Seborrhoeic Dermatitis

Presentation

Seborrhoeic dermatitis presents with red well defined areas covered with greasy scale, affecting mainly the scalp, face and upper trunk, and often the flexures. Aetiology is linked to a harmless yeast Pityrosporum ovale.

 

Cradle cap in young baby

 

Facial Seborrhoeic dermatitis in adult

Management

Treatment of cradle cap

Use bath emollients regularly and sponge scalp clean.

Avoid paraffin ointments and olive oil is not recommended.

If red, 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 or step  down in potency

Mild to moderate potency topical steroid to face then reduce frequency or potency.

Referral

Criteria for referral

Severe or extensive disease unresponsive to appropriate treatment  for 4-6 weeks

Therapeutic Tips
  • Consider off label use of calcineurin inhibitors (tacrolimus, pimecrolimus) for steroid sparing effect.
  • 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 trimovate cream.
  • More severe involvement is common with Parkinson's, HIV, or a family history of psoriasis.
  • Consider oral itraconazole 100mg/d x 3 weeks in resistant cases.
  • Other products to consider: topical metronidazole gel, benzoyl peroxide, 5% lithium succinate ointment
Patient Information
  • NHS24 Tel: 08454 242424
  • Text Phone: 18001 08454 24 24 24