Seborrheic dermatitis is a chronic inflammatory skin condition associated with an inflammatory response to Malassezia yeast, with common involvement of the scalp, face, and other sebaceous areas.¹ Many treatment plans rely on topical antifungals such as ketoconazole shampoo or cream, often combined with short courses of topical corticosteroids to reduce inflammation.¹ While this approach can help both yeast burden and inflammation, seborrheic dermatitis commonly relapses and often requires maintenance therapy.¹ Chronic or repeated topical corticosteroid exposure, especially on thinner skin such as the face, can increase the risk of adverse effects including skin atrophy, telangiectasias, steroid-induced rosacea, and rebound flares.² We offer several steroid-sparing alternatives for patients with incomplete control, frequent relapses, or concerns about long-term steroid use.

Tacrolimus (Protopic) – Tacrolimus 0.1% ointment is a topical calcineurin inhibitor used off-label for seborrheic dermatitis, particularly facial disease where long-term topical corticosteroid use is problematic.^1,3 In a randomized trial of adults with facial seborrheic dermatitis, tacrolimus 0.1% ointment produced clinical improvement comparable to hydrocortisone 1% ointment while requiring fewer applications.³ Proactive twice-weekly tacrolimus maintenance therapy has also been shown to help keep stabilized facial seborrheic dermatitis in remission and reduce recurrence compared with vehicle.⁴ Because tacrolimus is not a corticosteroid, it avoids steroid-related skin thinning, although transient burning or stinging can occur in some patients.^1,2

Roflumilast (Zoryve) – Roflumilast is a topical phosphodiesterase-4 (PDE4) inhibitor that provides a nonsteroidal anti-inflammatory option for seborrheic dermatitis.^5,7 For seborrheic dermatitis, the FDA-approved formulation is Zoryve topical foam 0.3%, indicated for adults and pediatric patients 9 years of age and older; Zoryve cream 0.15% is FDA-approved for mild-to-moderate atopic dermatitis in patients 6 years and older, and Zoryve cream 0.05% is approved for mild-to-moderate atopic dermatitis in pediatric patients 2 to 5 years of age.^5,6 In phase 2a and phase 3 randomized vehicle-controlled trials, once-daily roflumilast foam 0.3% significantly improved seborrheic dermatitis signs and itch and was generally well tolerated.^7,8 For appropriate patients, it can be used as a steroid-sparing option on affected scalp, facial, and body areas where repeated corticosteroid exposure is undesirable.^2,5,7,8

Ciclopirox shampoo – Ciclopirox is a broad-spectrum antifungal with anti-inflammatory properties, making it useful for scalp seborrheic dermatitis where both Malassezia activity and inflammation contribute to symptoms.^9,10 Randomized clinical studies support ciclopirox shampoo for reducing scaling, inflammation, and itching in scalp seborrheic dermatitis.^9,11 In a large multicenter trial, ciclopirox 1% shampoo used once or twice weekly improved scalp seborrheic dermatitis, and continued intermittent use reduced relapse rates during maintenance therapy.¹¹ In a comparative shampoo trial, ciclopirox olamine 1.5% was superior to placebo and at least as effective as ketoconazole 2% shampoo for scalp seborrheic dermatitis.¹⁰ Ciclopirox is therefore a strong alternative for patients who have not achieved adequate control with ketoconazole or who need a different antifungal maintenance strategy.^1,10,11

We create individualized regimens that target inflammation and fungal overgrowth while minimizing cumulative corticosteroid exposure.^1,2 By combining steroid-sparing anti-inflammatory agents with effective antifungal maintenance therapy, our goal is durable symptom control without the avoidable risks of chronic topical steroid use.^1,2,4,5,8,11

References

1. Clark GW, Pope SM, Jaboori KA. Diagnosis and treatment of seborrheic dermatitis. Am Fam Physician. 2015;91(3):185-190. Accessed June 6, 2026. https://www.aafp.org/pubs/afp/issues/2015/0201/p185.html
2. Stacey SK, McEleney M. Topical corticosteroids: choice and application. Am Fam Physician. 2021;103(6):337-343. Accessed June 6, 2026. https://www.aafp.org/pubs/afp/issues/2021/0315/p337.html
3. Papp KA, Papp A, Dahmer B, Clark CS. Single-blind, randomized controlled trial evaluating the treatment of facial seborrheic dermatitis with hydrocortisone 1% ointment compared with tacrolimus 0.1% ointment in adults. J Am Acad Dermatol. 2012;67(1):e11-e15. doi:10.1016/j.jaad.2011.02.032
4. Kim TW, Mun JH, Jwa SW, et al. Proactive treatment of adult facial seborrhoeic dermatitis with 0.1% tacrolimus ointment: randomized, double-blind, vehicle-controlled, multi-centre trial. Acta Derm Venereol. 2013;93(5):557-561. doi:10.2340/00015555-1532
5. ZORYVE (roflumilast) topical foam, 0.3%, for topical use [prescribing information]. Arcutis Biotherapeutics, Inc; revised May 2025. Accessed June 6, 2026. FDA prescribing information
6. ZORYVE (roflumilast) cream 0.3%, 0.15%, 0.05%, for topical use [prescribing information]. Arcutis Biotherapeutics, Inc; revised October 2025. Accessed June 6, 2026. FDA prescribing information
7. Zirwas MJ, Draelos ZD, DuBois J, et al. Efficacy of roflumilast foam, 0.3%, in patients with seborrheic dermatitis: a double-blind, vehicle-controlled phase 2a randomized clinical trial. JAMA Dermatol. 2023;159(6):613-620. doi:10.1001/jamadermatol.2023.0846
8. Blauvelt A, Draelos ZD, Stein Gold L, et al. Roflumilast foam 0.3% for adolescent and adult patients with seborrheic dermatitis: a randomized, double-blinded, vehicle-controlled, phase 3 trial. J Am Acad Dermatol. 2024;90(5):986-993. doi:10.1016/j.jaad.2023.12.065
9. Altmeyer P, Hoffmann K; Loprox Shampoo Dosing Concentration Study Group. Efficacy of different concentrations of ciclopirox shampoo for the treatment of seborrheic dermatitis of the scalp: results of a randomized, double-blind, vehicle-controlled trial. Int J Dermatol. 2004;43(suppl 1):9-12. doi:10.1111/j.1461-1244.2004.02381.x
10. Ratnavel RC, Squire RA, Boorman GC. Clinical efficacies of shampoos containing ciclopirox olamine 1.5% and ketoconazole 2.0% in the treatment of seborrhoeic dermatitis. J Dermatolog Treat. 2007;18(2):88-96. doi:10.1080/16537150601092944
11. Shuster S, Meynadier J, Kerl H, Nolting S. Treatment and prophylaxis of seborrheic dermatitis of the scalp with antipityrosporal 1% ciclopirox shampoo. Arch Dermatol. 2005;141(1):47-52. doi:10.1001/archderm.141.1.47