Topical Antifungals

A topical antifungal may be applied to reduce the number of yeast present. This means that the medication is fungistatic (inhibits the growth of yeast) as opposed to being fungicidal (destroys the yeast already present). Some specific antifungals include:

Ketoconazole is available in an over-the-counter 1% concentration and a 2% strength that is available by prescription only. It is available in gel, cream, foam, and shampoo formulations. While ketoconazole is effective, some patients have reported irritation, itching, and burning as some of the more common adverse events.

Ciclopirox is a common antifungal medication that is found in shampoos and skin products. A small number of patients have reported irritation, itching, and burning associated with its use.

Corticosteroids

Topical corticosteroids help alleviate the annoying symptoms of SD by reducing inflammation and itching. As a result of their potential side effects (eg, skin damage, excessive hair growth, increased susceptibility to infection, high blood sugar, and suppression of certain hormones), these medications are recommended only for the short-term, periodic treatment of SD flares. Healthcare professionals typically recommend the corticosteroid that is just strong enough to effectively control symptoms. As SD is a chronic condition that comes and goes, there is concern about long-term corticosteroid use and the risk for skin damage and systemic issues.

Calcineurin Inhibitors

When other therapies are ineffective or not well tolerated, calcineurin inhibitor creams may be an option for short-term use. These medications have been shown to lower the body’s immune system activity as a means for achieving symptom relief. It is because of this mechanism of action that they are reserved for those patients who have not found effective relief with other more benign therapies.  These topical treatments can often burn on application, especially when used on the face.

Shampoos

When SD affects hairy areas, especially the scalp, symptomatic relief is best derived from therapeutic shampoos. As this is a chronic condition, patients are often told to alternate between two types of shampoos when the effectiveness of one shampoo is lost. It is also important that these shampoos be left on the scalp for a period of time, as directed in the product’s labeling, to allow the ingredients to work.

Some common ingredients in these shampoos include Selenium sulfide, a key ingredient that is typically found in prescription strength products. Hair color lightening and scalp irritation are two of the most commonly reported adverse reactions. Zinc pyrithione, found in many over-the-counter shampoos and is sometimes found to be irritating. Coal tar is another common active ingredient. Salicylic acid has been shown to loosen upscales on the scalp and is a relatively mild compound.