Seborrheic Dermatitis is a chronic disease, so, it requires long-term maintenance treatment. Currently, there is no gold standard treatment of Seborrheic Dermatitis because the exact etiology is not clear. Since the pathogenesis of Dermatitis is the combination of various things, so antifungal and anti-inflammatory (particularly corticosteroids) are still the treatment options.

The management of seborrheic dermatitis requires special attention. The patient can be asked about the preferred vehicle and tailored to the patient's activities and habits. Treatment regimens, product prices, and the patient's motivation and knowledge of optimal health affect patient adherence.

The management of seborrheic dermatitis lesions in hairy areas is often different from that of hairless regions. Seborrheic dermatitis is generally treated with topical preparations: creams, foams, sprays, gels, shampoos, and other hair washes.

Additional treatments that serve as adjuvants or alternatives to standard drugs include various cosmetic products with varying clinical trial results. The advantages of this product are generally rarely or without side effects when compared to prescription drugs.

In one product, there are generally one or more ingredients with softening benefits and mild anti-inflammatory effects. The difference between drugs and cosmetic products is the concentration of active ingredients. The use of non-prescription products is a useful treatment option, especially for the facial area.

Products can be the first alternative, especially for patients who are reluctant to use conventional medicine. The cream containing emollients will moisturize dry skin and promote healing.

Moisturizer in the adjuvant treatment of Nonscalp Seborrheic Dermatitis

Moisturizer is good for hydrating the skin of Seborrheic Dermatitis patients, is non-irritating, and accelerates healing. Moisturizer is a mixture of various chemicals to soften the skin and increase the skin's moisture content. Moisturizer should be used at least 1/2 ounce or 50 grams for the entire body except for the face and skin folds, with a frequency of twice a day. Moisturizer is applied in the direction of hair growth to produce soft skin. Apply it, preferably after bathing when the skin is still damp and helps absorption so that the tissue's hydration is better. Moisturizers are found in various formulas, such as lotions, creams, ointments, and pastes. The difference is in the water content.
Creams have less water than lotions, and most of the lipids they contain can treat dry skin without feeling greasy.

The choice of preparation also depends on the environment; for example, use the ointment is better in winter and applying cream in spring. Creams are applied more often than ointments, and ointments are more oily because they tend not to be absorbed by the skin.

Moisturizers are divided into several types based on their character;  emollient, humectant, occlusive, and therapeutic. The use Emollients to soften and smooth the skin by filling in the spaces or gaps between the desquamated corneocytes so that the skin surface becomes smooth and increases cohesion. The edges of the corneocytes are flat reduces friction.

Other types of moisturizers are humectants, lipophilic materials capable of drawing water from a humid external environment, and epidermis, depending on the environment's moisture content, such as sodium hyaluronic urea and alpha-hydroxy acids.

The occlusive moisturizer will coat the stratum corneum. It retains water in the skin by slowing down transepidermal water loss (TEWL). Occlusive moisturizers are found in petrolatum, mineral oil, paraffin, and squalene.

The ointment containing petrolatum and applied daily is useful in seborrheic dermatitis to soften the scale so that it is easily exfoliated, especially in infants.

Therapeutic moisturizers have various properties, namely occlusive ingredients to repair the skin barrier, emollients to soften and smooth the skin, and humectants to retain water in the stratum corneum. The combination of the various properties of a therapeutic moisturizer makes the therapeutic moisturizer better than other moisturizers. 

Various active ingredients in the adjuvant treatment of Nonscalp Seborrheic Dermatitis

The vehicle used for the management of seborrheic dermatitis is available in various forms. The dosage form's choice is determined by the severity of the case, the location of the disorder, and the patient's preference. The form that is generally preferred for non-scalp areas in the tropics is light and non-greasy preparations such as cream because it is convenient to use, including for folds. The addition of various active ingredients to preparations used as adjuvants for maintenance therapy in seborrheic dermatitis management plays a role in the success of treatment and prevention of recurrences. Active ingredients in cosmetic products as adjuvant DS therapy include:

18β-Glycirrhetinic acid.
18β-Glycirrhetinic acid (Enoxolone) has anti-inflammatory, anti-irritant, allergy, and antiviral properties. A randomized comparative study tested a shampoo containing β-Glycirrhetinic acid in ciclopirox olamine and Zinc pyrithione, with significant clinical improvement results (p <0.0001), namely reduced erythema, dandruff, and reduced number of Malassezia spp on the skin surface within two weeks.

