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Seborrhoeic dermatitis - Management
View full scenario
What advice should I give?
- Reassure the person that seborrhoeic dermatitis is not caused by lack of cleanliness or excessive dryness of the skin, and is not transmissable.
- Explain that treatment cannot cure seborrhoeic dermatitis but can control it. Symptoms often recur after treatment has stopped.
- Avoid using cosmetic products that contain alcohol.
- Avoid using soap and shaving cream on the face if they cause irritation. Advise the use of non-greasy emollients or emollient soap substitutes.
- A diet rich in yeast-containing products will not affect the disease. If the person has known dietary triggers, these should be avoided, and if the diet is generally poor, advise an improved diet.
- Advise stress reduction, if possible.
In depth
How should I treat?
- Consider ketoconazole 2% cream (or other topical imidazole) in all people with seborrhoeic dermatitis of the face and body. Continue treatment until the skin has improved to a level that is acceptable to the person.
- Consider the addition of a mild topical corticosteroid cream, such as hydrocortisone 1% (or use of a combined imidazole and hydrocortisone preparation) to settle inflammation more quickly. Hydrocortisone 1% is well tolerated in long-term use (up to 6 months), but specialist advice should be sought if symptoms have not resolved at 6 months, or sooner if response to treatment is poor:
- The use of topical corticosteroids needs to be balanced against their potential for adverse effects, particularly in people requiring treatment for frequent relapses.
- If the eyelids are involved, consider daily hygiene measures using cotton buds moistened with baby shampoo. If this is not effective, seek specialist advice regarding further treatment.
In depth
What maintenance treatment is recommended?
- Wash the affected area with ketoconazole 2% shampoo or apply ketoconazole 2% cream (or other topical imidazole), weekly or every other week (depending on the frequency of recurrence).
- Avoid using topical corticosteroids for maintenance treatment.
In depth
How should I follow up?
- Routine follow up is not usually required.
- Advise the person to seek further medical advice if:
- Response to treatment is poor.
- Symptoms worsen despite treatment.
- Signs of infection (e.g. crusting, oozing, bleeding) develop.
In depth
When should I refer?
- Consider referral to a dermatologist if there is:
- Diagnostic uncertainty.
- Failure to respond to routine treatment.
- Severe or widespread seborrhoeic dermatitis.
- Eyelid involvement (where simple eyelid hygiene measures have been unsuccessful).
In depth
Prescriptions
Topical antifungal (treatment)
Age from 1 year onwards
Ketoconazole 2% cream: apply once or twice a day
Ketoconazole 2% cream
Apply to the affected area(s) once or twice a day. Continue for a few days after the affected area has healed.
Supply 30 grams.
Clotrimazole 1% cream: apply two to three times a day
Clotrimazole 1% cream
Apply to the affected area 2 to 3 times a day. Continue for 2 to 3 days after area has healed.
Supply 20 grams.
Econazole 1% cream: apply twice a day
Econazole 1% cream
Apply to the affected area twice a day. Continue for 2 to 3 days after the affected area has healed.
Supply 30 grams.
Miconazole 2% cream: apply twice a day
Miconazole 2% cream
Apply to the affected area twice a day. Continue for 2 to 3 days after the affected area has healed.
Supply 30 gram.
Topical corticosteroid: add on to antifungal if severe
Age from 1 year onwards
Hydrocortisone 1% cream: apply thinly once or twice a day
Hydrocortisone 1% cream
Apply thinly to the affected area(s) once or twice a day.
Supply 30 grams.
Topical antifungal + corticosteroid
Age from 1 year onwards
Multi-therapy: Ketoconazole 2% + hydrocortisone 1% cream
Ketoconazole 2% cream: apply once or twice a day
Ketoconazole 2% cream
Apply to the affected area(s) once or twice a day. Continue for a few days after the affected area has healed.
Supply 30 grams.
Hydrocortisone 1% cream: apply thinly once or twice a day
Hydrocortisone 1% cream
Apply thinly to the affected area(s) once or twice a day.
Supply 30 grams.
Clotrimazole 1% + hydrocortisone 1% cream
Clotrimazole 1% / Hydrocortisone 1% cream
Apply thinly to the affected area(s) once or twice a day.
Supply 30 grams.
Miconazole 2% + hydrocortisone 1% cream
Miconazole 2% / Hydrocortisone 1% cream
Apply thinly to the affected area(s) once or twice a day.
Supply 30 gram.
Topical antifungal (prophylaxis)
Age from 1 year onwards
Ketoconazole 2% cream: apply once every 1 to 2 weeks
Ketoconazole 2% cream
Apply to the affected area once every 1 to 2 WEEKS.
Supply 30 grams.
Ketoconazole 2% shampoo: use once every 1 to 2 weeks
Ketoconazole 2% shampoo
Apply to the affected area once every 1 to 2 WEEKS. Leave for 3 to 5 minutes before rinsing.
Supply 120 ml.
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