Scalp seborrhoeic dermatitis
For mild scalp seborrhoeic dermatitis (including dandruff), use a standard shampoo daily until the scalp is clear.
If treatment is ineffective, or if the dermatitis is severe, use an antiyeast shampoo twice a week to daily, depending on severity and response. Suitable antiyeast shampoos include those containing zinc pyrithione, selenium sulfide, ketoconazole or coal tar. Response to a particular shampoo can diminish; consider rotating between different shampoos.
If the antiyeast shampoo is inadequate, adding a topical corticosteroid may be effective because it will have longer contact with the scalp. Lotions are easier to apply to hair-bearing areas than creams. In addition to the antiyeast shampoo, use:
1betamethasone dipropionate 0.05% lotion topically, applied to scalp once daily at night for 7 nights1 betamethasone dipropionate betamethasone dipropionate betamethasone dipropionate
OR
1methylprednisolone aceponate (adult, or child 4 months or older) 0.1% lotion topically, applied to scalp once daily at night for 7 nights methylprednisolone aceponate methylprednisolone aceponate methylprednisolone aceponate
OR
1mometasone furoate 0.1% lotion topically, applied to scalp once daily at night for 7 nights. mometasone furoate mometasone furoate mometasone furoate
If the antiyeast shampoo with a topical corticosteroid lotion is not sufficient, or the scalp has thick areas of scale, add a tar preparation. In addition to the antiyeast shampoo and topical corticosteroid lotion, use:
1coal tar prepared 1% emulsion or gel topically, applied to scalp at night once or twice weekly or as needed2 coal tar coal tar coal tar
OR
1LPC 3 to 6%+salicylic acid 3% in aqueous cream topically, applied to scalp at night once or twice weekly or as needed23. coal tar + salicylic acid coal tar+salicylic acid coal tar+salicylic acid
Wash the tar preparation off the next morning with antiyeast shampoo.
If the antiyeast shampoo with topical corticosteroid lotion and tar preparation fails, replace the antiyeast shampoo with a topical corticosteroid shampoo twice a week. Use:
clobetasol propionate 0.05% shampoo topically, twice weekly (use an antiyeast shampoo on the other 5 days). clobetasol propionate clobetasol propionate clobetasol propionate
If seborrhoeic dermatitis still does not respond, see Lack of response to treatment of dermatitis. Also consider specialist referral.