Adult Scalp Seborrhoeic Dermatitis

by | Dec 17, 2017

Bill is a 35 year old man, just started at Medical School who presents with months of itchy flaky scalp with severe dandruff. He has shaved his head in an effort to control symptoms but hasn’t succeeded.

Questions:

  1. What is the pathogen that is thought to cause Seborrhoeic Dermatitis?
  2. What are the associated diseases?
  3. What is the 1st to 5th line management of Seborrhoeic Dermatitis

Causes of dandruff/seb derm

  • Malassezia yeast

What diseases are associated with seb derm?

  • Blepharitis

1st Line Treatment of dandruff/seb derm

  • Standard shampoo daily

2nd Line Treatment of dandruff/seb derm

  • Antiyeast Shampoo
    • ciclopirox olamine
    • zinc pyrithione
    • selenium sulfide
    • ketoconazole
    • miconazole or
    • coal tar

  • Combining the antiyeast shampoo with a topical corticosteroid lotion and/or a tar may be needed to treat symptoms (eg itch) and scale.

3rd Line Treatment of dandruff/seb derm

  • Add topical corticosteroids in a lotion, in addition to above
    • Diprosone or Eulaphrat – Betamethasone dipropionate 0.05% lotion topically, applied to scalp once daily at night for 7 nights
    • Advantan – Methylprednisolone aceponate 0.1% lotion topically, applied to scalp once daily at night for 7 nights
    • Elocon, Momasone, Zatamil, Novasone – Mometasone furoate 0.1% lotion topically, applied to scalp once daily at night for 7 nights

4th Line Treatment of dandruff/seb derm

  • Add Coal Tar to above
    • Scytera or Exorex – coal tar prepared 1% emulsion or gel topically, applied to scalp at night once or twice weekly or as needed. Wash tar off the next morning with antiyeast shampoo
    • Sebitar – LPC 3–6% + salicylic acid 3–6% + salicylic acid 3% in aqueous cream topically, applied to scalp at night once or twice weekly or as needed [Note 2]. Wash tar off the next morning with antiyeast shampoo.

5th Line Treatment of dandruff/seb derm

  • Replace anti yeast shampoo with TCS shampoo, keep coal tar and lotion
    • Clobex – clobetasol propionate 0.05% shampoo topically, twice weekly (use antiyeast shampoo on the other 5 days).

References

  • eTG – best reference for this case was here.
  • Murtaghs – treatment was typically blase
  • DermNet – good info on background but poor on management, but then deep good links to the detail on how to apply the shampoos.