Here’s the thing nobody tells you when you first get a seb derm diagnosis. The condition has two separate problems that need two separate approaches. There’s the Malassezia overgrowth – the actual fungal element, the thing that causes the flares. And then there’s the aftermath: the redness, the oiliness, the skin barrier that’s been through it and needs repair. Most people focus on one and ignore the other. That’s why they stay stuck in the flare-calm-flare cycle forever.
I did this for years. I was obsessive about ingredient checking – nothing was going on my face that might feed Malassezia – but I wasn’t actually treating the condition. I was just managing the environment. And then someone online mentioned ketoconazole in passing and I realised I’d never even tried an antifungal. A week of Nizoral on my face and the flare I’d had for two months was gone. I could have cried. I nearly did, honestly. All that time.
So. This post is specifically about the active treatments for facial seb derm – the ingredients that are actually doing something to the Malassezia or to the skin issues it causes. It’s not a full skincare routine guide (that’s the Seb Derm Directory) and it’s not about cleansers (I wrote a separate UK guide to seb derm cleansers for that). This is just the treatment ingredients, what they do, and how to find them in formulas that won’t make the Malassezia problem worse at the same time.
I’m not a dermatologist. This is lived experience plus a lot of research, not medical advice. If your seb derm is severe or hasn’t shifted after months of consistent treatment, please see a GP or dermatologist – some cases genuinely need prescription intervention.
Antifungal treatments
Start here. This is the actual treatment. Everything else on this list helps – genuinely, really helps – but if you’re in an active flare, none of it will get you out of it as fast as an antifungal will. The other ingredients are maintenance and support. Antifungals are what you reach for when things are bad.
The reason seb derm flares in the first place is Malassezia yeast overgrowth on the skin. Antifungals target Malassezia directly. Everything else is working around it. That’s not nothing – it genuinely matters – but knowing the hierarchy is useful. Antifungal first. Repair second. Maintenance third.
Ketoconazole
Ketoconazole is the gold standard. It’s a broad-spectrum antifungal with the most direct action against Malassezia of anything available. In the UK, prescription ketoconazole cream at 2% is what your GP can give you – and it’s worth asking for if your flares are persistent or severe. Short courses during bad flares, not permanently, and always follow up with a good moisturiser because it’s drying.
The over-the-counter route is Nizoral shampoo. Yes, the one for your scalp. A small amount used as a face wash two or three times a week – apply, leave for a couple of minutes, then rinse – is a widely used approach in the seb derm community and it works. It’s not elegant. It smells like a pharmacy. But the 2% ketoconazole is doing exactly what the prescription cream does, you just need to let it sit on your skin long enough to act. Follow with your normal routine. If you’re going to try one thing from this entire post, this is the one.
Nizoral is available at Boots, Superdrug, and most pharmacies. You can also grab it via ShopMy.
Clotrimazole (Daktarin Gold)
Daktarin Gold is the easiest antifungal to access in the UK without a prescription. It’s clotrimazole rather than ketoconazole – a slightly different antifungal, a bit less powerful specifically against Malassezia than ketoconazole, but still genuinely effective and much easier to get than a GP appointment. Available over the counter at Boots, Superdrug, and most pharmacies.
Use it in short courses during flares – a few weeks on, then assess. Apply a thin layer to the affected areas after cleansing. It’s thick and slightly sticky, so use it as the last step before moisturiser, or at night when you don’t need to layer anything else over it. Don’t use it indefinitely – antifungal resistance is a real thing and you want it to keep working when you need it.
A note on the Malassezia angle: clotrimazole cream formulas are worth checking through Sezia before applying, because some cream bases contain fatty acid esters. The treatment ingredient is doing good work, but the vehicle can be feeding Malassezia at the same time. It’s a rinse-off situation with Nizoral so less of an issue there, but with leave-on creams it matters.
Sulfur treatments
Sulfur is the oldest ingredient on this list and still one of the most useful. It has antifungal, antibacterial, and keratolytic properties – meaning it fights Malassezia, keeps infection at bay, and helps break down the excess skin cell buildup that seb derm causes. The flaky patches around the nose and eyebrows specifically respond well to it. And critically: sulfur does not feed Malassezia at all. It’s one of the few active treatments where you don’t need to worry about the ingredient itself making the problem worse.
The downsides are real though. It smells. Genuinely, properly smells – like old eggs if you’re being polite about it. And it can be quite drying, especially if you use it too often or over too large an area. Start slowly, apply targeted to problem patches rather than all over, and don’t combine it with other drying actives on the same day.
