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Seborrhoeic dermatitis - Management
View full scenario
What should I advise?
- Reassure the parents that infantile seborrhoeic dermatitis is not a serious condition, does not usually trouble the infant, and will spontaneously resolve within weeks to a few months.
- Try simple measures. Suggested methods include:
- Regular washing of the scalp with a baby shampoo, followed by gentle brushing with a soft brush to loosen scales and improve the condition.
- Softening the scales with baby oil first, followed by gentle brushing, then washing off with baby shampoo.
- Soaking the crusts overnight with white petroleum jelly or a slightly warmed vegetable or olive oil, and shampooing in the morning.
- If these methods do not achieve softening, a greasy emollient or soap substitute, such as emulsifying ointment, can be used, which helps to remove the scales more easily.
In depth
How should I treat?
- If simple measures are not effective, prescribe ketoconazole 2% cream once a day (or other topical imidazole). Ketoconazole shampoo is another 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.
In depth
How should I treat recurrence?
- Use clinical judgement depending on the overall duration and appearance of the rash, bearing in mind that seborrhoeic dermatitis in infants usually resolves spontaneously:
- If confident that the diagnosis is correct, consider repeating a course of treatment.
- If the diagnosis is uncertain, seek specialist advice.
In depth
When should I follow up?
- Routine follow up is not usually required.
- Advise seeking 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
Antifungal cream
Age under 11 months
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.
Clotrimazole 1% cream: apply 2 or 3 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.
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.
Age under 1 year
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.
Antifungal shampoo
Age under 1 year
Ketoconazole 2% shampoo: use twice a week
Ketoconazole 2% shampoo
Apply to the affected area twice a WEEK for 2 to 4 weeks until symptoms have cleared.
Supply 120 ml.
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