Practical Algorithm Guiding Seborrheic Dermatitis Treatment in Adults and Adolescents: New Evidence and Consensus Expert Opinion
November 2026 | Volume 25 | Issue 11 | 1019 | Copyright © November 2026
Published online November 1, 2026
Benjamin Ungar MD,a Andrew Alexis MD MPH,b Anneke Andriessen PhD,c Christopher G. Bunick MD PhD,d Eileen Cheever PA-C,e Adam Friedman MD,f Heather Woolery-Lloyd MD,g Raj Chovatiya MD PhD MSCIh,i
aDepartment of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
bClinical Dermatology, Diversity and Inclusion, Department of Dermatology, Weill Cornell Medicine, New York City, NY
cRadboud Academy; Radboud UMC, Nijmegen and Andriessen Consultants, Malden NL
dYale Institute for Global Health, Yale School of Medicine, New Haven, CT
eClearview Dermatology, Leominster, MA
fThe George Washington University School of Medicine and Health Sciences, Washington, DC
gSkin of Color Division Dr Phillip Frost Department of Dermatology and Cutaneous Surgery University of Miami, Miller School of Medicine Miami, FL
hRosalind Franklin University of Medicine and Science Chicago Medical School, North Chicago, IL
iCenter for Medical Dermatology + Immunology Research, Chicago, IL
Abstract
Background: Seborrheic dermatitis (SD) is a common, chronic inflammatory skin disease characterized by greasy, scaly plaques on the scalp or body, often with pruritus and impaired quality of life. The pathogenesis involves dysbiosis, including Malassezia colonization, excess sebum production, and immune dysregulation with Th17/Th22 activation. Although therapy historically targeted Malassezia, growing evidence supports anti-inflammatory strategies.
Methods: A systematic literature review identified current treatments and management strategies for SD. Of 399 articles screened, 77 met inclusion criteria and informed algorithm development. A draft algorithm was created from these data and refined through a virtual workshop with 6 board-certified dermatologists and 1 physician assistant.
Results: Experts recommended initial evaluation of disease extent and relevant comorbidities or lifestyle factors, along with patient education on disease etiology and scalp/hair care. Management is divided into (1) scalp and (2) face, trunk, or intertriginous involvement. First-line therapy emphasizes anti-inflammatory treatment with topical roflumilast 0.3% foam or corticosteroids. If disease persists, adjunctive antifungals are recommended. For nonscalp areas, alternatives include topicals, calcineurin inhibitors, tapinarof, or ruxolitinib. Recalcitrant or high-impact disease may warrant off-label systemic therapy such as isotretinoin, anti-IL-12/23 biologics, or oral antifungals.
Conclusions: This algorithm integrates an updated understanding of SD pathophysiology, prioritizing anti-inflammatory and immune-modulating therapies in management. It provides a practical framework for clinicians to tailor therapy based on disease location, severity, and response to prior treatment. Future studies are needed to validate outcomes and optimize long-term management strategies in diverse patient populations. Further research should clarify mechanisms and refine targeted therapeutic approaches further.
INTRODUCTION
Seborrheic dermatitis (SD) is a common, chronic inflammatory skin disease that affects approximately 5% of the global population.1 It is characterized by erythematous patches and plaques with white-yellow greasy scale, generally affecting sebaceous gland-rich areas such as the face, scalp, chest, and upper back.2 Mild cases may present with isolated flaking; severe cases may involve erythematous, greasy, scaly plaques on the face and trunk. SD is associated with a significant negative impact on patients.3 In a study evaluating patient-reported level of negative impact of SD, 76% of patients reported some degree of negative impact on their emotional well-being, and 78% reported a significant negative impact on their self-esteem.3
SD pathogenesis has historically been thought to be primarily driven by Malassezia yeast species, with first-line treatment consisting of antifungal therapy.4 However, it has become
