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PostPosted: 25 Aug 2014 15:13 
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seborric dermatitis with hairfall is very common..how far the treatment is effective?


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PostPosted: 27 Aug 2014 02:21 
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Hello Asha Mohan,

Welcome to the Forum. Allow me to initially present some basics of treatment.

Seborrhoeic dermatitis
Management of scalp and beard

How should I manage seborrhoeic dermatitis of the scalp and beard?

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 (for example salicylic acid) or coal tar–keratolytic preparation.

Prescribe ketoconazole 2% shampoo for adolescents and adults, if it has not been tried already. Selenium sulphide shampoo may be used as an alternative.
Consider treatment with other medicated shampoos such as zinc pyrithione (e.g. Head and Shoulders®), coal tar, or salicylic acid, if ketoconazole or selenium sulphide is not appropriate or acceptable to the person.

Confirm that zinc pyrithione, coal tar, or salicylic acid have not been tried already.
Medicated shampoos (as well as ketoconazole and selenium sulphide shampoos) may be purchased over the counter.

Advise the person that:
Shampoos should be used twice a week for at least one month.
Once symptoms are under control, the frequency of shampooing may be reduced, for example to once a week or once every 2 weeks.
Shampoos can also be applied to the beard area.

If the person has severe itching of the scalp consider co-prescribing 4 weeks of treatment with a potent topical corticosteroid scalp application such as betamethasone valerate 0.1%, hydrocortisone butyrate 0.1%, or mometasone furoate 0.1%.
Potent topical corticosteroid scalp applications are not suitable for application to the beard, because of adverse effects such as thinning of the skin on the face.

Seek specialist advice if symptoms have not resolved after 4 weeks, or sooner if response to treatment is poor.

Topical corticosteroids are not appropriate for continuous long-term use, and their use as maintenance treatment is not recommended.


Management of severe or widespread seborrhoeic dermatitis involves considering:

Alternative diagnoses of seborrhoeic dermatitis (such as psoriasis, systemic lupus erythematosus, and infected eczema, candidiasis, depending on the location of dermatitis).

Whether the person may be immunocompromised (e.g. has HIV infection). The need for blood tests should be considered based on clinical judgement (e.g. full blood count, glucose measurement, viral serology).

The need for referral to a dermatologist.

People with seborrhoeic dermatitis should be advised to avoid:

Cosmetic products that contain alcohol.

Soap and shaving cream on the face, if they cause irritation.

Greasy emollients.

Any known dietary triggers.

Stress (if possible).

It would be good to hear from our Dermatology colleagues.


To follow- Infantile Seborrhoeic dermatitis- Management.

G Mohan.


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Last edited by gmohan on 27 Aug 2014 02:40, edited 2 times in total.

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PostPosted: 27 Aug 2014 02:29 
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How should I manage an infant with seborrhoeic dermatitis?

Reassure the parents that infantile seborrhoeic dermatitis is not a serious condition, it does not usually trouble the infant, and, it will spontaneously resolve within weeks to a few months.

If the scalp is affected (the most common presentation) advise parents to try simple measures including:

Regular washing of the scalp with a baby shampoo, followed by gentle brushing with a soft brush to loosen scales and improve the condition of the skin.

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

If the above simple measures are not effective, prescribe a topical imidazole cream (clotrimazole, econazole, or miconazole). The frequency of application and duration of treatment depends on the imidazole used.

Clotrimazole 1% cream: apply 2–3 times daily.

Econazole 1% cream: apply twice daily.

Miconazole 2% cream: apply twice daily.

[]Treat until symptoms resolve. If symptoms persist longer than 4 weeks with treatment, seek specialist advice.

If other areas of the skin are affected (including the napkin area):

Advise bathing the infant at least once a day and cleaning the affected areas using an emollient as a soap substitute.

Consider prescribing a topical imidazole once or twice a day.

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.

G Mohan.


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