Guidelines

Management – younger than 12 months

Advise parents / carers:

• It does not affect the baby
• Tend to resolve spontaneously by ~8 months

Management of Scalp Disease

1st line: massage a topical emollient onto the scalp to loosen scales → remove with infant brush / fine tooth comb → wash off with a suitable shampoo

2nd line: topical imidazole (clotrimazole / miconazole) – up to 4 weeks

3rd line: consider short course (up to 2 weeks) of mild topical steroid (e.g. hydrocortisone 1%)

Management of Other Body Areas

1st line: conservative care

• Bathe the infant every day with an emollient as a soap substitute
• Change nappy once wet / soiled
• Use barrier emollients in nappy area

2nd line: consider topical imidazole (clotrimazole / miconazole)

3rd line: consider short course of mild topical steroid (e.g. hydrocortisone 1%)

Management – older than 12 months

General Advice / Conservative Management

• Advise that it is a chronic condition, long-term maintenance treatment may be needed
• Use gentle soap-free wash on the skin and affected areas, and apply light moisturiser after washing
• If the patient wears make-up → use products that do not block the pores and are non-comedogenic
• Fruit consumption may reduce flares
• Stress may exacerbate and lead to flares

Management of Scalp/Beard Disease

1st line: ketoconazole 2% shampoo (twice a week for up to 4 weeks, then once every 1-2 weeks for maintenance)

• Scales can be removed by applying a keratolytic agent (e.g., salicylic acid) for several hours before applying shampoo
• Ketoconazole shampoo should be left on for 5 minutes before rinsing off

2nd line: OTC medicated shampoos (e.g. zinc pyrithione, coal tar, salicylic acid)

Consider short course (up to 2 weeks) of a topical steroid (e.g., hydrocortisone 1%) for severe scalp/beard inflammation

• Mild topical steroids on the beard
• Higher potency can be used on the scalp

Management of Face and Body Disease

1st line:

• Ketoconazole (2% cream or 2% shampoo to be used as body wash) OR
• Alternative topical imidazole cream (e.g., clotrimazole or miconazole)

Consider short course (up to 2 weeks) of mild topical steroid for flares

References

Original Guideline