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Posts: 841
Joined: 24 Mar 2013 01:28
Full Name: Govind Mohan
Name of Your College/Medical School: Madras Medical College


Post by gmohan »

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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