Anethum graveolens.
It is a herbal plant from the Apiaceae or Umbelliferae family. Based on a double randomized comparative study in 115 patients with facial seborrheic dermatitis, the use of Anethum graveolens can avoid recurrence. After eight weeks of use, recurrence was lower (21%) than controls (40%). This may be due to the effect of the toll-like receptor (TLR) regulation.

Emu oil.
Derived from the emu (Dromaius novahollandiae) adipose tissue, it has antioxidant and anti-inflammatory properties. A randomized controlled study on 126 patients with seborrheic dermatitis on the face proved that 20% of emu oil is useful for reducing itching and erythema. However, the effectiveness is lower than clotrimazole 1% and hydrocortisone 1%.

Hyaluronic acid.
It is a non-sulfate anionic glycosaminoglycan found in connective tissue, epithelium, and nerve tissue. A prospective study that administered 0.2% hyaluronic acid sodium salt gel to DS patients with facial lesions twice a day after washing the face resulted in improvements in the form of a reduction in scale (76%), erythema (64%), and complaints of itching (50%).

Lithium gluconate.
 Lithium gluconate is a monovalent cation, efficacious in Seborrheic Dermatitis patients with facial lesions twice a day after washing face, resulted in thought to be anti-inflammatory. Based on a multicentre randomized study in 289 patients with facial seborrheic dermatitis, the effectiveness of lithium gluconate ointment was 8% (52%) higher than ketoconazole emulsion 2% (30.1%). The safety of the two products was similar.23 A double randomized, placebo-based study resulted in a 90.9% remission of the 8% lithium gluconate ointment group versus 54.7% of the control group.

Including the water-soluble amides in nicotinic acid. Shows inhibition of sebocyte secretion and anti-inflammatory effects in a dose-dependent manner. In an open randomized study, 48 patients treated once daily using 4% nicotinamide cream had a 75% reduction in the observed total score.

Propylene glycol.
It is a non-aromatic material with the properties of a humectant, hygroscopic, and has absorbency. It has been used as an alternative to corticosteroids in the management of scalp seborrheic dermatitis. Other benefits of this material were also found, namely, significantly reducing the colony of Pityrosporum orbiculare after using solution therapy containing propylene glycol in Seborrheic Dermatitis patients scalp.

Quassia Amara.
It is an ingredient rich in triterpenoid quassinoids. It can be useful as an antimicrobial, antifungal, and anti-inflammatory. A closed double randomized comparative study found that a gel containing 4% Quassia extract was quite effective, safe, and tolerable for managing seborrheic dermatitis on the face. This material resembles 2% ketoconazole gel or ciclopirox olamine gel.

Tar has antifungal and anti-inflammatory properties and can reduce sebum. Fungistatic activity in in vitro studies was comparable to that of ketoconazole. Tar shampoo has been used frequently, although the evidence for its effectiveness is lacking.

 Tea tree oil.
It is derived from the Melaleuca alternifolia (Narrow-leaved paperbark) tree, which is useful as an antimicrobial and anti-inflammatory. This material was found to provide better clinical improvement from a closed randomized study of patients with scalp Seborrheic Dermatitis than placebo. Although considered safe, tea tree oil is limited due to its possible estrogenic and anti-androgenic effects.

Other natural ingredients. Allantoin, Aloe vera, Borago officinalis, Burdock, Echinacea purpurea (Purple coneflower), Incense, Lactoferrin, Potassium alum, Retinyl palmitate, salicylic acid, Tarassaco, and vitamin E can also be used to treat Seborrheic Dermatitis or similar conditions through their role as a moisturizer, keratolytic, anti-inflammatory, antioxidant, immunological, antimicrobial, antifungal, regulation of sebum and itching. However, studies on the efficacy and mechanism of action are not yet known.