• 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

• 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

• 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

• 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

• 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