The use of topical metronidazole in the management of seborrheic dermatitis – a systematic review and meta-analysis of randomized controlled trials

Authors

DOI:

https://doi.org/10.15584/ejcem.2024.4.25

Keywords:

dermatitis, meta-analysis, metronidazole, seborrheic

Abstract

Introduction and aim. Topical metronidazole, with its well-known anti-inflammatory and antibacterial properties, could be beneficial for managing seborrheic dermatitis (SD), but studies report conflicting results. The aim was to evaluate the efficacy and safety of topical metronidazole in the treatment of SD.

Material and methods. A systematic search of Medline, Embase, and CENTRAL was conducted from inception to April 2024. Randomized controlled trials (RCTs) comparing metronidazole to any comparator for SD were included in this study. Data were pooled using random-effects models.

Analysis of the literature. Seven RCTs were included. Overall, topical metronidazole did not significantly reduce SD symptom severity when compared to any comparator/treatment. However, it significantly reduced symptom severity compared to placebo after 4 to 8 weeks (standardized mean difference (SMD) -3.00, 95% CI, -5.21 to -0.78). Specifically for facial SD, metronidazole showed significant symptom reduction (SMD -0.85, 95% CI, -1.41 to -0.29). No significant differences were found in the proportion of patients with clinical improvement or side effect frequency. Most studies had a high risk of bias and lacked information on missing data and assessor masking.

Conclusion. Topical metronidazole demonstrates potential for managing SD, but current trials lack quality. Larger, high-quality trials are needed to confirm its efficacy and compare it with other treatments for SD.

Downloads

Download data is not yet available.

References

Dall’Oglio F, Nasca MR, Gerbino C, Micali G. An Overview of the Diagnosis and Management of SD. Clin Cosmet Investig Dermatol. 2022;15:1537-1548. doi: 10.2147/CCID.S284671

Gupta AK, Bluhm R. SD. J Eur Acad Dermatol Venereol JEADV. 2004;18(1):13-26; quiz 19-20. doi: 10.1111/j.1468-3083.2004.00693.x

Naldi L, Rebora A. Clinical practice. SD. N Engl J Med. 2009;360(4):387-396. doi: 10.1056/NEJMcp0806464

Zip CM. Innovative use of topical metronidazole. Dermatol Clin. 2010;28(3):525-534. doi: 10.1016/j.det.2010.03.015

Parsad D, Pandhi R, Negi K, Kumar B. Topical metronidazole in SD-a double-blind study. Dermatol Basel Switz. 2001;202(1):35-37. doi: 10.1159/000051582

Koca R, Altinyazar H, Eştürk E. Is topical metronidazole effective in SD? A double-blind study. Int J Dermatol. 2003;42(8):632-635. doi: 10.1046/j.1365-4362.2003.01981.x

Page MJ, Moher D, Bossuyt PM, et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ. 2021;372:n160. doi: 10.1136/bmj.n160

Higgins JPT, Thomas J, Chandler J, Li T, Page MJ, Welch VA. Cochrane Handbook for Systematic Reviews of Interventions version 6.4 (updated August 2023). Published online 2023. https://training.cochrane.org/handbook. Accessed January 15, 2024.

Sterne JAC, Savović J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. Bmj. 2019;366:l4898. doi: 10.1136/bmj.l4898

DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7(3):177-188. doi: 10.1016/0197-2456(86)90046-2

Higgins JPT. Commentary: Heterogeneity in meta-analysis should be expected and appropriately quantified. Int J Epidemiol. 2008;37(5):1158-1160. doi: 10.1093/ije/dyn204

Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. Bmj. 1997;315(7109):629-634. doi: 10.1136/bmj.315.7109.629

Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336(7650):924-926. doi: 10.1136/bmj.39489.470347.AD

Cicek D, Kandi B, Bakar S, Turgut D. Pimecrolimus 1% cream, methylprednisolone aceponate 0.1% cream and metronidazole 0.75% gel in the treatment of seborrhoeic dermatitis: a randomized clinical study. J Dermatol Treat. 2009;20(6):344-349. doi: 10.3109/09546630802687349

Siadat A, Iraji F, Shahmoradi Z, Enshaieh S, Taheri A. The efficacy of 1% metronidazole gel in facial SD: a double blind study. Indian J Dermatol Venereol Leprol. 2006;72(4):266-269. doi: 10.4103/0378-6323.26745

