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Seborrhoeic dermatitis - Management
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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?

  • 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

What maintenance treatment is recommended?

  • If relapse is a problem, advise use of an antifungal shampoo once a week, or once every other week, or according to the manufacturer's instructions.
  • Topical corticosteroids are not appropriate for continuous long-term use, and their use as maintenance treatment is not recommended.

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.

In depth

Prescriptions

Antifungal shampoo (treatment)

Age from 1 year onwards
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.
Age: from 1 year onwards
NHS cost: £4.66
OTC cost: £8.35
Licensed use: yes
Patient information: Wet hair thoroughly and massage a small amount of ketoconazole shampoo into the affected area. Leave for 3-5 minutes then rinse thoroughly. Do not use more often than directed. If you need to shampoo your hair more often, use your normal shampoo. If your hair is very thick or long use your normal shampoo before using ketoconazole.
Age from 5 years onwards
Selenium sulphide 2.5% shampoo: use twice a week
Selenium sulphide 2.5% shampoo
Apply twice weekly for 2 weeks, then once weekly for 2 weeks, and then as necessary.
Supply 100 ml.
Age: from 5 years onwards
NHS cost: £1.96
OTC cost: £3.45
Licensed use: yes
Patient information: Wet the hair then massage selenium sulphide into the affected area to form a lather. Leave for 3 minutes then rinse thoroughly and repeat. If you need to shampoo your hair more often than twice a week, use your normal shampoo. Avoid using 48 hours before or after applying hair colouring, straightening, or waving preparations.

Topical corticosteroid: add on to antifungal if severe

Age from 1 year onwards
Betamethasone 0.1% scalp application: use twice a day
Betamethasone valerate 0.1% scalp application
Apply thinly to dry hair in the morning and at night. As your symptoms improve, this can be reduced.
Supply 100 ml.
Age: from 1 year onwards
NHS cost: £3.92
Licensed use: yes
Patient information: Cover the area with a thin layer and massage in gently. Allow hair to dry naturally. Wash your hands after using this lotion. Use this scalp lotion until symptoms start to improve, do not use for longer than 7 days for a child.
Mometasone 0.1% scalp lotion: use once a day
Mometasone 0.1% scalp lotion
Apply a few drops to the affected area(s) of the scalp once a day. Massage in gently and thoroughly until the lotion disappears.
Supply 30 ml.
Age: from 1 year onwards
NHS cost: £4.54
Licensed use: yes
Patient information: Wash your hands after using this lotion. Use this scalp lotion until symptoms start to improve, do not use for longer than 5 days for a child.
Hydrocortisone butyrate 0.1% scalp lotion: use twice a day
Hydrocortisone butyrate 0.1% scalp lotion
Apply thinly to dry hair in the morning and at night. As your symptoms improve, this can be reduced.
Supply 100 ml.
Age: from 1 year onwards
NHS cost: £9.76
Licensed use: yes
Patient information: Cover the area with a thin layer and massage in gently. Allow hair to dry naturally. Wash your hands after using this lotion. Use this scalp lotion until symptoms start to improve, do not use for longer than 7 days for a child.

