Atopic dermatitis (eczema)

It is important to realise that the treatment of Seborrheic dermatitis is aimed at control of the disease and not at cure. The reason for that is simply that there are no known cures for Seborrheic dermatitis. That off course does not mean that you will be suffering from Seborrheic dermatitis indefinitely. The disease can spontaneously remit.

You should not be disheartened by the fact that the aim of treatment is control and not cure, because most people find the condition quite easy to control.

The most important thing to do is to make the treatment of the condition part of your daily routine. Learn to like to treat it!

A 2% Ketoconazole containing shampoo should be used preventatively on a 3-4 times weekly basis. Use it not only on the scalp, but also on other affected areas, like you face, armpits or inguinal area. Leave the shampoo on for a few minutes and then wash it off.

When the condition flares up you must continue to used the Ketoconazole containing shampoo, but more frequently. In addition you will use a corticosteroid-containing lotion or mousse daily on your scalp and a corticosteroid-containing cream daily on the affected areas on your body. Mometasone furoate is the preferred corticosteroid for use on the face and flexural areas and Betamethasone the preferred corticosteroid for the scalp. The moment your Seborrheic dermatitis starts to improve you can start reducing the frequency of application of the corticosteroid containing compounds. Aim to taper the use of the corticosteroid containing mousse/lotion/creams off over a week or two. The aim is to use the minimum frequency of application of the corticosteroid containing compounds that will just control the condition.

If you find that you are unable to reduce the frequency of application of the corticosteroid containing compounds without inducing a flare-up (a very uncommon occurrence) then your doctor could consider trying other compounds like Tacrolimus or Pimecrolimus ointment.

Other rarely necessary treatment options include oral itraconazole and terbinafine. One treatment schedule is to take 200mg of itraconazole on the first 2 days of each month.

Another factor that can lead to difficult to control Seborrheic dermatitis is very thick scaling on the scalp. The excess scale prevents the medicinal compounds from actually reaching the skin! In these cases you must first reduce the scaling. Salicylic acid (2-6%) containing compounds are effective descaling agents.

Triggering factors for Seborrheic dermatitis include stress, immunosuppression (e.g. HIV infection) and certain medications (e.g. Lithium). These factors can be addressed as necessary.