Topical antifungals for seborrhoeic dermatitis
Okokon EO
Published in Cochrane Database of Systematic Reviews
Methodology
Cochrane systematic review and meta-analysis of randomised trials of topical antifungals (ketoconazole, ciclopirox, bifonazole, clotrimazole, miconazole, lithium) versus placebo, vehicle, steroids or each other in seborrhoeic dermatitis, with risk ratios for failed clearance or remission and for adverse events.
Key Findings
This Cochrane review of topical antifungals for seborrhoeic dermatitis included 51 trials with 9052 participants, 45 of which assessed outcomes at five weeks or less. Ketoconazole 2% cut the risk of failed clearance by 31% versus placebo (risk ratio 0.69, 95% CI 0.59 to 0.81, eight studies, low quality evidence) against a 69% failure rate on placebo, and ciclopirox 1% reduced failed remission (RR 0.79, 95% CI 0.67 to 0.94, moderate quality). Ketoconazole matched topical steroids for remission (RR 1.17, 95% CI 0.95 to 1.44) with 44% fewer side effects (RR 0.56, 95% CI 0.32 to 0.96), and performed similarly to ciclopirox (RR 1.09, 95% CI 0.95 to 1.26). A small trial of lithium versus placebo in facial seborrhoeic dermatitis in people with HIV found similar outcomes in both arms.
Conclusions
Ketoconazole and ciclopirox are more effective than placebo, but limited evidence suggests that either of these agents is more effective than any other agent within the same class.
Limitations
Twenty-four of 51 trials had a likely conflict of interest such as pharmaceutical funding, most evidence was low to moderate quality with substantial heterogeneity, and only six trials followed patients beyond five weeks; no study assessed quality of life and only one reported treatment compliance.
Related Health Concerns
Study Details
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