Chronic SD Requires Mechanism-Based Management

Seborrheic dermatitis (SD), long approached through an antifungal-centered paradigm due to the role of Malassezia species, is seeing a shift in therapeutic focus as new insights into disease biology emerge. At the 2026 South Beach Symposium, Benjamin Ungar, MD, highlighted how understanding SD as primarily an inflammatory disorder is reshaping clinical management.

Ungar, assistant professor at the Icahn School of Medicine at Mount Sinai and director of the Rosacea and Seborrheic Dermatitis Clinic in New York City, stressed that inflammation drives disease expression. “One of the things we’ve come to appreciate about seborrheic dermatitis in recent years is that this is fundamentally an inflammatory condition,” he said. Recognition of this underlying inflammation has significant implications for treating a chronic, relapsing disease affecting cosmetically sensitive areas.

Historically, antifungal agents—often paired with topical corticosteroids—have been first-line therapy. While antifungals remain important, particularly for scalp involvement, repeated steroid use carries risks including skin atrophy, telangiectasia, perioral dermatitis, and tachyphylaxis, limiting their suitability for long-term management.

Ungar noted a shift toward steroid-sparing, nonsteroidal anti-inflammatory therapies. “Fortunately, we’re entering an era where there are effective anti-inflammatory nonsteroidal treatments, and that’s typically where I go,” he explained. These agents target inflammation directly, reducing reliance on corticosteroids and their cumulative adverse effects.

He emphasized that antifungal and barrier-targeted therapies remain valuable adjuncts, especially in patients with triggers such as fungal colonization or barrier dysfunction. “At the core, because it’s inflammatory, that really should be the approach that we take toward treating this,” Ungar said.

For most patients, including those with neurologic disease or immunocompromise, topical anti-inflammatory therapies are sufficient. More refractory cases may require individualized escalation beyond standard topical therapy.

Looking ahead, Ungar expressed optimism about emerging therapies. As mechanistic understanding deepens, novel treatments with diverse modes of action may provide additional options for patients who do not achieve sufficient control with current approaches. This evolving framework positions SD alongside other chronic inflammatory dermatoses, reinforcing the importance of long-term, mechanism-based management rather than episodic symptom suppression.