Facial, flexural and scrotal seborrhoeic dermatitis

To prevent irritation, advise patients with seborrhoeic dermatitis on the face, flexures or scrotum to use a low-irritant skin cleanser. Patients with facial seborrhoeic dermatitis should also wash their hair often with an antiyeast shampoo to reduce the yeast burden on the scalp (yeast can spread from the scalp to the face). Suitable antiyeast shampoos include those containing ketoconazole, selenium sulfide, zinc pyrithione or coal tar.

For facial, flexural and scrotal seborrhoeic dermatitis, use combination products containing a topical corticosteroid and an antifungal cream. Use:

1hydrocortisone+clotrimazole 1%+1% cream topically, once or twice daily until skin is clear or for up to 2 weeks hydrocortisone + clotrimazole hydrocortisone+clotrimazole hydrocortisone+clotrimazole

OR

1hydrocortisone+miconazole 1%+2% cream topically, once or twice daily until skin is clear or for up to 2 weeks. hydrocortisone + miconazole hydrocortisone+miconazole hydrocortisone+miconazole

If the combination product has no effect after 2 weeks, apply a topical corticosteroid cream and an antifungal cream separately. Use:

1desonide 0.05% lotion topically, once daily until skin is clear or for up to 2 weeks desonide desonide desonide

OR

1methylprednisolone aceponate (adult, or child 4 months or older) 0.1% cream topically, once daily until skin is clear or for up to 2 weeks methylprednisolone aceponate methylprednisolone aceponate methylprednisolone aceponate

PLUS (with either of the above regimens)

1bifonazole 1% cream topically, once daily until skin is clear or for up to 2 weeks bifonazole bifonazole bifonazole

OR

1clotrimazole 1% cream topically, twice daily until skin is clear or for up to 2 weeks clotrimazole clotrimazole clotrimazole

OR

1econazole 1% cream topically, twice daily until skin is clear or for up to 2 weeks econazole econazole econazole

OR

1ketoconazole 2% cream topically, once daily until skin is clear or for up to 2 weeks ketoconazole ketoconazole ketoconazole

OR

1miconazole 2% cream topically, twice daily until skin is clear or for up to 2 weeks. miconazole miconazole miconazole

If separate treatment with topical corticosteroid cream and antifungal cream fails, use a weak tar preparation. Use:

LPC 1 to 2% in aqueous or sorbolene cream topically, once daily until skin is clear or for up to 2 weeks1. tar tar tar

When the skin clears, advise the patient to frequently use an emollient for maintenance therapy (see Emollient types and properties). Relapses are common; when the condition relapses, repeat topical treatments for short periods (eg 7 days).

For severe flares, or for facial, flexural and scrotal seborrhoeic dermatitis that does not respond to topical therapy, refer for specialist advice. See also Lack of response to treatment of dermatitis.

1 LPC = liquor picis carbonis = coal tar solutionReturn