In people with seborrheic dermatitis, skin can become discolored, itchy, and flaky, especially on the scalp, face, or chest. Although the exact cause of this condition isn’t clear, researchers know that inflammation plays a big role. That’s why healthcare providers may recommend anti-inflammatory topical treatments — medicines you put on your skin — to help calm the irritation.

There are several kinds of anti-inflammatory topicals for seborrheic dermatitis, such as corticosteroids, calcineurin inhibitors, and phosphodiesterase 4 (PDE4) inhibitors. These treatments help reduce swelling and discoloration, and they may be used along with antifungal creams or shampoos.

Read on for seven key facts about anti-inflammatory topical medications for seborrheic dermatitis.

1. Corticosteroids Help Reduce Inflammation

Corticosteroids are medications that are similar to the human hormone cortisol. In the body, cortisol helps lower inflammation. Corticosteroids work to reduce the inflammation that happens with skin conditions such as seborrheic dermatitis. They also narrow blood vessels, which helps keep inflammatory proteins from reaching the skin.

Your doctor or dermatologist may recommend topical corticosteroids that you can get over the counter (OTC) at grocery stores or pharmacies. The most common OTC topical corticosteroid is hydrocortisone cream, which is available in 0.5 percent to 1 percent strengths. Always check with your doctor before using topical steroids for seborrheic dermatitis.

Prescription topical corticosteroids are stronger than OTC types and may be recommended for the scalp, face, and body. Examples include:

• Betamethasone
• Clobetasol
• Desonide
• Fluocinolone (Derma-Smoothe/FS, Synalar)

Due to the risk of serious side effects, your healthcare provider will likely start you with a lower-potency corticosteroid for the shortest time needed before trying stronger options.

2. Calcineurin Inhibitors Help Prevent Inflammation

Calcineurin inhibitors, such as tacrolimus (Protopic) and pimecrolimus (Elidel), are another topical anti-inflammatory used to treat seborrheic dermatitis. These medications block the activity of immune cells in the skin, reducing and preventing inflammation.

Dermatologists often prescribe these calcineurin inhibitors instead of corticosteroids because they tend to have fewer side effects and don’t cause skin atrophy (thinning of the skin), which is a risk with corticosteroids. Topical calcineurin inhibitors may be a good option for seborrheic dermatitis on the face and may be safe for sensitive areas, such as the eyelids, neck, and genitals.

3. Topical Anti-Inflammatories Come in Different Forms

Topical anti-inflammatories for seborrheic dermatitis come in forms that help them get absorbed better into the skin so they’re more effective. These forms may include:

• Lotions — Good for skin with hair because they spread easily and usually aren’t greasy
• Creams — Thicker than lotions and don’t leave residue, which can be good for treating seborrheic dermatitis in skin folds
• Ointments — Better for areas with thick skin (like the palms of the hands or the soles of the feet), but not typically used on the scalp because their high oil levels can cause folliculitis (inflammation of hair follicles)
• Foams — Ideal for scalp treatment
• Shampoos — Ideal for scalp treatment because they deliver medication to the skin without leaving it greasy

Topical corticosteroids are often prescribed as lotions, creams, foams, ointments, or shampoos. Topical calcineurin inhibitors come in ointments and creams.

4. Topical PDE4 Inhibitors Block Inflammation

Phosphodiesterase 4 inhibitors work by blocking inflammation-causing proteins in the immune system that overreact in people with seborrheic dermatitis. Roflumilast (Zoryve) is the only PDE4 inhibitor approved to treat seborrheic dermatitis, but more options are being studied. Research shows that roflumilast has few side effects and may reduce key inflammatory agents in the immune system in some people with seborrheic dermatitis.

5. Topical Anti-Inflammatory Treatments May Work Well

Study findings suggest that both topical corticosteroids and calcineurin inhibitors can help treat seborrheic dermatitis. One report found that both corticosteroids and calcineurin inhibitors reduced seborrheic dermatitis symptoms compared with placebo, an inactive substance used in clinical trials. Strong prescription steroids were found to be more effective than antifungal agents for reducing itching, discoloration, and scaling.

Other studies have shown that low- to mid-dose corticosteroids improve symptoms better than other treatment options. Researchers have also found that calcineurin inhibitors offer longer-lasting relief from seborrheic dermatitis than corticosteroids.

6. Anti-Inflammatory Topicals Can Have Side Effects

Like all medications, topical anti-inflammatories come with the risk of side effects. Your doctor or dermatologist will carefully prescribe seborrheic dermatitis anti-inflammatory topicals to help avoid these unwanted effects. It’s always essential to use topical treatments exactly as recommended.

Corticosteroids

Topical corticosteroids are generally safe when used short term, and they’re typically recommended to manage flare-ups. Long-term use or high dosages can cause skin damage, such as:

• Skin atrophy
• Increased bleeding and bruising
• Enlarged blood vessels
• Stretch marks
• Increased hair growth
• Fungal skin infections (such as tinea or Malassezia folliculitis)
• Steroid rosacea (skin discoloration)
• Withdrawal symptoms after stopping corticosteroid use

Calcineurin Inhibitors

After starting a topical calcineurin inhibitor, some people experience a burning, irritating, or itching sensation on their skin, which may last around 20 minutes. These symptoms usually go away after a week or so. Sun sensitivity also occurs with these topicals. Other adverse effects may include:

• Skin flushing
• Rosacea-type rash
• Viral or fungal skin infections, such as warts or cold sores
• Clogged pores and folliculitis

PDE4 Inhibitors

Common side effects of roflumilast include:

• Nausea
• Headaches
• The common cold

Always talk with your doctor about potential side effects when trying any new medication.

7. Side Effects of Topical Anti-Inflammatories Can Be Managed

To help prevent side effects, use topical corticosteroids only as directed by your doctor or dermatologist. Don’t use these medications longer than the prescribed time or on areas of the body for which they’re not designed.

Follow up with your doctor or dermatology healthcare team if you experience any uncomfortable side effects.

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