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A Handout for the Non-Dermatologist


Seborrheic Dermatitis

Seborrheic dermatitis is a common process, present in 2-5% of the population. This process is commonly called "dandruff" in adults and "cradle cap" in infants. It may be present in individuals of all age ranges, with the two age peaks in the first 3 months of life and in the 4 th -7 th decade of life. The etiology of seborrheic dermatitis is uncertain. One proposed etiology suggests the causative role of Pityrosporum ovale , lipophilic yeast. Seborrheic dermatitis is also likely affected by factors such as hormones and stress.

This condition presents as erythematous plaques with overlying yellow dry or greasy scales of various sizes. The most common sites of involvement include the scalp, eyebrows, nasolabial folds, lips, ears, sternal area, axillae, umbilicus and gluteal crease. In general, there is increased involvement at sites where the sebaceous glands are most active. Pruritus may be a common symptom.

Shampoos: Apply and massage into scalp. Leave on for 5 minutes, and then rinse off. May use daily initially, and then use 2-3 times a week for maintenance once clear.

Over-the-counter shampoos
Selenium sulfide 1% (Selsun Blue), pyrithione zinc 1% (Dandrex, Zincon, Head and Shoulders), pyrithione zinc 2% (DHS Zinc, Sebulon, ZNP Bar), coal tar (DHS Tar, Zetar), ketoconazole 1% shampoo.

Prescription shampoos

Selenium sulfide 2.5% (Exsel, Selsun), ketoconazole 2% (Nizoral).

Topical Preparations: Apply to affected areas daily until clear, and then as needed.

Over-the-counter topical preparations

Hydrocortisone 1% cream, miconazole 2% cream.

Prescription topical preparations

Hydrocortisone 2.5% cream, fluocinolone acetonide 0.01% solution (Synalar)*, ketoconazole 2% cream (Nizoral), sodium sulfacetamide lotion (Klaron).

Topical preparations may be used as adjunct therapy to medicated shampoos in the treatment of seborrheic dermatitis.

*If using potent topical steroid preparations, advise patients to use them sparingly and to avoid excessive and prolonged use since this may lead to skin atrophy.

To preserve appointments for patients who need dermatologic consultations, UM Dermatology does not accept patients for seborrheic dermatitis that has not been evaluated and previously treated. Patients' personal physicians are the best source for such evaluations and initial therapies.