Background: Seborrheic dermatitis (SD) is a chronic inflammatory skin disorder primarily affecting the scalp, characterized by erythema, scaling, and pruritus. Ketoconazole and coal tar–based shampoos are commonly used therapeutic agents. This study aimed to compare the efficacy and safety of ketoconazole-based shampoo versus coal tar–based shampoo in patients with mild to moderate scalp SD.

Material and Methods:A prospective, randomized, comparative study was conducted among 100 patients diagnosed with SD, who were randomly assigned to two equal groups (n=50 each). Group A received ketoconazole 2% shampoo, and Group B received coal tar 1% shampoo, both applied twice weekly for four weeks. Outcomes were assessed using the Seborrheic Dermatitis Severity Score (SDSS), a Visual Analogue Scale (VAS) for symptom relief, and documentation of adverse events at baseline, week 2, and week 4. Statistical analysis was performed using appropriate parametric and non-parametric tests.

Results:Both groups showed a significant reduction in SDSS from baseline to week 4. However, Group A (ketoconazole) demonstrated a greater reduction in SDSS at both week 2 (p=0.012) and week 4 (p<0.001). VAS scores indicated a higher proportion of patients reporting good symptom relief (VAS 7–10) in Group A (64%) compared to Group B (40%) (p=0.044). Adverse events were fewer in Group A, with a significantly lower incidence of foul odor and overall adverse effects (p=0.047).

Conclusion: Ketoconazole-based shampoo is more effective and better tolerated than coal tar–based shampoo in the short-term management of Seborrheic dermatitis. It significantly reduces clinical severity and improves patient satisfaction with fewer adverse events, making it a preferred therapeutic option.