Initial therapy includes anti-dandruff shampoo for mild disease with addition of ketoconazole shampoo and cream (two to three times per week for 4 weeks, with a maintenance treatment once per week as needed), topical steroids, selenium sulfide, ciclopirox, salicylic acid and tars for advanced disease. Ultraviolet B (UVB) light therapy is another modality in addition to topical therapies.[132][133][134] 83,84,86 Severe seborrhoeic dermatitis and seborrhoeic dermatitis unresponsive to first-line therapy should be treated with a combination therapy of topical antifungals (e.g. ketoconazole 2%) and topical corticosteroids.[135] Pilot studies have demonstrated the benefit of topical pimecrolimus cream 1% twice daily in adults with facial seborrhoeic dermatitis who had not responded satisfactorily to conventional topical corticosteroids and antifungals.[136] Systemic therapy with oral antifungals, prednisone or isotretinoin is not routinely indicated.[137][138]