Topical corticosteroid + topical antifungal

Age from 1 year onwards
Multi-therapy: Ketoconazole shampoo + betamethasone scalp application
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.
Age: from 1 year onwards
NHS cost: £4.66
OTC cost: £8.35
Licensed use: yes
Patient information: Wet hair thoroughly and massage a small amount of ketoconazole shampoo into the affected area. Leave for 3-5 minutes then rinse thoroughly. Do not use more often than directed. If you need to shampoo your hair more often, use your normal shampoo. If your hair is very thick or long use your normal shampoo before using ketoconazole.
Betamethasone 0.1% scalp application: use twice a day
Betamethasone valerate 0.1% scalp application
Apply thinly to dry hair in the morning and at night. As your symptoms improve, this can be reduced.
Supply 100 ml.
Age: from 1 year onwards
NHS cost: £3.92
Licensed use: yes
Patient information: Cover the area with a thin layer and massage in gently. Allow hair to dry naturally. Wash your hands after using this lotion. Use this scalp lotion until symptoms start to improve, do not use for longer than 7 days for a child.
Multi-therapy: Ketoconazole shampoo + mometasone scalp lotion
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.
Age: from 1 year onwards
NHS cost: £4.66
OTC cost: £8.35
Licensed use: yes
Patient information: Wet hair thoroughly and massage a small amount of ketoconazole shampoo into the affected area. Leave for 3-5 minutes then rinse thoroughly. Do not use more often than directed. If you need to shampoo your hair more often, use your normal shampoo. If your hair is very thick or long use your normal shampoo before using ketoconazole.
Mometasone 0.1% scalp lotion: use once a day
Mometasone 0.1% scalp lotion
Apply a few drops to the affected area(s) of the scalp once a day. Massage in gently and thoroughly until the lotion disappears.
Supply 30 ml.
Age: from 1 year onwards
NHS cost: £4.54
Licensed use: yes
Patient information: Wash your hands after using this lotion. Use this scalp lotion until symptoms start to improve, do not use for longer than 5 days for a child.
Multi-therapy: Ketoconazole shampoo + hydrocortisone butyrate scalp application
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.
Age: from 1 year onwards
NHS cost: £4.66
OTC cost: £8.35
Licensed use: yes
Patient information: Wet hair thoroughly and massage a small amount of ketoconazole shampoo into the affected area. Leave for 3-5 minutes then rinse thoroughly. Do not use more often than directed. If you need to shampoo your hair more often, use your normal shampoo. If your hair is very thick or long use your normal shampoo before using ketoconazole.
Hydrocortisone butyrate 0.1% scalp lotion: use twice a day
Hydrocortisone butyrate 0.1% scalp lotion
Apply thinly to dry hair in the morning and at night. As your symptoms improve, this can be reduced.
Supply 100 ml.
Age: from 1 year onwards
NHS cost: £9.76
Licensed use: yes
Patient information: Cover the area with a thin layer and massage in gently. Allow hair to dry naturally. Wash your hands after using this lotion. Use this scalp lotion until symptoms start to improve, do not use for longer than 7 days for a child.
Age from 5 years onwards
Multi-therapy: Selenium shampoo + betamethasone scalp application
Selenium sulphide 2.5% shampoo: use twice a week
Selenium sulphide 2.5% shampoo
Apply twice weekly for 2 weeks, then once weekly for 2 weeks, and then as necessary.
Supply 100 ml.
Age: from 5 years onwards
NHS cost: £1.96
OTC cost: £3.45
Licensed use: yes
Patient information: Wet the hair then massage selenium sulphide into the affected area to form a lather. Leave for 3 minutes then rinse thoroughly and repeat. If you need to shampoo your hair more often than twice a week, use your normal shampoo. Avoid using 48 hours before or after applying hair colouring, straightening, or waving preparations.
Betamethasone 0.1% scalp application: use twice a day
Betamethasone valerate 0.1% scalp application
Apply thinly to dry hair in the morning and at night. As your symptoms improve, this can be reduced.
Supply 100 ml.
Age: from 1 year onwards
NHS cost: £3.92
Licensed use: yes
Patient information: Cover the area with a thin layer and massage in gently. Allow hair to dry naturally. Wash your hands after using this lotion. Use this scalp lotion until symptoms start to improve, do not use for longer than 7 days for a child.
Multi-therapy: Selenium shampoo + mometasone scalp application
Selenium sulphide 2.5% shampoo: use twice a week
Selenium sulphide 2.5% shampoo
Apply twice weekly for 2 weeks, then once weekly for 2 weeks, and then as necessary.
Supply 100 ml.
Age: from 5 years onwards
NHS cost: £1.96
OTC cost: £3.45
Licensed use: yes
Patient information: Wet the hair then massage selenium sulphide into the affected area to form a lather. Leave for 3 minutes then rinse thoroughly and repeat. If you need to shampoo your hair more often than twice a week, use your normal shampoo. Avoid using 48 hours before or after applying hair colouring, straightening, or waving preparations.
Mometasone 0.1% scalp lotion: use once a day
Mometasone 0.1% scalp lotion
Apply a few drops to the affected area(s) of the scalp once a day. Massage in gently and thoroughly until the lotion disappears.
Supply 30 ml.
Age: from 1 year onwards
NHS cost: £4.54
Licensed use: yes
Patient information: Wash your hands after using this lotion. Use this scalp lotion until symptoms start to improve, do not use for longer than 5 days for a child.
Multi-therapy: Selenium shampoo + hydrocortisone butyrate scalp application
Selenium sulphide 2.5% shampoo: use twice a week
Selenium sulphide 2.5% shampoo
Apply twice weekly for 2 weeks, then once weekly for 2 weeks, and then as necessary.
Supply 100 ml.
Age: from 5 years onwards
NHS cost: £1.96
OTC cost: £3.45
Licensed use: yes
Patient information: Wet the hair then massage selenium sulphide into the affected area to form a lather. Leave for 3 minutes then rinse thoroughly and repeat. If you need to shampoo your hair more often than twice a week, use your normal shampoo. Avoid using 48 hours before or after applying hair colouring, straightening, or waving preparations.
Hydrocortisone butyrate 0.1% scalp lotion: use twice a day
Hydrocortisone butyrate 0.1% scalp lotion
Apply thinly to dry hair in the morning and at night. As your symptoms improve, this can be reduced.
Supply 100 ml.
Age: from 1 year onwards
NHS cost: £9.76
Licensed use: yes
Patient information: Cover the area with a thin layer and massage in gently. Allow hair to dry naturally. Wash your hands after using this lotion. Use this scalp lotion until symptoms start to improve, do not use for longer than 7 days for a child.

