Is clotrimazole effective against seborrheic dermatitis?

Clotrimazole is a medication that is used to treat fungal infections. It comes in a variety of formulations, including in the form of cream, ointment or pessary tablet. This broad-spectrum antifungal drug can be used to treat a variety of fungal infections, including vaginal yeast infections, ringworm, and athlete’s foot.

Clotrimazole is also one of the most common over-the-counter antifungal medication used to treat seborrheic dermatitis. Lab and human studies show that it has antifungal activity against Malassezia. Clotrimazole can improve seborrheic dermatitis symptoms in 3 days. 

Let’s take a deep dive:

What is clotrimazole?

Clotrimazole is an antifungal drug that belongs to the same family of drugs as fluconazole (Diflucan), miconazole (Micatin, Monistat), and itraconazole (Sporanox). Clotrimazole prevents growth of several types of fungi by poking holes in the fungal cell membranes, causing its insides to leak out (gross!).

Clotrimazole is most commonly used topically on the skin or inserted vaginally to treat local fungal infections due to Candida albicans but is also active against other fungi like Malassezia, Tricophyton and Microsporum.

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To be clear:

Is clotrimazole an antifungal?

Clotrimazole is a broad-spectrum antifungal medication that can be used to treat a range of skin and vaginal fungal infections like vaginal thrush, tinea corporis, tinea versicolor, athlete’s foot and ringworm.

Lotrimin is a popular antifungal brand that sells clotrimazole creams for athlete’s foot and ringworm but they are actually the exact same cream.

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Is clotrimazole an antibiotic?

Azoles have some activity againts gram positive bacteria but its antibacterial action is weak. Clotrimazole is not classed as an antibiotic and will never be used to treat bacterial infections.

Is clotrimazole a steroid?

Clotrimazole itself is purely an antifungal medication and has no immunosuppressant properties. However, some brands combine clotrimazole with a steroid medication like betamethasone and hydrocortisone to suppress local inflammation and itching.

Is clotrimazole effective against Malassezia?

While most of clotrimazole’s research is in the treatment of candida infections, there is strong lab evidence that clotrimazole is active against Malassezia as well.

There is even a guinea pig study showing that clotrimazole improves Malassezia-induced dermatitis after 3 days.

In humans, a double-blind study compared clotrimazole to Whitfield ointment, which is a benzoic and salicylic acid combo in the treatment of pityriasis versicolor. For those who are not familiar, pityriasis versicolor is also caused by Malassezia but doesn’t involve the same inflammatory mechanisms as seborrheic dermatitis.

Anyway, this study showed that clotrimazole was just as effective as Whitfield ointment and was better tolerated. They also found repeated treatment with clotrimazole did not reduce its efficacy, suggesting that Malassezia doesn’t build a resistance to the agent.

Does antifungal cream work on seborrheic dermatitis?

You may have heard time and again that seborrheic dermatitis is not a fungal infection. This is true. So why is antifungal cream one of the first treatments prescribed for SD?

Antifungal creams work on seborrheic dermatitis because Malassezia, a common fungus that lives on our skin, plays a pivotal role in the condition. Time and again, studies as well as real-life experience have shown that when the number of Malassezia present on the skin is reduced, it improves seborrheic dermatitis.

That is why a large tube of antifungal cream is the only cream most people need to treat your seborrheic dermatitis.

Find out more about how Malassezia affects the skin and causes seborrheic dermatitis.

Can you use clotrimazole cream for seborrheic dermatitis?

Ketoconazole is the most studied antifungal agent for treatment of seborrheic dermatitis and dandruff. In comparison studies, ketoconazole was also found to be the most effective. However, there is also strong evidence that clotrimazole is effective against Malassezia.

Even though there are minimal human studies on clotrimazole and seborrheic dermatitis, it is one of the most common over-the-counter antifungal creams used for SD. This is because ketoconazole creams are prescription-only. People all over the world have found relief with the cream. Certainly, in my own experience, I’ve used clotrimazole for seborrheic dermatitis successfully time and again.

