# Seborrhoeic dermatitis (adult scalp and face) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: BAD Guidelines for Seborrhoeic Dermatitis 2019 · Hydrocortisone 1% cream SmPC section 4.2 (eMC product 13103) · Nizoral 2% Shampoo SmPC section 4.2 (eMC product 1510) · Seborrheic Dermatitis - StatPearls - NCBI Bookshelf - disease-level clinical article (seborrhoeic-dermatitis-full.txt) - Verified date: 2026-08 ## Verified against - Nizoral 2% Shampoo SmPC section 4.2 (eMC product 1510) - Hydrocortisone 1% cream SmPC section 4.2 (eMC product 13103) - Seborrheic Dermatitis - StatPearls - NCBI Bookshelf - disease-level clinical article (seborrhoeic-dermatitis-full.txt) ## Treatment metadata - Ketoconazole — topical - Referral & safety-netting (no drug therapy) - Selenium sulphide — topical - Hydrocortisone — topical ## Complete treatment card ```text SEBORRHOEIC DERMATITIS (ADULT SCALP AND FACE) Sources: BAD Guidelines for Seborrhoeic Dermatitis 2019 · Hydrocortisone 1% cream SmPC section 4.2 (eMC product 13103) · Nizoral 2% Shampoo SmPC section 4.2 (eMC product 1510) · Seborrheic Dermatitis - StatPearls - NCBI Bookshelf - disease-level clinical article (seborrhoeic- dermatitis-full.txt) Review status: REVIEWED against 3 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (5) - Itch is usual in adults, worst on the scalp, and burning is regularly reported [itching] - Abrupt onset of severe disease is a red flag for undiagnosed HIV - The infantile form is generally neither itchy nor sore; babies stay content while parents worry [anxiety] - Adults typically complain of a red face with scaling and dandruff [scaling] - Coexisting atopic dermatitis is frequent in babies but not in adults SIGNS - what you find (12) - Distribution is the key clue: sebum-rich skin, above all scalp and face - Salmon-coloured follicle-centred papules and plaques bearing fine white scale under a greasy yellow crust [papules · plaques] - Borders are ill-defined and flexures scale less than other sites - In adults the face, scalp and chest carry lesions in roughly 88%, 70% and 27% of cases - Head and neck disease is symmetrical over the middle third of the face: malar area, mid forehead, medial eyebrows, behind the ear and the ear canal - Nasolabial and alar folds are typical sites, and blepharitis along the lash line is common - Mildest form sheds small pale flakes, obvious against dark clothes [pallor] - In darker skin, lasting patchy pigment change appears, both darker and lighter - Chest lesions look psoriasiform but are often petaloid; annular lesions are common on darker facial skin - Infantile disease starts around the second week of life and runs 4 to 6 months - Cradle cap is a stuck-on yellowish scale-crust over the vertex and forehead margin that can spread across the whole scalp - Related Malassezia problems may sit alongside it, such as pityriasis versicolor and Malassezia folliculitis TESTS (9) - Routine testing is unnecessary, but push HIV serology through fast when disease is severe, particularly of sudden onset - Potassium hydroxide microscopy on scrapings from the skin - Bacterial swab for culture and sensitivity - Skin biopsy for histology with direct immunofluorescence - Syphilis testing by VDRL - Serum zinc level - Autoimmune screen: ANA, ENA and ESR - In elderly patients, look for parkinsonian features - Go through the drug list as part of the assessment IF NOT THIS - what else fits (12) - Scalp psoriasis, favouring occipital and frontal scalp while this disease takes vertex and parietal areas - Psoriasis elsewhere: firm red plaques, crisp margin, loose silvery scale, nail change, positive Auspitz sign - Contact eczema from shampoo