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Seborrhoeic dermatitis - Management
How should I treat?

  • If simple measures (see Advice) are not effective, prescribe ketoconazole 2% cream once a day (or other topical imidazole). Ketoconazole shampoo is an alternative option:
    • Treat until symptoms resolve. If symptoms persist longer than 4 weeks with treatment, seek specialist advice.
  • Topical corticosteroids are not usually advised, although they may be of use for certain infants with nappy rash. For more information, see the CKS topic on Nappy rash.
Basis for recommendation
  • Advice regarding simple measures was available in peer-reviewed journals, although not systematically reviewed [Janniger, 1993; O'Connor et al, 2008; Plewig and Jansen, 2008].
  • Ketoconazole 2% cream once a day has been shown to be effective for infantile seborrhoeic dermatitis in a small open-label study [Taieb et al, 1990]. Studies of percutaneous absorption in seven infants showed minimal plasma levels, despite the large surface area of topical application [Levron and Taieb, 1991]:
    • CKS has extrapolated evidence from ketoconazole to apply to other imidazole creams on the basis of feedback from expert reviewers and their similar safety profiles in terms of absorption.
  • CKS could find no trial evidence for ketoconazole shampoo, but expert feedback and a review article suggest it as an option [O'Connor et al, 2008].
  • CKS could find no evidence for the duration of topical ketoconazole treatment. CKS suggests treating until symptoms resolve but seeking specialist advice if symptoms persist beyond 4 weeks, as the diagnosis may need to be reconsidered. This takes into account feedback from expert reviewers and information from the manufacturers [ABPI Medicines Compendium, 2008c].
  • CKS could find no systematic reviews of the safety and effectiveness of topical corticosteroids in infants. The available evidence regarding the use of topical corticosteroids in infants was of low quality. There is concern about systemic absorption in paediatric populations compared with topical ketoconazole [Sheffield et al, 2007].

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