Table 2

Steroids versus antifungals in the treatment of seborrhoeic dermatitis

CitationStudy groupStudy type (level of evidence)OutcomeKey resultsComments
Pari et al (1988) 36 adult patients with face and trunk seborrhoeic dermatitis. Randomised to 2% ketoconazole v 0.05% clobetasol BD for 4 weeksRandomised double blind trial (level 1b)Resolution at 4 weeksEffective remission in both groups (ketoconazole 64.7%, clobetasone 63.2%). ARR −0.015 95% CI –0.33 to 0.30Not applied to scalp (coal tar shampoo given if scalp affected). No comparison of patient characteristics. Small numbers in trial
Recurrence at 3 monthsRecurrence 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 monthsEffective remission in both groups at 1 month (ketoconazole 90%, betamethasone 73%). ARR 0.226 95% CI −0.44 to 0.90Adverse 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
RecurrenceRecurrence 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 weeksRandomised double blind trial (level 1b)Response of seborrhoeic dermatitis at 2 and 4 weeksAt 4 weeks effective remission in both groups (ketoconazole 81%, hydrocortisone 94%). ARR −0.139 95% CI −0.29 to 0.012 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 weeksRandomised double blind trial (level 1b)Resolution at 3 and 6 weeksAt 3 weeks poor remission in all groups (miconazole 33%, hydrocortisone 33%). ARR −0.116 95% CI −0.15 to −0.01No details of randomisation. Interesting look at steroid-fungicide combination
Recurrence after using same solution in patients achieving remission twice monthly for 3 monthsRisk 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 weeksRandomised double blind trial (level 1b)Response at 4 weeksEffective response in both groups (ketoconazole 83%, hydrocortisone 96%). ARR −0.128 95% CI −0.30 to 0.04Low 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 weeksPoor quality cohort study (level 4)Resolution at 4 weeks71% patients cured at 4 weeksNo randomisation or placebo comparator. Experimenters assumed in conclusion that the high rate of cures makes analysis “straightforward and self-evident”