CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.
Seborrhoeic dermatitis - Management
How should I treat?
- Remove thick crusts or scales on the scalp before using an antifungal shampoo. Removal of crusts can be achieved by:
- Applying warm mineral or olive oil to the scalp for several hours, then washing with a detergent or coal tar shampoo, or
- Application of a keratolytic preparation (e.g. salicylic acid) or coal tar–keratolytic preparation.
- Prescribe ketoconazole 2% shampoo if it has not been tried already. Selenium sulphide shampoo may be used as an alternative.
- If ketoconazole or selenium sulphide is not acceptable to the person, treat with anti-dandruff shampoos (e.g. containing coal tar or salicylic acid) which are available over-the-counter, after confirming that they have not been tried already. Shampoo can also be applied to the beard area.
- For adults with severe itching, add a potent topical corticosteroid scalp application, such as betamethasone valerate 0.1%, hydrocortisone butyrate 0.1%, or mometasone furoate 0.1%. Try 4–6 weeks of treatment (to the scalp, not the beard). If symptoms have not resolved after this time, seek specialist advice, or sooner if response to treatment is poor.
- Once symptoms are under control, the frequency of shampooing with medicated shampoos may be reduced or stopped.
In depth
© NHS Institute for Innovation and Improvement