RISK FACTORS : Parkinson disease, AIDS (disease severity correlated with progression of
immune deficiency), Emotional stress
GENERAL MEASURES :
β’ Increase frequency of shampooing
β’ Sunlight in moderate doses may be helpful
PATIENT EDUCATION : Goal of treatment is control, rather than cure, of disease. Seborrheic dermatitis does not cause hair loss.
DRUG(S) OF CHOICE :
. Cradle cap:
. Frequent shampooing with a mild, non-medicated shampoo
. Remove thick scale by applying warm olive or mineral oil and then wash off several hours later with Dawn
dishwashing detergent and a soft bristle toothbrush
. May use a coal tar shampoo or ketoconazole (Nizoral) shampoo if the non-medicated shampoo is ineffective
. Adults:
. Wash off all affected areas with antiseborrheic shampoos. Start with over-the-counter brands (Tegrin, Selsun Blue) and increase to more potent preparations (containing coal tar, sulfur, selenium or salicylic acid) if no improvement is noted.
. For dense scalp scaling, 10% Liquor Carbonic Detergens (LCD) in Nivea Oil may be used at bedtime, covering the head with a shower cap. This should be done nightly for 1-3 weeks.
. Ketoconazole (Nizoral) cream may be used to clear scales in other areas, followed by application of steroids
to reduce infl ammation. Begin with 1% hydrocortisone and advance to more potent (fl uorinated) steroid preparations as needed. Avoid continuous use of the more potent steroids to reduce the risk of skin atrophy or systemic absorption (especially in infants and children).
. Once controlled, washing with zinc soaps or selenium lotion with periodic use of steroid cream will help
maintain remission
. For secondary infections: Short course of erythromycin or dicloxacillin
ALTERNATIVE DRUGS : In severe seborrhea nonresponsive to topical therapy - isotretinoin, 0.1-0.3
mg/kg/day may be helpful. This agent should be used cautiously.
PATIENT MONITORING : Every 2 to 12 weeks as necessary, depending on disease severity and degree of patient sophistication
POSSIBLE COMPLICATIONS:
β’ Skin atrophy or striae possible from fl uorinated corticosteroids, especially if used on the face
β’ Glaucoma - can result from use of fl uorinated steroids around the eyes
β’ Photosensitivity - occasionally caused by tars
β’ Herpes keratitis - rare complication of herpes simplex. Instruct patient to stop eyelid steroids if herpes simplex
develops.
EXPECTED COURSE/PROGNOSIS :
β’ In infants, seborrheic dermatitis usually remits after 6 to 8 months
β’ In adults, seborrheic dermatitis is usually chronic and unpredictable, with exacerbations and remissions.
Disease is usually easily controlled with shampoos and topical steroids.