This guidance is based on NICE CKS Seborrhoeic dermatitis (last revised November 2024). Products may vary in licensed indications, age, and duration of use; refer to the SmPC.

Yeasts play an important role in the development of seborrhoeic dermatitis but the exact mechanism is not known. Control of the yeasts improves symptoms.

Sources of patient information:

• British Association of Dermatologists leaflet Seborrhoeic dermatitis
• National Eczema Association website information on Seborrhoeic dermatitis.

From birth to 12 months

For the scalp, advise the parent/carer to massage a topical emollient onto the scalp to loosen scales, then remove them using an infant brush or fine-tooth comb before washing with a suitable shampoo.

For other areas of the body, advise bathing the infant every day using an emollient as a soap substitute to help loosen scales and moisturise the skin. Encourage frequent nappy checks so they can be changed as soon as they become wet or soiled, and use of barrier emollients.

Consider offering a topical imidazole cream:

Clotrimazole 1% cream

• Apply thinly two to three times a day for up to 4 weeks
• See section 13.10.2 Antifungal preparations

Miconazole 2% cream

• Apply twice a day for up to 4 weeks
• See section 13.10.2 Antifungal preparations

For inflamed skin

Consider adding a short course (up to 2 weeks) of a mild or moderate topical corticosteroid if there is significant inflammation or no response to topical imidazole:

Mild steroid

Hydrocortisone 1% cream/ointment

• Apply thinly once or twice a day for up to 2 weeks
• See section 13.4 Topical corticosteroids

Moderate steroid

Eumovate cream/ointment (clobetasone butyrate 0.05%)

• Apply thinly once or twice a day for up to 2 weeks
• See section 13.4 Topical corticosteroids

Scalp disease (aged over 12 months)

Mild disease

Use an antidandruff shampoo containing zinc pyrithione (e.g. Head & Shoulders), coal tar (e.g. Polytar), or salicylic acid (e.g. Neutrogena T/Gel); many of these can be bought over the counter.

Moderate and severe disease

Ketoconazole 2% shampoo

• Use twice a week for up to 4 weeks, then once every 1-2 weeks for maintenance
• Shampoo should be left on for 5 minutes before rinsing off
• For use in 12 years and over
• See section 13.9 Shampoos and other preparations for scalp and hair conditions

For severely inflamed scalp

Consider adding a short course of a strong topical corticosteroid to help settle inflammation:

Strong steroid

Betamethasone valerate 0.1% scalp application

• Apply to affected scalp sites (allow to dry) morning and evening for 5 days
• For use in patients aged 1 year and over
• See section 13.4 Topical corticosteroids

Mometasone furoate 0.1% scalp lotion

• Apply to affected scalp sites and once a day for up to 5 days
• For use in patients aged 2 years and over
• See section 13.4 Topical corticosteroids

Disease affecting face and body (aged over 12 months)

Use a gentle, soap-free wash on skin and affected areas when washing and apply a light moisturiser after.

Fruit consumption may help to reduce flares.

Mild disease

Offer an imidazole cream (see options below) and, if required, ketoconazole shampoo as a body wash:

Cream

Ketoconazole 2% cream

• Apply once or twice a day for up to 4 weeks, once symptoms are under control reduce to once or twice a week or every other week
• For use in adults only
• See section 13.10.2 Antifungal preparations

Clotrimazole 1% cream

• Apply thinly two to three times a day for up to 4 weeks
• For use in all ages
• See section 13.10.2 Antifungal preparations

Miconazole 2% cream

• Apply twice a day for up to 4 weeks
• For use in all ages
• See section 13.10.2 Antifungal preparations

Body wash

Ketoconazole 2% shampoo

• Can be used as a body wash, leave on for 3-5 minutes before rinsing
• For use in 12 years and over
• See section 13.9 Shampoos and other preparations for scalp and hair conditions

For inflamed skin

Consider adding a short course (up to 2 weeks) of a mild or moderate topical corticosteroid to help settle inflammation:

Mild steroid

Hydrocortisone 1% cream/ointment

• Apply thinly once or twice a day for up to 2 weeks
• For use in all ages
• See section 13.4 Topical corticosteroids

Moderate steroid

Eumovate cream/ointment (clobetasone butyrate 0.05%)

• Apply thinly once or twice a day for up to 2 weeks
• For use in all ages
• See section 13.4 Topical corticosteroids

Betnovate RD cream/ointment (betamethasone valerate 0.025%)

• Apply thinly once or twice a day for up to 2 weeks
• For use in children from 1 year of age
• See section 13.4 Topical corticosteroids

Topical calcineurin inhibitors (off-label use)

Frequent, recurrent, and resistant cases of seborrhoeic dermatitis may need treatment with topical calcineurin inhibitors (off-label) particularly if topical corticosteroids are ineffective or there are concerns about important adverse effects from topical corticosteroid treatment (e.g. skin atrophy).

Advice and guidance are available for GPs when considering initiating topical calcineurin inhibitors for seborrhoeic dermatitis. For additional information, including advice to give patients on the use of topical calcineurin inhibitors please see section 13.5.1 Preparations for eczema.

Pimecrolimus 1% cream

• Apply twice daily for up to 2 weeks (off-label use)
• Not for use in patients under 3 months of age
• See section 13.5.1 Preparations for eczema

Tacrolimus 0.03% ointment

• Apply twice daily for up to 2 weeks (off-label use)
• Not for use in patients under 2 years of age
• See section 13.5.1 Preparations for eczema

Tacrolimus 0.1% ointment

• Apply twice daily for up to 2 weeks (off-label use)
• Not for use in patients under 16 years of age
• See section 13.5.1 Preparations for eczema

Reassessment and referral

Routine follow-up is not usually required, however, the patient should be advised to attend for review if:

• response to treatment is poor
• symptoms worsen despite treatment
• signs of infection (for example, crusting, oozing, bleeding) develop.

Refer the patient to a dermatologist if there is:

• severe or widespread seborrhoeic dermatitis
• diagnostic uncertainty
• failure to respond to routine treatment.

Please see local referral guideline:

• South Devon & Torbay
• Western locality