What are the treatment options for pediatric seborrheic dermatitis (dandruff)?

From the Guidelines

For pediatric dandruff treatment, start with a gentle, child-formulated anti-dandruff shampoo containing either 1% selenium sulfide, 1-2% zinc pyrithione, or 1% ketoconazole, used 2-3 times weekly. This approach is based on the principle of using the least harsh treatment first, given that dandruff in children can often be managed with over-the-counter formulations. The use of coal tar, as discussed in the guidelines for the management and treatment of psoriasis in pediatric patients 1, is not typically recommended for dandruff treatment due to its potential side effects, such as folliculitis, irritation, contact dermatitis, and photosensitivity/phototoxicity.

Key Considerations for Treatment

• Apply the shampoo to the scalp, massage gently, leave on for 5 minutes, then rinse thoroughly to ensure effective removal of scales without irritating the scalp.
• For mild cases, regular washing with a mild baby shampoo may be sufficient, emphasizing the importance of scalp hygiene.
• If the child has thick scales, apply mineral oil or olive oil to the scalp 1-2 hours before shampooing to help loosen scales, making the shampooing process more effective and less irritating.
• Avoid adult-strength formulations which may be too harsh for children's sensitive skin, as they can increase the risk of adverse effects without providing additional benefits for dandruff treatment.

Monitoring and Follow-Up

• If dandruff persists after 2-3 weeks of treatment, consult a pediatrician as it may indicate seborrheic dermatitis requiring prescription-strength medication, such as topical corticosteroids or antifungals.
• Dandruff in children typically results from either dry skin, fungal overgrowth (Malassezia), or seborrheic dermatitis, and understanding the underlying cause can guide the treatment approach.
• Maintaining proper scalp hygiene, using appropriate shampoos, and ensuring adequate hydration can help manage this common condition effectively, reducing the need for more aggressive treatments.

From the FDA Drug Label

For treatment of dandruff and seborrheic dermatitis: Usually two applications each week for two weeks will afford control. The answer to pediatric treatment of dandruff is not directly addressed in the provided drug labels. Key points:

• The provided drug labels do not mention pediatric treatment.
• The labels only provide general treatment information for dandruff and seborrheic dermatitis. The FDA drug label does not answer the question.

From the Research

Pediatric Treatment of Dandruff

• Dandruff is a common complaint that can affect people of all ages, including children, although its prevalence and severity are greatest in young men 2.
• The condition is characterized by the presence of flakes on the scalp and in the hair, and by itch, with symptoms varying in severity from mild scaling to severe scaling 2.
• In pediatric patients, dandruff can be treated with everyday shampooing and a longer period of lathering, and the use of hair spray or hair pomades (gels) should be stopped 2.
• Salicylic acid, tar, selenium, sulfur, and zinc are effective in shampoos and may be alternated, while overnight occlusion of salicylic or urea oil may help to soften thick, scalp plaques 2.
• Selenium sulfide, imidazoles or ciclopirox olamine shampoos may help by reducing Malassezia scalp reservoirs, which is the common causative agent of dandruff 2, 3.
• Antidandruff formulations exhibiting some direct or indirect anti-inflammatory activity can improve both dandruff and its subsequent hair cycle disturbance 3.
• Ketoconazole and zinc pyrithione shampoos have been shown to be effective in treating dandruff, with a combination of ketoconazole (2%) and zinc pyrithione (1%) offering a safe and effective option 4, 5.
• However, there is limited information available on the specific treatment of pediatric dandruff, and most of the available evidence is focused on adult populations or does not specifically address pediatric treatment 2, 3, 4, 5.
• One study provides evidence-based recommendations for the diagnosis and treatment of pediatric acne, but does not address dandruff specifically 6.