Scalp Seborrheic Dermatitis in Adults

What is Seborrheic Dermatitis?

• Common skin condition in infants, adolescents, and adults.
• The skin changes are thought to result from an inflammatory response to Malassezia yeast. 
• Common manifestations of seborrheic dermatitis include redness, erythema, itching, greasy, & swollen skin and white or yellowish crusty flake. 
• Occur most often on the scalp, face, chest, back, axilla, and groin.

Treatment (General Principle)

• Primary goals are to lessen the visible signs of the condition and to reduce pruritus and erythema. 
• Treatment includes topical antifungals, calcineurin inhibitors, and corticosteroids. 
• For mild seborrheic dermatitis of the scalp, shampoos containing selenium sulfide, zinc pyrithione, or coal tar can control symptoms. 
• For long-term control, antifungal shampoos containing ketoconazole 2%  can be used daily or at least two or three times per week for several weeks, until remission is achieved. 
• These shampoos should remain on the hair for at least five minutes to guarantee adequate exposure to the scalp.

Product	Dosing Frequency	Common Adverse Effects
Keratolytics
Coal tar	Twice per week	Contact dermatitis, folliculitis, photosensitivity
Selenium sulfide shampoo	Twice per week	Alopecia, hair discoloration, irritation
Zinc pyrithione shampoo	Twice per week	Irritation
Antifungal
Ketoconazole 2% shampoo (Nizoral)	Daily initially, then twice per week	Irritation, pruritus, xeroderma
Corticosteroid
Clobetasol 0.05% shampoo (Clobex), alternating with ketoconazole 2% shampoo	Each twice weekly, alternating medications, for up to two weeks	Burning, erythema, folliculitis, hypopigmentation, pruritus, skin atrophy

Coal Tar Counselling Point

1. Apply to wet hair/ scalp, lather for at least 5 minutes ( to guarantee adequate exposure to the scalp), then rinse thoroughly. 
2. Use twice weekly for 2 weeks then once weekly or as needed. 
3. Once weekly of the shampoo can prevent relapse.
4. Avoid contact with eyes, inflamed or broken skin and genital/groin area.
5. Avoid exposure to sunlight at least 24 hours after application.
6. Keep away from fire/flame (coal tar is flammable).
7. Possible side effects: stinging/ burning of scalp, may cause discoloration or staining.  

References: 

1. Diagnosis and Treatment of Seborrheic Dermatitis, American Family Physician 2015 . Retrieved from http://www.aafp.org/afp/2015/0201/p185.html
2. Seborrheic Dermatitis Medication. Retrieved from http://emedicine.medscape.com/article/1108312-medication#4
3. Seborrheic Dermatitis in Adolescent & Adults, Retrieved from  http://www.uptodate.com.ezcontents/seborrheic-dermatitis-in-adolescents-and-adults?source=machineLearning&search=sebhorrheic+dermatitis&selectedTitle=2~150&sectionRank=3&anchor=H1431767#H1431767
4. https://nationaleczema.org/eczema/types-of-eczema/seborrheic-dermatitis/
5. Medscape 
6. Micromedex