Seborrhoeic Dermatitis

Who to refer

Severe or extensive disease unresponsive to appropriate treatment – 4-6 weeks with mild to moderate topical steroid and 2 weeks for potent.

Management

Treatment of cradle cap

• Use bath emollients regularly and sponge scalp clean.
• Avoid paraffin ointments. The use of olive oil is recommended by some and can be effective.
• If inflamed, use mild topical steroid for intermittent treatment.

Treatment of dandruff/adult scalp involvement

• Regular use of shampoos containing zinc pyrithione, selenenium sulphide, ciclopirox, tar or ketoconazole.  If very inflamed, intermittent use of potent topical steroid lotions/gels.

Treatment of mild disease

• Regular use of emollients for dry flaky skin.
• Mild topical steroid to face e.g. hydrocortisone 1% ointment or topical anti fungal therapy alone or combined with mild steroid e.g. clotrimazole, miconazole or nystatin.
• Mild to moderate topical steroid e.g. clobetasone ointment to trunk or flexures.

Treatment of moderate disease

• Potent topical steroid ointment to torso and limbs e.g. betamethasone ointment until signs of improvement, then consider frequency reduction  (e.g. 2 days per week) or step down in potency.
• Mild to moderate potency topical steroid to face then reduce frequency or potency.

Therapeutic Tip

• Use shampoos containing selenium sulphide, zinc pyrithione or ketoconazole to wash body – leave on for 5-10 minutes before washing off.
• Treat flexural involvement as intertrigo with barrier preparations or use of combination topical therapy such as Clotrimazole/hydrocortisone 1% cream (trimovate cream works well but is not on formulary)
• More severe involvement is common with Parkinson’s, HIV, or a family history of psoriasis.
• Consider oral itraconazole 100mg once daily x 3 weeks in resistant cases.
• Other products to consider: topical metronidazole gel, benzoyl peroxide, 5% lithium succinate ointment, calcineurin inhibitors (tacrolimus, pimecrolimus) though many of these are off label.

For Patients

http://www.bad.org.uk/for-the-public/patient-information-leaflets/seborrhoeic-dermatitis/?showmore=1

For Health Professionals

Link to PCDS  seborrhoeic-eczema guidance