The Ordinary Sulfur 10% Powder-to-Cream Concentrate
The Ordinary Sulfur 10% Powder-to-Cream Concentrate is the one I’d recommend first if you’re in the UK. The formula is genuinely clean – confirmed Malassezia safe across SkinSort and Folliculitis Scout, with no oils, no fatty alcohols, no esters. The ingredient list is just glycerin, propanediol, silica silylate, sulfur, water, carnitine, niacinamide, acacia senegal gum, kaolin, polylysine. That’s it. Nothing flagged.
The 10% concentration is the highest available over the counter. Clinical testing showed visible reduction in redness, height, and diameter of inflamed patches in under an hour, which is impressive for a skincare product. The format is a bit unusual – it’s a powder that transforms into a cream when it contacts skin – but it means you can press it out and apply precisely to problem areas rather than slapping it all over. Leave-on spot treatment, not wash-off. Available at Lookfantastic – use my Lookfantastic discount code LFTFNEVEEN for 20% off.
Click here to see full ingredients list
Glycerin, Propanediol, Silica Silylate, Sulfur, Water, Carnitine, Niacinamide, Acacia Senegal Gum, Kaolin, Polylysine
De La Cruz Sulfur Ointment 10%
De La Cruz Sulfur Ointment 10% is the American cult product that’s become the most referenced sulfur treatment in the global seb derm community. Two ingredients: 10% sulfur and petrolatum. That is genuinely the entire formula. No esters, no oils, nothing that feeds Malassezia – petrolatum is an occlusive, not a fatty acid ester, and it screens cleanly.
It’s available on Amazon UK, which makes it easy enough to get. The texture is thick and ointment-y, not something you’d want to wear under makeup, so most people use it as a short-contact treatment – apply for 10-15 minutes, wipe off, then continue your routine. The smell is more noticeable than the Ordinary version. But it works, it’s cheap, and the formula is about as clean as it gets for a sulfur treatment.
Click here to see full ingredients list
Sulfur 10% (active ingredient), Petrolatum (inactive ingredient)
A note on sulfur cleansers: There are sulfur-based cleansers out there – Kate Somerville EradiKate is the most famous, with 3% sulfur, available at Sephora UK and Space NK. The sulfur is doing useful things, but the formula also contains cetearyl alcohol, stearyl alcohol, and behenyl alcohol – all fatty alcohols that some Malassezia checkers flag. As a rinse-off cleanser the contact time is limited and plenty of people tolerate it, but if you’re particularly reactive it’s worth knowing before you spend £30. Run the current INCI through Sezia first.
Azelaic acid
Azelaic acid is the ingredient I wish I’d known about earlier. It has antifungal properties (so it’s actively working against Malassezia), anti-inflammatory properties (so it calms the redness and irritation), and it helps with the post-flare hyperpigmentation and redness that often lingers long after the actual flare has settled. It’s also gentler than most acids in terms of irritation potential, which matters when your barrier is already compromised. And it’s one of the few ingredients that does useful things for both rosacea and seb derm – if you’re dealing with both (hello, it me), it earns its place on the shelf twice over.
I wrote a whole review of the Anua Azelaic Acid Serum if you want the full breakdown of one specific formula. The short version of the broader azelaic acid situation: the active is great, the formula matters enormously, and you need to read the INCI rather than just looking for “azelaic acid” on the front of the bottle.
The Ordinary Azelaic Acid Suspension 10%
The Ordinary Azelaic Acid Suspension 10% uses a silicone-based vehicle, which makes it one of the more Malassezia-friendly azelaic acid formulas available. Silicone doesn’t feed Malassezia. The formula screens clean. It’s very affordable and widely available. The texture is slightly gritty – it’s a suspension, so there’s a bit of a powdery quality when it first goes on – and not everyone gets on with it, but if the texture is fine for you the formula is solid. Available at Boots, Superdrug, and Lookfantastic (use my Lookfantastic discount code LFTFNEVEEN for 20% off).
Click here to see full ingredients list
Aqua (Water), Isodecyl Neopentanoate, Glycerin, Dimethicone, Azelaic Acid, Dimethicone Crosspolymer, Dimethyl Isosorbide, Lauryl Glucoside, Hydroxypropyl Cyclodextrin, Stearic Acid, Isostearic Acid, Cetostearyl Isononanoate, Polysilicone-11, Dimethiconol, Phenoxyethanol, Kaolinite, Silica
Anua Azelaic Acid 10% Serum
Anua Azelaic Acid 10% Serum feels more like a proper serum than The Ordinary version – lighter, more pleasant to apply, layers better under other products. I’ve reviewed it in detail at the link above. The formula screens reasonably well for Malassezia. It’s the azelaic acid I’d point someone toward if they find The Ordinary texture off-putting. Available at Skinsider (code NEVEEN15) and Olive Young (code NEVEEN20).
