Pari et al (1988)
| 36 adult patients with face and trunk seborrhoeic dermatitis. Randomised to 2% ketoconazole v 0.05% clobetasol BD for 4 weeks | Randomised double blind trial (level 1b) | Resolution at 4 weeks | Effective remission in both groups (ketoconazole 64.7%, clobetasone 63.2%). ARR −0.015 95% CI –0.33 to 0.30 | Not applied to scalp (coal tar shampoo given if scalp affected). No comparison of patient characteristics. Small numbers in trial |
Recurrence at 3 months | Recurrence rates 30% ketoconazole and 50% steroid. ARR 0.180 95% CI −0.13 to 0.49 |
Ortonne et al (1992)
| 62 adult patients with scalp seborrhoeic dermatitis and other locations. Randomised to 2% ketoconazole foaming gel or betamethasone in reducing course over 4 months. | Randomised single blind trial (level 1b) | Resolution at 1 and 4 months | Effective remission in both groups at 1 month (ketoconazole 90%, betamethasone 73%). ARR 0.226 95% CI −0.44 to 0.90 | Adverse effects greater in betamethasone group (52% v 16%) NNT 3 |
At 4 months ketoconazole 89%, betamethasone 62%. ARR 0.290 95% CI 0.09 to 0.49 |
Recurrence | Recurrence rates similar 70% ketoconazole and 86% betamethasone. ARR 0.153 95% CI −0.08 to 0.38 |
Stratigos et al (1988)
| 78 adult patients with seborrhoeic dermatitis. Randomised to 2% ketoconazole cream or 1% hydrocortisone cream OD for 4 weeks | Randomised double blind trial (level 1b) | Response of seborrhoeic dermatitis at 2 and 4 weeks | At 4 weeks effective remission in both groups (ketoconazole 81%, hydrocortisone 94%). ARR −0.139 95% CI −0.29 to 0.01 | 2 week result similar. Low incidence of side effects in both groups. |
Faergemann (1986)
| 70 adult patients with scalp seborrhoeic dermatitis. Randomised to 2% miconazole, 1% hydrocortisone or Daktacort combination OD for 3 weeks and then if no cure for a further 3 weeks | Randomised double blind trial (level 1b) | Resolution at 3 and 6 weeks | At 3 weeks poor remission in all groups (miconazole 33%, hydrocortisone 33%). ARR −0.116 95% CI −0.15 to −0.01 | No details of randomisation. Interesting look at steroid-fungicide combination |
Recurrence after using same solution in patients achieving remission twice monthly for 3 months | Risk of recurrence higher in miconazole group (hydrocortisone 82%, miconazole 33%). ARR 0.452 95% CI 0.22 to 0.67 | |
Katsambas et al (1989)
| 50 adult patients with seborrhoeic dermatitis. Randomised to 2% ketoconazole cream or 1% hydrocortisone cream BD for 4 weeks | Randomised double blind trial (level 1b) | Response at 4 weeks | Effective response in both groups (ketoconazole 83%, hydrocortisone 96%). ARR −0.128 95% CI −0.30 to 0.04 | Low incidence of side effects in both groups. No details of randomisation. No comparison of patient characteristics |
Zeharia et al (1995)
| 36 children from 1 month to 10 years (mean 17 months) with scalp seborrhoeic dermatitis treated with bifonazole 1% shampoo 3 times a week for 4 weeks | Poor quality cohort study (level 4) | Resolution at 4 weeks | 71% patients cured at 4 weeks | No randomisation or placebo comparator. Experimenters assumed in conclusion that the high rate of cures makes analysis “straightforward and self-evident” |