INTRODUCTION
Seborrheic dermatitis (SD) is a chronic, relapsing inflammatory condition that predominantly affects sebaceous gland-rich areas such as the scalp, face, and chest.1 Characterized by erythematous scaly patches, SD affects up to 5% of the general population and has a higher prevalence in individuals with immunosuppression or neurologic disease.2 SD arises from multifactorial interactions among sebaceous activity, Malassezia colonization, immune dysregulation, and barrier dysfunction.3 First-line therapies (topical corticosteroids and topical antifungals) often achieve short-term control but are limited by frequent relapse and adverse effects such as atrophy and telangiectasia.4 These challenges highlight the need for safe, durable alternatives. Emerging evidence supports several adjunctive and off-label options targeting immune modulation, inflammation, microbial balance, and barrier repair (Figure 1). This narrative review synthesizes data across seven such treatments, including topical calcineurin inhibitors (TCIs), metronidazole, phosphodiesterase-4 (PDE4) inhibitors, systemic antifungals, isotretinoin, natural treatments, and microbiome-modulating therapies. Due to length limitations, the full table underlying the summarized results is not included in the manuscript. The complete dataset is available at: https://doi.org/10.6084/m9.figshare.30815681 or from the corresponding author upon request.
Topical Calcineurin Inhibitors
Ten studies (n=367; 9 facial, 1 scalp) evaluated pimecrolimus 1% cream and tacrolimus 0.1% ointment applied twice daily for SD.5-14 Pimecrolimus demonstrated rapid and significant improvement in erythema, scaling, and pruritus, with >80% reduction in composite severity scores reported in multiple studies.5,7,9
Tatlican et al observed a mean cure time of 13.3 days and remission duration of 48 days, while Kim et al reported >85% of patients rated "almost clear" or "clear" after 4 weeks.5,7
Topical Calcineurin Inhibitors
Ten studies (n=367; 9 facial, 1 scalp) evaluated pimecrolimus 1% cream and tacrolimus 0.1% ointment applied twice daily for SD.5-14 Pimecrolimus demonstrated rapid and significant improvement in erythema, scaling, and pruritus, with >80% reduction in composite severity scores reported in multiple studies.5,7,9
Tatlican et al observed a mean cure time of 13.3 days and remission duration of 48 days, while Kim et al reported >85% of patients rated "almost clear" or "clear" after 4 weeks.5,7
