Seborrheic Dermatitis: Severe Dandruff with eczematization
Seborrheic Dermatitis: Severe Dandr

We have already seen the causes and triggers of Seborrheic dermatitis. Now let us examine ways on how to get rid of seborrheic dermatitis.

How to treat Seborrheic Dermatitis?

Principles of management
  • Patient education is important:
  • No Cure, can only be controlled.  Like dental care: need daily attention.
  • Regular Washing of scalp
  • Anti seborrhoeic treatment alternating with normal shampooing
  •  Hair tonics & tinctures with alcohol base: Aggravate
  •  Normal Soap & Shaving Creams: Use emollients and emollient soap substitutes
  • Alter Food Habits: low fat, low sugar diet ;cut down on the alcohol.
  •  Manage Stress
Regulation of Hyperseborrhea
  • Control Of Dietary Habits
  • Stress Management 
  • Regular Washing without causing irritation
  • Avoidance of offending drug, alcohol
  • Usage of creams containing antiseborrhoeic agents: Zinc Acetyl Methionate,  Undecylenic Acid Derivatives
  • Other antifungal creams and solutions to control Malassezia
Removal Of Thick Scales
  • —Overnight application of tar/urea/salicylic acid containing creams 
  • Rubbing with warm mineral oil and  washing off
  • If crusting and oozing: A course of antibiotic with a steroid-antifungal cream for 5-7 days;once scales and 2ry infection is cleared; start antimalassezia treatment.
  • —1- 2 Weeks’ course of systemic antiyeast treatment with Ketoconazole,Itraconazole or Fluconazole
  • Class IV or lower strength topical steroid creams, lotions or solutions for acute flares for 5-7 days only.
  • Continue with anti seborrhoeic/ antiyeast measures
  • Other alternatives: Calcineurin derivatives Pimecrolimus/tacrolimus, metronidazole gel, Narrow band UVB therapy etc. 
  • A course of low dose Isotretinoin may help some patients
Treating the acute phase
  • Antifungal treatments remove the Malassezia yeasts, and this is followed by improvement in the inflamed lesions.Relapse after antifungal treatment is common, but is delayed until re-colonisation has occurred.
  • The most important component of any treatment is frequent shampooing. This will stop the sebum from accumulating and the seborrhoeic dermatitis will be controlled. Commercially available products such as Nizoral 2% or Selsun ‘Yellow’ will assist in controlling this condition.
  • Changing your diet also helps this condition. Sufferers should eat a low fat, low sugar diet and cut down on the alcohol.
  • Topical steroid lotions for severe cases is often indicated. Tar products which were once a mainstay, are gradually being replaced by “cosmetic” products and of which new and even more effective treatment modalities, are now in development.
  • Modern shampoos incorporating antidandruff ingredients such as ZPT and imidazoles can effectively eliminate the clinical condition of seborrheic dermatitis to an extent that dermatologists would envy in other therapeutic areas .
  • Topical corticosteroids may hasten recurrences, may foster dependence because of a rebound effect, and are discouraged except for short-term use. Skin involvement responds to ketoconazole, naftifine, or ciclopirox creams and gels. Alternatives include calcineurin inhibitors (ie, pimecrolimus, tacrolimus), sulfur combinations, or propylene glycol. Class IV or lower corticosteroid creams, lotions, or solutions can be used for acute flares. Systemic ketoconazole or fluconazole may help if seborrheic dermatitis is severe or unresponsive.
  • Dandruff responds to more frequent shampooing or a longer period of lathering. Use of hair spray or hair pomades should be stopped. Shampoos containing salicylic acid, tar, selenium, sulfur, or zinc are effective and may be used in an alternating schedule.  Selenium sulfide (2.5%), ketoconazole, and ciclopirox shampoos may help by reducing Malassezia yeast scalp reservoirs. 
  • Seborrheic blepharitis may respond to gentle cleaning of eyelashes with baby shampoo and cotton applicators. The use of ketoconazole cream in this anatomical region is controversial.
What is the Prognosis of Seborrheic Dermatitis?
Infantile Seborrheic dermatitis or cradle cap.
Infantile Seborrheic dermatitis or cradle cap.
  • Infantile seborrheic dermatitis: spontaneous resolution may occur within a few weeks or it may persist for several months, but in most cases resolves by 8 months of age.
  • Adult seborrheic dermatitis: usually lasts for years to decades, with periods of improvement in warmer seasons and periods of exacerbation in colder months.

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The information given in this article is for educational purpose only so that patients are aware of the options available for diagnosis and treatment of common skin, hair and nail diseases. No diagnosis should be made or treatment undertaken without first consulting your dermatologist. If you do so, the author will not be responsible for any consequences. The images provided are for illustration purpose only and should not be reproduced without the consent of the author.

About the Author of Skin Care Tips from Dermatologist: Dr Hanish Babu, MD
Dr Hanish Babu, MD, Dermatologist, Sharjah and Ajman, UAE
Dr Hanish Babu, MD

Dr Hanish Babu, MD is a dermatologist with more than 3 decades of experience in treating skin and sexually transmitted diseases in UAE and India. He has been practicing in UAE since last 22 years. He is a respected speaker during the Continuing Medical education Programmes for doctors, medical students and paramedical staff and is also a Stress Management Trainer. He organises group therapy sessions for patients with psoriasis, eczema and vitiligo.

He is available for consultation at Cosmolaser Medical Centre in Samnan, Sharjah (06 5678 200) from 9 am – 1 pm and at City Medical Centre, Al Bustan, Ajman (06-7 441 882) from 4.30 pm – 9.30 pm.

Visit his personal website for more details and for educational articles on Skin, hair, nail and sexually transmitted diseases. Click here to Book an Appointment with dermatologist Dr Hanish Babu, MD

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