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What to do for patient who have complain of seboorihic dermatitis

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"seborrheic dermatitis" AND treatment

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seborrheic dermatitis treatment guidelines ketoconazole shampoo topical corticosteroid

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https://www.aad.org/public/diseases/a-z/seborrheic-dermatiti…

Seborrheic dermatitis is a common, recurring inflammatory rash that causes dandruff or greasy scale, itching, and redness, usually on the scalp, eyebrows, sides of the nose, ears, beard area, chest, or skin folds. It is manageable, but often needs ongoing maintenance. - Textbook of Family Medicine 9e, p. 927

Practical treatment plan

1. For scalp dandruff/flaking
  • Use an anti-dandruff or antifungal shampoo containing ketoconazole, selenium sulfide, zinc pyrithione, or ciclopirox.
  • Use it 2 times weekly for about 4 weeks. Massage onto the scalp, leave it on for the time directed on the label, then rinse.
  • Once controlled, reduce to once weekly or every 1-2 weeks to prevent recurrence.
  • Avoid scratching and avoid heavy hair oils or irritating hair products.
2. For face, ears, chest, or beard area
  • Use a gentle non-soap cleanser and a light, fragrance-free moisturizer.
  • A clinician may advise ketoconazole or ciclopirox cream once daily for 2-4 weeks.
  • If it is very red or itchy, hydrocortisone 1% can be used in a thin layer for a short period, usually up to 1-2 weeks.
  • Do not use stronger steroid creams on the face unless prescribed. Prolonged steroid use can thin the skin and can worsen acne or rosacea.
3. If frequent facial flare-ups
  • Ask a dermatologist about non-steroid anti-inflammatory treatments such as pimecrolimus or tacrolimus, especially if steroids are repeatedly needed.
4. If thick scale
  • A shampoo or product with salicylic acid can help loosen scale. Do not pick at adherent scales.

When to see a clinician or dermatologist

Seek review if:
  • The diagnosis is uncertain, or it could be psoriasis, eczema, fungal infection, or contact dermatitis.
  • There is pain, pus, crusting, spreading redness, fever, or hair loss.
  • Symptoms are severe, widespread, or not improving after 4 weeks of correct treatment.
  • The patient is an infant, immunocompromised, or has extensive/refractory disease.
Topical antifungals and short intermittent courses of low-potency topical corticosteroids are standard treatments. AAD treatment guidance and DermNet guidance give similar advice. Recent systematic reviews found no newer evidence that changes this first-line approach (PMIDs: 39102684, 38958996).
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