Click here to see full ingredients list
Water, Azelaic Acid, Propylene Glycol, Sodium Hydroxide, Dipropylene Glycol, 1,2-Hexanediol, Panthenol, Hydroxyethylcellulose, Betaine Salicylate, Glycerin, Biosaccharide Gum-1, Ethylhexylglycerin, Allantoin, Dipotassium Glycyrrhizate, Melia Azadirachta Leaf Extract, Camellia Sinensis Leaf Water, Sodium Hyaluronate, Melia Azadirachta Flower Extract, Niacinamide, Aloe Barbadensis Leaf Juice, Beta-Glucan, Centella Asiatica Extract, Centella Asiatica Leaf Extract, Centella Asiatica Root Extract, Madecassoside, Asiaticoside, Asiatic Acid, Madecassic Acid, Squalane, Zinc PCA, Butylene Glycol, Pentylene Glycol, Caprylyl/Capryl Glucoside, Hydrogenated Lecithin, Ceramide NP
Skin1004 Madagascar Centella Azelaic Acid 10 Ampoule
Skin1004 Madagascar Centella Azelaic Acid 10 Ampoule is the one I’ve recently started using. It uses a 3X Azelaic Active Formula – 10% azelaic acid plus two azelaic acid derivatives – which in theory improves delivery and stability compared to straight azelaic acid alone. The formula itself is clean – no oils, no fatty acid esters, no problematic fatty alcohols. Water-based, lightweight, with centella, panthenol, and beta-glucan doing soothing support work alongside. Screens well for Malassezia. Available at Skinsider (code NEVEEN15), YesStyle (code NEVEEN15), and StyleKorean (code NEVEEN20).
Click here to see full ingredients list
Water, Azelaic Acid, Hydroxypropyl Cyclodextrin, Disodium Phosphate, Pentylene Glycol, Propanediol, Potassium Azeloyl Diglycinate, Maltodextrin, Azelamide MEA, Panthenol, Butylene Glycol, 1,2-Hexanediol, Glycerin, Ethylhexylglycerin, Allantoin, Centella Asiatica Extract, Melia Azadirachta Leaf Extract, Biosaccharide Gum-1, Sodium Hyaluronate, Melia Azadirachta Flower Extract, Beta-Glucan, Centella Asiatica Leaf Extract, Phellinus Linteus Extract, Tocopherol, Citric Acid, Sodium Citrate, Glycyrrhiza Glabra (Licorice) Root Extract
Paula’s Choice 10% Azelaic Acid Booster
Paula’s Choice 10% Azelaic Acid Booster has mixed reviews in the Malassezia community – the formula contains some flagged ingredients that the other two above don’t. Run the current INCI through Sezia before committing. It’s effective as an azelaic acid formula, but whether it’s right specifically for Malassezia-prone skin depends on your individual tolerance. If The Ordinary or Anua work for you, I’d stay with those.
Click here to see full ingredients list
Water, Azelaic Acid, Niacinamide, Glycerin, Butylene Glycol, Cyclopentasiloxane, Cetyl Alcohol, Dimethicone, Stearyl Alcohol, Carbomer, Disodium EDTA, Phenoxyethanol, Sodium Hydroxide, Limonene
Salicylic acid
BHA is genuinely useful for seb derm for a very specific reason: it’s oil-soluble. That means it can get into the pore and into the oily areas on the face where Malassezia tends to set up and thrive. It exfoliates, it cuts through congestion, and it helps with the texture and flaking that seb derm causes. For oilier skin types or the oilier areas of the face – forehead, nose, chin – it earns its place in a maintenance routine.
The caveats: don’t go high percentage when your barrier is already struggling. 0.5% to 2% is plenty. And don’t use it daily during sensitive phases – two or three times a week maximum. More is very much not more here. And as always, the formula around the salicylic acid matters just as much as the acid itself.
Paula’s Choice Skin Perfecting 2% BHA Liquid Exfoliant
Paula’s Choice Skin Perfecting 2% BHA Liquid Exfoliant is the classic. Screens well, pH is correct for the BHA to actually work, formula is reasonably clean. Use two to three times a week maximum. Available directly from Paula’s Choice UK.