Just be aware that it’s not a cure. Your SD will likely flare again when triggered. In fact, most doctors consider seborrheic dermatitis incurable. I disagree. However, a cure involves much more than topical creams. You’ll need to dig deeper to make significant lifestyle and diet changes.

How to use clotrimazole cream for seborrheic dermatitis

First and foremost, make sure you buy clotrimazole cream rather than the 2-in-1 clotrimazole and steroid cream. You’ll know it from the list of ingredients. If it lists a ‘-sone’, for example, bethamethasone, hydrocortisone or clobethasone, that’s a steroid.

You can use clotrimazole on your face and anywhere you need to from your neck downwards.

Using clotrimazole on your face

Apply Clotrimazole cream twice a day to freshly-cleaned affected areas. If like me, your SD affected both your T-zone and U-zone, apply a thin layer over your whole face. Leave it on for a few minutes to absorb. There is no need to wash it off.

You can apply serums, moisturizers, and other creams on top once it’s absorbed.

Using clotrimazole on the scalp

The most common formulation for clotrimazole is as a cream. Even though it will probably work on your dandruff, applying creams on the scalp can be messy. You’re better off using a ketoconazole or zinc pyrithione shampoo like Head & Shoulders.

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How quickly does clotrimazole work?

A guinea pig study found that clotrimazole improved Malassezia-induced dermatitis after 3 days of regular use. Anecdotally, myself and others have noticed similar results. Even after 2 applications, my skin was less inflammed. By day 3, I usually have less scaling. By day 5, there is often no outward sign of SD although my skin could still feel itchy sometimes.

Even though your symptoms have improved (and maybe even resolved), it’s recommended that you use clotrimazole regularly for 2 weeks to ensure proper erradication of Malassezia. To be fair, you don’t actually erradicate them totally. Malassezia is a permanent resident on your skin. But the lower the levels of Malassezia, the longer it will take them to grow to the extent where they may cause problems again.

Ketoconazole vs clotrimazole for seborrheic dermatitis

Ketoconazole and clotrimazole belong to the same antifungal family. However, ketoconazole has more research backing it up for treatment of seborrheic dermatitis and dandruff. It has also been found to be more effective than clotrimazole for Malassezia and seborrheic dermatitis.

Clotrimazole is mostly found in cream or pessary formulations while ketoconazole is available in cream and shampoo form. However, my preferred cream is clotrimazole because it works well enough and can be bought without a prescription. Ketoconazole cream is only available through a doctor’s prescription.

Unfortunately, clotrimazole doesn’t come in a shampoo form for treatment of scalp SD or dandruff. Ketoconazole 1% shampoo can be bought over-the-counter but if you want the stronger ketoconazole 2% shampoo which is more effective, you’ll need a script.

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Clotrimazole vs miconazole for seborrheic dermatitis

In lab studies, both clotrimazole and miconazole have been found to have antifungal activity against Malassezia and were just as effective as each other. The creams look, feel and smell the same and both are well-tolerated. Anecdotally, I’ve tried both and found clotrimazole more effective for my SD but you can try either.

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Side effects of clotrimazole

Clotrimazole is generally well tolerated. However, if you have sensitive skin, it may cause skin irritation or redness. If your skin is already inflammed and weeping from SD, you may feel burning and stinging.

What happens if you use too much clotrimazole?

For the most part, using too much clotrimazole will leave you with nothing more than a smear of unabsorbed cream on your face. In some people, it may make your skin irritated or red.

I wouldn’t worry about ‘overdosing’ on clotrimazole cream. But you’ll find that a thin layer of cream on your skin is more than enough to treat SD without leaving your skin feeling greasy heavy. Less is more, as always.

Can clotrimazole thin the skin?

Clotrimazole doesn’t thin the skin. In fact, because it’s reducing Malassezia levels on your skin and reducing inflammation, this gives your skin the chance to repair the skin barrier.

However, if you use a Clotrimazole-steroid combination cream, the steroid component will most definitely thin your skin with repeated use. That’s another reason to throw steroid creams in the bin.

To wrap up

Clotrimazole is my go-to antifungal cream, not just for seborrheic dermatitis but for pityriasis versicolor, candida rash and even athlete’s foot. It’s cheap, freely available and like white vinegar, should be in every household.