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Seborrhoeic dermatitis - Management
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What over-the-counter products are available for the treatment of seborrhoeic dermatitis?

  • Several over-the-counter products available for the treatment of seborrhoeic dermatitis are outlined in Table 1.
Table 1. Shampoo preparations available for seborrhoeic dermatitis.*
Proprietary name
Active ingredient(s)
Instructions for use
Mode of action of ingredients
Dandrazol® 2% shampoo, Nizoral®
Ketoconazole 2%
Apply twice weekly for 2–4 weeks (for prophylaxis, apply once every 1–2 weeks); leave preparation on for 3–5 minutes before rinsing
Antifungal
Alphosyl 2 in 1®
Alcoholic coal tar extract 5%
Use every 2–3 days
Anti-eczematous, antipruritic, antimitotic
Capasal®
Coal tar 1%,
Coconut oil 1%,
Salicylic acid 0.5%
Apply daily as necessary
Anti-eczematous, antipruritic, antimitotic
Emollient, softening agent, and lubricant
Keratolytic
Ceanel Concentrate®
Cetrimide 10%,
Undecenoic acid 1%,
Phenylethyl alcohol 7.5%
Apply 3 times in first week, then twice weekly
Antiseptic, detergent
Fungicidal
Antiseptic
Clinitar®
Coal tar extract 2%
Apply up to 3 times weekly
Anti-eczematous, antipruritic, antimitotic
Dermax®
Benzalkonium chloride 0.5%
Apply as necessary
Antiseptic, anti-dandruff
Meted®
Salicylic acid 3%,
Sulphur 5%
Apply at least twice weekly
Keratolytic
Mild antiseptic
Pentrax®
Coal tar 4.3%
Apply at least twice weekly
Anti-eczematous, antipruritic, antimitotic
Polytar AF®
Extract of coal tar 0.3%,
Coal tar solution 0.1%,
Pyrithione zinc 1%
Apply 2–3 times weekly for at least 3 weeks
Anti-eczematous, antipruritic, antimitotic
Antibacterial, antifungal
Selsun®
Selenium sulphide 2.5%
Apply twice weekly for 2 weeks, then once weekly for 2 weeks, and then as necessary
Antifungal, antiseborrhoeic
T/Gel®
Coal tar extract 2%
Apply as necessary
Anti-eczematous, antipruritic, antimitotic
Cocois®
Coal tar solution 12%,
Salicylic acid 2%,
Precipitated sulphur 4%,
Coconut oil emollient base
Apply to scalp once weekly as necessary (if severe use daily for first 3–7 days), shampoo off after 1 hour
Anti-eczematous, antipruritic, antimitotic
Keratolytic
Mild antiseptic
Emollient, softening agent, and lubricant
Sebco®
Coal tar solution 12%,
Salicylic acid 2%,
Precipitated sulphur 4%,
Coconut oil emollient base
Apply to scalp as necessary (if severe use daily for first 3–7 days), shampoo off after 1 hour
Anti-eczematous, antipruritic, antimitotic
Keratolytic
Mild antiseptic
Emollient, softening agent, and lubricant
* This list is not exhaustive.
Data from: [BNF 55, 2008]

Topical corticosteroids

What should I be aware of before prescribing a topical corticosteroid?

  • Hydrocortisone 1% cream is a mildly potent topical corticosteroid, and when used for a short period, it is rarely associated with adverse effects [BNF 55, 2008].
  • More potent topical corticosteroids rarely cause serious adverse effects when used correctly:
    • The risk of adverse effects increases with the potency of the topical corticosteroid, duration of use, and area of application.
    • Topical corticosteroids are associated with localized effects, such as skin atrophy and exacerbation of skin infection (e.g. fungal infection), acneiform eruption, striae, hypertrichosis (excess localized hair growth), hypopigmentation, purpura, and perioral dermatitis.
    • There is little risk of skin thinning with mild-to-moderately potent topical corticosteroids when used for up to 4 weeks [DTB, 2003].
  • Betamethasone valerate 0.1%, hydrocortisone butyrate 0.1%, and mometasone furoate 0.1% are potent topical corticosteroids [BNF 55, 2008].

What advice should I give about topical corticosteroids?

  • Topical corticosteroids rarely cause adverse effects if they are used correctly.
  • Hydrocortisone 1% cream should be applied thinly to the affected area [BNF 55, 2008].

Topical ketoconazole

What should I be aware of before prescribing topical ketoconazole or another imidazole?

  • Treatment with an imidazole cream or ketoconazole shampoo is generally well tolerated.
  • Contact dermatitis, irritation, and a burning sensation have been rarely reported with both ketoconazole cream and shampoo.

[ABPI Medicines Compendium, 2008b; ABPI Medicines Compendium, 2008c]

  • Burning or irritation rarely occurs immediately after applying clotrimazole cream. Skin irritation can also occur with miconazole cream [ABPI Medicines Compendium, 2008c].
  • Ketoconazole shampoo has been rarely reported to cause oily and dry hair.
  • Symptoms should improve gradually; a full effect is usually seen after 4 weeks [Cohen, 2004; Manriquez and Uribe, 2007].

What advice should I give about topical ketoconazole?

  • Treatment with ketoconazole cream and shampoo is generally well tolerated.
  • Contact dermatitis, irritation, and a burning sensation have been rarely reported with both ketoconazole cream and shampoo [ABPI Medicines Compendium, 2008b].
  • Ketoconazole shampoo has been rarely reported to cause oily and dry hair.
  • Symptoms should improve gradually; a full effect is usually seen after 4 weeks [Cohen, 2004; Manriquez and Uribe, 2007].

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