or hair dye - Discoid lupus erythematosus, leaving atrophy and scarring alopecia - Rosacea, with erythema and telangiectasia, sometimes meibomianitis on the posterior lid - Acne vulgaris, where comedones are the giveaway - Staphylococcal blepharitis at the anterior lash line - Pityriasis rosea, with a herald patch, collarette scale and fir-tree pattern - Pityriasis versicolor, asymmetrical with lighter or darker patches - Tinea corporis, with a raised advancing edge and clearing centre - Erythrasma, fluorescing coral-red under Wood lamp - Candidiasis, showing satellite lesions Source StatPearls "Seborrheic Dermatitis" - disease-level clinical article Status traced to the source above Rx: Medicated shampoo - first line for the scalp | Main treatment MEDICATED SHAMPOO - FIRST LINE FOR THE SCALP - choose one 1. KETOCONAZOLE [1st line] Adult Wash hair twice weekly. x 2-4 weeks for treatment, then once every 1-2 weeks for prophylaxis Peds Children >12 years: apply twice weekly for 2-4 weeks Choice Alternatives - either will do, and ketoconazole is the one to write first. It is the agent the evidence in the card's own article supports for both scalp and non-scalp disease, and it is safe on the face, where selenium sulfide is a scalp-only treatment. Reach for selenium sulfide when the problem is scalp only, when ketoconazole has not held it, or on cost - the 2.5% lotion is a fraction of the price. Source Nizoral 2% Shampoo SmPC section 4.2 (eMC product 1510) Why Ketoconazole is a topical antifungal that targets the Malassezia yeast implicated in seborrhoeic dermatitis, reducing the scaling and inflammation of the scalp and face; it is first-line therapy for this condition. Caution Leave shampoo on scalp for 3-5 minutes before thoroughly rinsing. Avoid contact with eyes; rinse immediately if exposed. May cause mild local skin irritation or dry skin. Steroid withdrawal: gradually withdraw prior topical steroid therapy over 2 to 3 weeks while using shampoo to prevent rebound effect. Egypt KONAZOLE 2% CREAM 15 GM ALFACURE PHAR... 6.00 EGP CURAZOLE 2% TOPICAL CREAM 15 GM EVA PHARMA 7.00 EGP KETODERM 2% TOP. CREAM 20 GM SEDICO 7.00 EGP KONAZOLE 2% SHAMPOO 60 ML ALFACURE PHAR... 12.00 EGP KETODERM 2% GEL SHAMPOO 60 GM SEDICO 18.00 EGP KENZO 2% SHAMPOO 60 ML BORG 27.50 EGP NIZAPEX 20MG/GM SHAMPOO 80 ML APEX PHARMA 68.00 EGP NIZORAL 2% SHAMPOO 60 ML MINA PHARM > ... 68.00 EGP 2. SELENIUM SULPHIDE [1st line] Adult Massage 5 to 10 mL of the 2.5% lotion or shampoo into the wet scalp, leave it on for 2 to 3 minutes, then rinse thoroughly - Twice a week for 2 weeks, then spaced out to hold it - once a week, or every 2 to 4 weeks Peds The monograph states no paediatric dose. For a baby with cradle cap, look up infantile seborrhoeic dermatitis instead. Source Egyptian National Drug Formulary - Antimicrobial 2023, selenium sulfide monograph - verbatim, for the indication: "Dandruff, scalp seborrhea: Treatment of dandruff and seborrheic dermatitis of the scalp", and for the dose: "Lotion, shampoo (2.25%): Massage ~5 to 10 mL into wet scalp; leave on scalp for 2 to 3 minutes, then rinse scalp thoroughly." and "Usually 2 applications each week for 2 weeks will be effective. After this, may repeat at less frequent intervals (eg, once weekly, every 2 to 4 weeks)." The monograph heads the same entry "Shampoo 0.025 gm (2.5%)"; every Egyptian product is 2.5%. Why The scalp treatment the Egyptian formulary names for this disease, and the cheapest thing on the card - a 2.5% lotion costs about 4 EGP. Caution Not on broken, weeping or acutely inflamed skin, and not on mucous membranes - the formulary is explicit that it is not for use where there is acute