Click here to see full ingredients list
Water, Methylpropanediol, Butylene Glycol, Salicylic Acid, Sodium Hydroxide, Polysorbate 20, Green Tea (Camellia Oleifera) Leaf Extract, Sodium Bisulfite, Tetrasodium EDTA
The INKEY List Beta Hydroxy Acid (BHA) Serum
The INKEY List Beta Hydroxy Acid (BHA) Serum is confirmed fungal acne safe on SkinSort. 2% salicylic acid plus 1% zinc – the zinc adds useful oil-control support on top of the BHA exfoliation, which is particularly useful for oilier seb derm presentations. Clean formula, no flags. A genuinely good budget alternative to the Paula’s Choice. Available at Lookfantastic (use my Lookfantastic discount code LFTFNEVEEN for 20% off).
Click here to see full ingredients list
Water, Salicylic Acid, Zinc PCA, Niacinamide, Sodium Hyaluronate, Panthenol, Allantoin, Glycerin, Sodium Hydroxide, Carbomer, Phenoxyethanol, Ethylhexylglycerin, Disodium EDTA
COSRX BHA Blackhead Power Liquid
COSRX BHA Blackhead Power Liquid uses willow bark water as its base rather than a straight salicylic acid formula, which gives it a gentler, lower-strength BHA effect. Good for reactive skin that still needs some exfoliation but can’t consistently tolerate a full 2% BHA treatment. Available at Skinsider (code NEVEEN15) and Stylevana (code INF10NEVE).
Click here to see full ingredients list
Salix Alba (Willow) Bark Water (98%), Butylene Glycol, Betaine Salicylate, Niacinamide, Sodium Hyaluronate, Panthenol, Allantoin, Xanthan Gum, 1,2-Hexanediol, Ethylhexylglycerin
Niacinamide
Niacinamide isn’t antifungal. Let’s be clear about that upfront – it’s not treating the Malassezia, it’s treating what Malassezia leaves behind. But what it does, it does well: it supports barrier repair, reduces redness, regulates oil production, and has some antimicrobial properties that are genuinely useful for the skin environment that seb derm creates. It’s also one of the most tolerated actives for reactive skin – not irritating, not sensitising, just quietly doing its job.
The catch, as with everything on this list: you have to find it in a clean formula. A lot of niacinamide serums are built on emollient bases that contain exactly the fatty acid esters that feed Malassezia. The active is doing good work and the vehicle is undoing it. Read the full ingredient list, not just the front of the bottle.
The Ordinary Niacinamide 10% + Zinc 1%
The Ordinary Niacinamide 10% + Zinc 1% is water-based, minimal, no fatty esters. Literally niacinamide and zinc in a boring base. Boring is correct. Available at Boots, Superdrug, and Lookfantastic (use my Lookfantastic discount code LFTFNEVEEN for 20% off).
Click here to see full ingredients list
Aqua (Water), Niacinamide, Pentylene Glycol, Zinc PCA, Dimethyl Isosorbide, Tamarindus Indica Seed Gum, Xanthan gum, Isoceteth-20, Ethanolamine, Phenoxyethanol
Superdrug Me+ Niacinamide & Zinc Booster
Superdrug Me+ Niacinamide & Zinc Booster is confirmed fungal acne safe on SkinSort, 10 ingredients, nothing flagged. Functionally near-identical to The Ordinary version at Superdrug prices. Available in store and online at Superdrug.
Click here to see full ingredients list
Water, Niacinamide, Glycerin, Butylene Glycol, Zinc Gluconate, Panthenol, Allantoin, Sodium Hyaluronate, Phenoxyethanol, Ethylhexylglycerin
COSRX Niacinamide 15% Face Serum
COSRX Niacinamide 15% Face Serum is a higher concentration option if you want more niacinamide doing more work. Screens clean. Panthenol in there too which supports barrier repair. Available at Skinsider (code NEVEEN15).
Click here to see full ingredients list
Water, Niacinamide, Glycerin, Butylene Glycol, Panthenol, Sodium Hyaluronate, Allantoin, Zinc PCA, Beta-Glucan, Dipotassium Glycyrrhizate, Centella Asiatica Extract, Carbomer, Tromethamine, 1,2-Hexanediol, Ethylhexylglycerin
Paula’s Choice Clinical Niacinamide 20% Treatment
Paula’s Choice Clinical Niacinamide 20% Treatment is confirmed fungal acne safe on SkinSort. 20% niacinamide alongside vitamin C (ascorbyl glucoside). This is the one if you want serious niacinamide work – the post-flare oiliness, enlarged pores, and persistent redness that seb derm leaves behind are exactly what high-percentage niacinamide is built for. Use it in maintenance phases, not during an active flare.