Ozcan H, Seyhan M, Yologlu S. Is metronidazole 0.75% gel effective in the treatment of seborrhoeic dermatitis? A double-blind, placebo controlled study. Eur J Dermatol. 2007;17(4):313-316. doi: 10.1684/ejd.2007.0206

Seckin D, Gurbuz O, Akin O. Metronidazole 0.75% gel vs. ketoconazole 2% cream in the treatment of facial SD: a randomized, double-blind study. J Eur Acad Dermatol Venereol JEADV. 2007;21(3):345-350. doi: 10.1111/j.1468-3083.2006.01927.x

Goldust M., Rezaee E., Raghifar R. A double blind study of the effectiveness of sertaconazole 2% cream vs. metronidazole 1% gel in the treatment of SD. Ann Parasitol. 2013;59(4):173-177.

Gomes TF, Calado R, Matos AL, Gonçalo M. Contact allergy to antifungals: Results of a 12-year retrospective study. Contact Dermatitis. 2022;86(6):539-543. doi: 10.1111/cod.14076

Nizoral Shampoo (Ketoconazole 2%): Side Effects, Uses, Dosage, Interactions, Warnings. RxList. https://www.rxlist.com/nizoral-shampoo-drug.htm. Accessed July 5, 2024.

Coondoo A, Phiske M, Verma S, Lahiri K. Side-effects of topical steroids: A long overdue revisit. Indian Dermatol Online J. 2014;5(4):416-425. doi: 10.4103/2229-5178.142483

Stacey SK, McEleney M. Topical Corticosteroids: Choice and Application. Am Fam Physician. 2021;103(6):337-343.

Clark GW, Pope SM, Jaboori KA. Diagnosis and Treatment of SD. Am Fam Physician. 2015;91(3):185-190.

Gupta A.K., Versteeg S.G. Topical Treatment of Facial SD: A Systematic Review. Am J Clin Dermatol. 2017;18(2):193-213. doi: 10.1007/s40257-016-0232-2

Tennis P, Gelfand JM, Rothman KJ. Evaluation of cancer risk related to atopic dermatitis and use of topical calcineurin inhibitors. Br J Dermatol. 2011;165(3):465-473. doi: 10.1111/j.1365-2133.2011.10363.x

Thaçi D, Salgo R. Malignancy concerns of topical calcineurin inhibitors for atopic dermatitis: facts and controversies. Clin Dermatol. 2010;28(1):52-56. doi: 10.1016/j.clindermatol.2009.04.001

Berger TG, Duvic M, Van Voorhees AS, VanBeek MJ, Frieden IJ, American Academy of Dermatology Association Task Force. The use of topical calcineurin inhibitors in dermatology: safety concerns. Report of the American Academy of Dermatology Association Task Force. J Am Acad Dermatol. 2006;54(5):818-823. doi: 10.1016/j.jaad.2006.01.054

Yang YL, Xiang ZJ, Yang JH, Wang WJ, Xu ZC, Xiang RL. Adverse Effects Associated With Currently Commonly Used Antifungal Agents: A Network Meta-Analysis and Systematic Review. Front Pharmacol. 2021;12:697330. doi: 10.3389/fphar.2021.697330

Commission Regulation (EU) 2021/1902 of 29 October 2021 Amending Annexes II, III and V to Regulation (EC) No 1223/2009 of the European Parliament and of the Council as Regards the Use in Cosmetic Products of Certain Substances Classified as Carcinogenic, Mutagenic or Toxic for Reproduction (Text with EEA Relevance). 2021;387. http://data.europa.eu/eli/reg/2021/1902/oj/eng. Accessed May 6, 2024.

SD and Rosacea | Rosacea.org. https://www.rosacea.org/patients/seborrheic-dermatitis. Accessed May 6, 2024.

SD in adolescents and adults - UpToDate. https://www.uptodate.cn/contents/seborrheic-dermatitis-in-adolescents-and-adults. Accessed May 6, 2024.

Downloads

Published

2024-12-30

How to Cite

Lee, E. L., Shanmugham, S., Kumar, S., Smales, F. C., Ching, S. M., & Veettil, S. K. (2024). The use of topical metronidazole in the management of seborrheic dermatitis – a systematic review and meta-analysis of randomized controlled trials. European Journal of Clinical and Experimental Medicine, 22(4), 954–960. https://doi.org/10.15584/ejcem.2024.4.25

Issue

Section

REVIEW PAPERS

Most read articles by the same author(s)