Efficacy

We found no systematic review. Ketoconazole

We found six double-blind placebo-controlled trials using cream or shampoo.5-10 The largest trial using 2% ketoconazole shampoo (n = 565) reported an excellent response in 88% of the patients treated and effectiveness in preventing relapses when used prophylactically once a week.5 A randomised controlled trial (RCT) comparing 2% ketoconazole shampoo with 2-5% selenium sulphide shampoo found both treatments to be better than placebo; ketoconazole was statistically superior to selenium sulphide (P = 0-0026) and better tolerated.6 In a double-blind crossover study the change in clinical score with ketoconazole shampoo was significant (P<0-01).7 Two RCTs demonstrated the clinical efficacy of 2% cream compared with placebo in 378 and 209 patients, respectively. One open randomised parallel study showed that the 2% formulation was significantly more effective than a 1% formulation (P<0-001) and that intermittent application of 2% ketoconazole shampoo can successfully prevent relapse.

A long-term prophylactic treatment has to meet a high standard with regard to patient safety.11 The safety of 2% ketoconazole shampoo is supported by absorption studies and by local irritancy and contact sensitivity studies. Ketoconazole shampoo does not influence sebum production but improves its delivery onto the skin surface.12

Bifonazole

We found three double-blind controlled trials and two open studies.13-15 The largest, involving 100 patients, reported that bifonazole 1% cream was significantly better than placebo (P<0-05).13

Ciclopirox olamine

One placebo-controlled double-blind study of ciclopirox olamine 1% cream in facial seborrhoeic dermatitis (57 patients in the ciclopiroxolamine group and 72 in the vehicle group) found a statistically significant (P<0-01) difference between the two treatment groups at the end of the initial phase (twice daily for

QUESTIONS

What are the effects of topical treatment?

28 days) and the maintenance phases (once daily for 28 days).16

Other antifungals

We found one RCT,17 in which the lesions cleared in 11 of 18 eligible patients after treatment with terbinafine 1% solution once daily for 4 weeks. Beneficial effects have been reported in open studies with fluconazole18 and fenticonazole.19

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