Click here to see full ingredients list
Water, Niacinamide, Glycerin, Butylene Glycol, Ascorbyl Glucoside, Panthenol, Allantoin, Zinc PCA, Sodium Hyaluronate, Dipotassium Glycyrrhizate, Carbomer, Sodium Hydroxide, Phenoxyethanol, Ethylhexylglycerin, Disodium EDTA
How to use these together
This is where people go wrong – they find all the right ingredients and then throw them all at their face at once. During a flare, don’t do that. During a flare: antifungal treatment, basic cleanser, barrier-repair moisturiser, SPF. That’s the whole routine. The actives come later, once things are calm.
In maintenance, once your skin is stable, the order I’d add things back in: niacinamide first (gentle, low-risk, doing useful barrier work), then azelaic acid (genuinely antifungal so earns its place even long-term), then salicylic acid two or three times a week if your skin is oily or congested. Sulfur stays as a targeted spot treatment when you feel a patch coming on, not a daily thing. Antifungal cream stays in reserve for actual flares.
And please, one new thing at a time. I know. It’s tedious. But if you introduce three things at once and something goes wrong, you have no idea which one caused it and you have to start again. One thing, two weeks, then assess.
Discount codes
Full list always at neveenwood.com/discount-codes – the ones most relevant for the products in this post:
- Lookfantastic – code: LFTFNEVEEN for 20% off (shop here) – The Ordinary Sulfur, The Ordinary Azelaic Acid, The INKEY List BHA, Medik8
- Skinsider – code: NEVEEN15 for 15% off (shop here) – COSRX Niacinamide, Anua Azelaic Acid, COSRX BHA, Skin1004
- Olive Young – code: NEVEEN20 (shop here) – Anua Azelaic Acid, K-beauty actives
- YesStyle – code: NEVEEN15 (shop here) – Skin1004, wide range of K-beauty actives
- StyleKorean – code: NEVEEN20 – Skin1004 Madagascar Centella Azelaic Acid Ampoule
- Stylevana – code: INF10NEVE for up to 25% off (shop here) – COSRX BHA, K-beauty serums
FAQ
The questions I get asked most about this one.
What’s the actual best treatment for facial seb derm?
An antifungal, full stop. Ketoconazole (prescription cream, or Nizoral shampoo used as a face wash) is what actually treats the Malassezia. Everything else on this list, azelaic acid, salicylic acid, niacinamide, is genuinely useful, but none of it clears an active flare the way an antifungal does.
Does ketoconazole shampoo really work on your face, not just your scalp?
Yes, and it’s how I fixed a two month flare in a week. Use Nizoral as a short-contact face wash, a small amount, leave it for a couple of minutes, then rinse. It’s not glamorous but the 2% ketoconazole is doing exactly what the prescription cream does.
Is it worth adding azelaic acid if I’m already using an antifungal?
Genuinely yes. It’s one of the only ingredients doing double duty, mild antifungal action plus calming the redness and pigmentation an antifungal alone won’t touch. I use it once my skin’s out of active flare mode, not instead of the antifungal.
How long before any of this actually starts working?
Antifungals first, usually one to two weeks for visible improvement. Azelaic acid and niacinamide are slower, think four to twelve weeks depending on what you’re trying to fix. Nobody tells you this and then you give up on something that was actually working, just slowly.
Ketoconazole or clotrimazole, does it actually matter which one I use?
Ketoconazole is the stronger, more targeted option and worth asking your GP for if flares keep coming back. Clotrimazole (Daktarin Gold) is the easier over-the-counter route and genuinely fine for most flares. I’d start with Daktarin Gold and only push for a ketoconazole prescription if that’s not cutting it.
Related reading
- Seborrhoeic Dermatitis on the Scalp vs Face: Why They’re Different and What Helps Each
- The Seb Derm Directory: Scalp and Hair Products That Actually Help (UK Edition)
- Seb Derm Cleansers: The UK Guide to What Actually Works
- 6 Malassezia Safe Moisturisers That Don’t Feel Like Grease
- The Anua Azelaic Acid Serum Review: Fine. It’s Fine.
- The Scalp Care Routine I Actually Stick To (And I’ve Tried a Lot)
- All discount codes: neveenwood.com/discount-codes
Some links in this post are affiliate links, meaning I may earn a small commission if you buy through them, at no extra cost to you. All products mentioned have been researched by me and most have been tested personally. Run everything through Sezia before buying and patch test new products.
