic review. We found two small RCTs that compared ketoconazole 2% cream versus placebo and one large RCT that compared ketoconazole 2% gel versus placebo. The first small RCT found that ketoconazole 2% cream improved symptoms (according to a composite clinical score in which 8 sites were graded for erythema, scaling, papules, and pruritus; range not given) compared with placebo after 4 weeks (37 people with seborrhoeic dermatitis; reduction in approximate mean sum of symptom scores from baseline [see comment below]: 19 with ketoconazole cream v 13 with placebo; P value not reported). The second small RCT compared ketoconazole 2% cream plus ketoconazole 2% shampoo versus placebo. It found that ketoconazole 2% cream improved facial symptoms (severity of symptoms graded on a 4 point scale from 0 = none to 3 = severe) compared with placebo after 4 weeks (20 people with seborrhoeic dermatitis of the face, with or without seborrhoeic dermatitis of the scalp, chest, or back [see comment below]; AR for improving by at least one symptom grade from baseline: 90% [9/10] with ketoconazole v 0% [0/10] with placebo; P value not reported).. The third large RCT compared a once daily 2 week course of ketoconazole 2% gel versus placebo (vehicle gel) in people with seborrhoeic dermatitis. Successful treatment was defined as both an erythema and scaling score of 0 (none) if the baseline score was 2 or less (moderate) or a score of 1 or less (mild) if the baseline score was 3 (severe) based on a 4 point scale for erythema and scaling, and an Investigator's Global Assessment score of 0 (clear) or 1 (almost clear), based on a 5 point scale measured at day 28. The RCT found that a significantly greater proportion of subjects were successfully treated with ketoconazole 2% gel compared with placebo after 4 weeks (459 people with seborrhoeic dermatitis; percentage of subjects successfully treated, intention to treat analysis: 25.3% [58/229] with ketoconazole v 13.9% [32/230] with placebo; P value = 0.0014).

Harms

Ketoconazole versus placebo:

Two of the RCTs reported that there were no adverse effects of treatment. One RCT found that there were mild or moderate adverse effects similarly distributed between treatment groups. The RCT reported that treatment related adverse effects in 1% or more of subjects were application site burning (2.6% with ketoconazole gel v 2.6% with placebo gel), erythema (1.7% v 1.3%), and application site reaction (0.4% v 1.7%; between group statistical analysis not reported).

Comment

Ketoconazole versus placebo:

Approximate mean scores were extracted from graphs because data were not tabulated. Of the 20 people with seborrhoeic dermatitis of the face, 16 (80%) also had seborrhoeic dermatitis of the scalp, seven (35%) had chest involvement, and five (25%) had back involvement.

Substantive changes

Ketoconazole (under question on topical treatments for seborrhoeic dermatitis of the face and body in adults) One large RCT added comparing ketoconazole gel versus placebo; benefits and harms data enhanced, recategorised from Unknown effectiveness to Beneficial.

2007; 2007: 1713.
Published online 2007 July 1.

Bifonazole

Summary

SYMPTOM SEVERITY Compared with placebo: Bifonazole cream may be more effective than placebo at improving symptoms and response to treatment at 4 weeks in people with seborrhoeic dermatitis of the face ( low-quality evidence ).

Benefits

Bifonazole versus placebo:

We found no systematic review. We found one RCT which compared bifonazole 1% cream versus placebo. It found that significantly more people responded to treatment (global improvement graded on a 4 point scale from 0 = no improvement or worsening to 3 = healing) with bifonazole compared with placebo at 4 weeks (100 people with seborrhoeic dermatitis of the face; AR for healing: 16/37 [43%] with bifonazole v 10/43 [23%] with placebo; AR for improvement: 20/37 [54%] with bifonazole v 26/43 [61%] with placebo; AR for treatment failure: 1/37 [3%] with bifonazole v 7/43 [16%] with placebo; overall P value = 0.044; P values for individual outcomes not reported).

Harms

Bifonazole versus placebo:

The RCT reported more minor adverse effects of treatment (including itch, burning, tightness, erythema, papules, and scaling) with bifonazole than with placebo (5/50 [10%] with bifonazole v 2/50 [4%] with placebo; P value not reported)..

Comment

None.