Keratolytic (to remove scaling)

Age from 6 years onwards
Cocois Ointment
Cocois ointment
Apply to the scalp once a day for 3 to 7 days until symptoms improve. Then apply once a week when required to remove scaling.
Supply 100 grams.
Age: from 6 years onwards
NHS cost: £11.69
OTC cost: £20.60
Licensed use: yes
Patient information: Gently rub the ointment into the scalp and leave for about one hour, then rinse off. Wash your hands immediately after use.
Sebco Ointment
Sebco ointment
Apply to the scalp once a day for 3 to 7 days until symptoms improve. Then apply once a week when required to remove scaling.
Supply 100 grams.
Age: from 6 years onwards
NHS cost: £8.52
OTC cost: £15.02
Licensed use: yes
Patient information: Gently rub the ointment into the scalp and leave for about one hour, then rinse off. Wash your hands immediately after use.

Antifungal shampoo (prophylaxis)

Age from 1 year onwards
Ketoconazole 2% shampoo: use once every 1 to 2 weeks
Ketoconazole 2% shampoo
Apply to the affected area once every 1 to 2 WEEKS when needed to control dandruff. Leave for 3 to 5 minutes before rinsing.
Supply 120 ml.
Age: from 1 year onwards
NHS cost: £4.66
OTC cost: £8.35
Licensed use: yes
Patient information: Wet hair thoroughly and massage a small amount of ketoconazole shampoo into the affected area. Leave for 3-5 minutes then rinse thoroughly. Do not use more often than directed. If you need to shampoo your hair more often, use your normal shampoo. If your hair is very thick or long use your normal shampoo before using ketoconazole.
Age from 5 years onwards
Selenium sulphide 2.5% shampoo: use as needed
Selenium sulphide 2.5% shampoo
Apply to the affected area when needed to control dandruff. Do not use more than twice a WEEK.
Supply 100 ml.
Age: from 5 years onwards
NHS cost: £1.96
OTC cost: £3.45
Licensed use: yes
Patient information: Wet the hair then massage selenium sulphide into the affected area to form a lather. Leave for 3 minutes then rinse thoroughly and repeat. Do not use more often than directed. If you need to shampoo your hair more often, use your normal shampoo.

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