This handout is for seborrheic dermatitis (incl. dandruff + infantile cradle cap). Your care team identified this based on: greasy yellow-white scale on erythematous skin in a seborrheic distribution (scalp, brows, glabella, nasolabial folds, ears, central chest) (sd overview dall'oglio pmid 35967915).
Other reasons your team may use this plan: diffuse fine scalp flaking ± itch without overt inflammation — dandruff / pityriasis capitis, the mild scalp variant of sd (scalp-sd consensus vano-galvan pmid 38919137); infant with greasy yellow adherent scalp scale ± flexural involvement in the first months of life — cradle cap (infantile sd) (infantile sd microbiome review pmid 39526559); chronic relapsing eruption of sebaceous-rich sites needing induction + maintenance — relapse-first chronic-care entry (sd treatment landscape pmid 39953371).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| ketoconazole | 2% shampoo | topical | 2×/week induction (~4 wk) then weekly–fortnightly maintenance | Scalp-SD consensus (PMID 38919137) + SD overview (PMID 35967915) — anti-Malassezia azole; first-line scalp SD/dandruff; ketoconazole 2% significantly reduces SD severity vs vehicle (Rousel RCT PMID 37762625). |
| ciclopirox | 1% (or 1.5%) shampoo | topical | 2–3×/week induction then weekly–fortnightly maintenance | Lebwohl RCT (PMID 15271196) — ciclopirox 1% shampoo "effective treatment" 26.0% vs vehicle 12.9% (OR 2.38, 95% CI 1.49–3.80); broad-spectrum antifungal + anti-inflammatory. |
| selenium sulfide | 1%–2.5% shampoo | topical | 2×/week induction then weekly maintenance | Scalp-SD consensus (PMID 38919137) — antifungal/antiproliferative medicated shampoo; effective low-cost first-line scalp option (can discolour hair / scalp irritation). |
| zinc pyrithione | 1%–2% shampoo | topical | 2–3×/week then maintenance | Scalp-SD consensus (PMID 38919137) — anti-Malassezia OTC medicated shampoo; well tolerated; mainstay of dandruff and mild scalp SD. |
| coal tar | 0.5%–5% shampoo | topical | 1–3×/week | Scalp-SD consensus (PMID 38919137) — keratoplastic/antiproliferative adjunct, useful with thick scale or sebopsoriasis overlap; cosmetic acceptability (odour/staining) limits use. |
| salicylic acid | 2%–6% shampoo/solution/oil | topical | as descaling adjunct then taper | SD overview (PMID 35967915) — keratolytic to debulk thick adherent scale (incl. pityriasis-amiantacea pattern) so antifungal/anti-inflammatory agents can penetrate; descaling adjunct, not monotherapy. |
| clobetasol propionate | 0.05% scalp solution/foam/shampoo | topical | short burst (≤2–4 wk) for an inflammatory flare then stop | Scalp-SD consensus (PMID 38919137) — short corticosteroid solution/foam burst layered on the antifungal base rapidly controls an inflammatory scalp flare; time-limited (folliculitis/atrophy/rebound) — antifungal shampoo carries maintenance. |
Plan: Seborrheic dermatitis — site/severity/age-stratified ladder + relapse-prevention maintenance (scalp-SD consensus 2024 + SD reviews 2022/2025)
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Chronic relapsing-disease maintenance: intermittent prophylactic antifungal shampoo/topical to recurrence-prone sites (the core of relapse control — counsel explicitly), facial steroid-sparing maintenance (CNI / antifungal / roflumilast), trigger counselling (stress, cold/dry season, infrequent washing), and education that SD is controllable but not curable. For the infant: reassure (self-limited, typically resolves by ~8–12 months) with return precautions for petechial/erosive/failure-to-thrive change. Re-evaluate for HIV/neurologic disease at follow-up if the course remains atypically severe or treatment-resistant.
Guideline: No SD-specific society guideline exists — authority chain: scalp-SD international expert consensus + treatment algorithm (Vano-Galvan et al, Eur J Dermatol 2024; PMID 38919137) + SD diagnosis & management overview, all sites + infantile (Dall'Oglio et al, Clin Cosmet Investig Dermatol 2022; PMID 35967915) + child & adult SD treatment-landscape review positioning roflumilast foam as potential first-line (Vidal/Green et al, Dermatol Ther 2025; PMID 39953371) + current understanding of SD treatment options (Turchin et al, J Cutan Med Surg 2025; PMID 40965088); anchored by the STRATUM roflumilast-foam phase-3 RCT (Blauvelt et al, JAAD 2024; PMID 38253129), ketoconazole + ciclopirox + pimecrolimus SD RCTs, and the SD–HIV/Parkinson/immunology evidence (Adalsteinsson et al, Exp Dermatol 2020; PMID 32125725)