inflammation or exudation. Not recommended in pregnancy, and use caution while breastfeeding. Rinse thoroughly. Left on, it can discolour hair or leave the scalp unusually dry or oily. Remove jewellery before treatment - it can damage it. Check the box lists selenium sulfide and nothing else. Most Egyptian anti-dandruff shampoos add zinc pyrithione, climbazole or piroctone olamine, and this dose was written for the single-agent 2.5% product - shampoo, lotion or cream alike, the formulary covers all three. Egypt VENEER HAIR SHAMPOO 120 ML EGYPTIAN COMP... 32.95 EGP SELENO CARE HAIR SHAMPOO 150 ML SIGMA > INTER... 98.00 EGP SELENGENA ANTI-DANDRUFF SHAMPOO 120 ML EGYPTIAN CO. FOR COSMETICS (E.C.C... 105.00 EGP SELENGENA ANTI-DANDRUFF SHAMPOO 220 ML EGYPTIAN CO. FOR COSMETICS (E.C.C... 165.00 EGP TINASEL 2.5 GM CREAM 20 GM ALFACURE PHAR... 5.00 EGP MAIN TREATMENT 3. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Seborrheic Dermatitis - disease-level clinical article (seborrhoeic-dermatitis-full.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - Sudden-onset or severe seborrhoeic dermatitis in an adult should prompt expedited HIV serology. In an elderly patient with seborrhoeic dermatitis, look actively for clinical features of Parkinson disease and review the medication list. Topical antifungals are the first-line treatment; topical corticosteroids and calcineurin inhibitors are reserved for significant symptoms and moderate-to-severe flares. Limit topical corticosteroid harm by using them intermittently at a potency appropriate to the site, or by switching to a steroid-sparing preparation such as topical 1% pimecrolimus. If oral antifungal treatment is needed for generalised or refractory disease: ketoconazole carries a Black Box warning and needs liver function monitoring, itraconazole has CYP450 interactions and can worsen heart failure, and fluconazole needs dose adjustment for renal function. Flexural areas and the eyelids are prone to secondary bacterial infection during acute flares, and the nappy area to Candida overgrowth. The commonest problem in both infant and adult seborrhoeic dermatitis is misdiagnosis - reconsider psoriasis, contact eczema, discoid lupus, rosacea, tinea and Darier disease before treating a resistant rash as seborrhoeic dermatitis. Erythroderma is a recognised progression, reported in immunosuppressed neonates with generalised infantile disease and more often seen in adults with HIV-AIDS. Topical salicylic acid, selenium and zinc lack safety and efficacy data in infants and should be used with care in that age group. 4. HYDROCORTISONE [add-on - not a substitute] Adult Apply sparingly to the affected skin two or three times daily after gently cleansing the area Peds Infant cradle cap has its own entry - see Infantile Seborrhoeic Dermatitis (Cradle Cap). Do not apply this adult regimen to an infant. Source Hydrocortisone 1% cream SmPC section 4.2 (eMC product 13103) Why Low-potency hydrocortisone is added to the antifungal regimen for facial seborrhoeic dermatitis to quickly settle inflammation and itching during a short course; it does not address the underlying Malassezia overgrowth on its own. Caution Use lowest potency (1%) on facial skin for short courses only. Do not apply near eyes. Limit a course in a child to 7-10 days, and remember the face and scalp absorb far more than limb skin. Contraindicated in rosacea, urticaria, ulcers, and local infection. Egypt NOVACORTIN 1% CREAM 15 GM PHAROPHARMA 4.75 EGP NOVACORTIN 1% OINT. 15 GM PHAROPHARMA 4.75 EGP MICORT 1% CREAM 20 GM MISR 12.50 EGP HYDROCORTISONE 1% OINT. 20 GM MISR 21.00 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)