Substantive changes

No new evidence

2007; 2007: 1713.
Published online 2007 July 1.

Topical corticosteroids (hydrocortisone, betamethasone valerate, clobetasone butyrate, mometasone furoate, clobetasol propionate)

Summary

We found no direct information about whether topical corticosteroids (hydrocortisone, betamethasone valerate, clobetasone butyrate, mometasone furoate, or clobetasol propionate) are better than no active treatment for seborrhoeic dermatitis of the scalp in adults. There is consensus that short courses of topical corticosteroids used episodically are effective in treating seborrhoeic dermatitis of the face and body in adults.

Benefits

Topical corticosteroids versus placebo:

We found no systematic review or RCTs comparing topical corticosteroids (hydrocortisone, betamethasone valerate, clobetasone butyrate, mometasone furoate, or clobetasol propionate) versus placebo in adults with seborrhoeic dermatitis of the face and body.

Harms

Topical corticosteroids versus placebo:

We found no RCTs.

Comment

Although we found no RCTs of topical corticosteroids in adults with seborrhoeic dermatitis of the face or body, consensus regards their use as effective. It is current practice to use short courses of topical corticosteroids episodically in seborrhoeic dermatitis. Affected areas of the body are treated with short courses of potent topical corticosteroids (betamethasone valerate [0.1%], mometasone furoate [0.1%]) while the face is treated with short courses of moderate (clobetasone butyrate [0.05%]) or low potency (hydrocortisone [1%]) corticosteroids.

Substantive changes

No new evidence

2007; 2007: 1713.
Published online 2007 July 1.

Emollients

Summary

We found no direct information about whether emollients are better than no active treatment in adults with seborrhoeic dermatitis of the face and body.

Benefits

Emollients versus no treatment:

We found no systematic review or RCTs of sufficient quality comparing emollients versus no treatment in adults with seborrhoeic dermatitis of the face and body.

Harms

Emollients versus no treatment:

We found no RCTs.

Comment

None.

Substantive changes

No new evidence

2007; 2007: 1713.
Published online 2007 July 1.

Lithium succinate

Summary

SYMPTOM SEVERITY Compared with placebo: Lithium succinate cream may be more effective than placebo at improving overall clinical impression, severity of redness, scaling, and greasiness in adults with seborrhoeic dermatitis of the face and body ( very low-quality evidence ).

Benefits

Lithium succinate versus placebo:

We found no systematic review or RCTs of sufficient quality comparing lithium succinate versus placebo in adults with seborrhoeic dermatitis of the face and body (see comment below).

Harms

Lithium succinate versus placebo:

We found no RCTs of sufficient quality.

Comment

We found one crossover RCT (30 people with seborrhoeic dermatitis of the face and/or the trunk) which compared lithium succinate 8% cream versus placebo. It found that lithium succinate significantly improved symptoms (graded on a 100 mm scale on severity of redness, scaling, greasiness, and overall clinical impression of the condition) compared with placebo (results not pre-crossover). However, these results should be interpreted with caution because of the potential for persistence of effects after crossover. The RCT also had a high withdrawal rate (37%) and it is not clear whether the analyses were conducted on an intention to treat basis. Withdrawals were due to non-compliance (2 people with lithium succinate, 3 with placebo), local stinging sensation and erythema (1 person with lithium succinate, 2 with placebo), worsening of acne vulgaris (1 person with lithium succinate, 1 with placebo), or resolution of lesions (1 person, group not reported).

Substantive changes

No new evidence

2007; 2007: 1713.
Published online 2007 July 1.

Selenium sulphide

Summary

We found no direct information about whether selenium sulphide is better than no active treatment in adults with seborrhoeic dermatitis of the face and body.

Benefits

Selenium sulphide versus placebo:

We found no systematic review or RCTs.

Harms

Selenium sulphide versus placebo:

We found no RCTs.

Comment

None.

Substantive changes

No new evidence

2007; 2007: 1713.
Published online 2007 July 1.

Terbinafine

Summary

We found no direct information about whether terbinafine is better than no active treatment in adults with seborrhoeic dermatitis of the face and body.

Benefits

Terbinafine versus placebo:

We found no systematic review or RCTs.

Harms

Terbinafine versus placebo:

We found no RCTs.

Comment

None.

Substantive changes

No new evidence


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