What treatment options are available for a patient with recurrent seborrheic dermatitis that has not responded to Selsun S (selenium sulfide) shampoo?

Treatment Instructions for Recurrent Seborrheic Dermatitis Not Responding to Selenium Sulfide

Since your seborrheic dermatitis has not responded to Selsun S (selenium sulfide) shampoo, you should switch to ketoconazole 2% shampoo as your primary treatment, which has an 88% response rate and is more effective than selenium sulfide for resistant cases. 1, 2

Your New Treatment Plan

Primary Scalp Treatment

• Apply ketoconazole 2% shampoo to your scalp twice weekly for 2-4 weeks 3, 2
• Leave the shampoo on your scalp for 5-10 minutes before rinsing to allow adequate contact time 4
• Make sure the shampoo reaches your scalp skin, not just your hair 5

If Inflammation and Itching Are Severe

• Add clobetasol propionate 0.05% shampoo twice weekly, alternating with your ketoconazole shampoo (use clobetasol on different days than ketoconazole) 6
• This combination provides superior results compared to ketoconazole alone and maintains effectiveness better during long-term use 6
• Apply clobetasol shampoo for 5-10 minutes before rinsing 4

After Your Condition Clears (Maintenance Phase)

• Continue ketoconazole 2% shampoo once weekly indefinitely to prevent relapse 2
• Without maintenance treatment, 47% of patients relapse, compared to only 19% with weekly ketoconazole use 2

Essential Daily Skin Care Measures

Cleansing

• Use mild, pH-neutral (pH 5) non-soap cleansers or dispersible creams instead of regular soap 1
• Regular soaps and detergents strip natural oils from your skin and worsen the condition 1
• Wash with tepid (lukewarm) water only—never hot water 1
• Pat your skin dry with a clean towel rather than rubbing 1

Moisturizing

• Apply fragrance-free moisturizers containing petrolatum or mineral oil immediately after bathing to damp skin 1
• Reapply moisturizer every 3-4 hours and after each face washing 1
• This creates a protective barrier that prevents water loss from your skin 1

Critical Things to Avoid

Products That Will Make Your Condition Worse

• Completely avoid all alcohol-containing lotions, toners, or aftershaves on affected areas—these significantly worsen dryness and trigger flares 1
• Avoid products containing neomycin, bacitracin, or fragrances due to high rates of skin sensitization 1
• Do not use greasy or occlusive creams, as these can promote folliculitis (infected hair follicles) 1
• Avoid harsh soaps, detergents, and hot water 1

Behaviors to Avoid

• Do not scratch or rub affected areas—keep your nails short to minimize trauma 1
• Do not wash your face immediately before or after applying any alcohol-based products 1

Watch for These Warning Signs

Signs of Bacterial Infection (Requires Antibiotics)

• Increased crusting, weeping, oozing, or honey-colored discharge 1
• If you notice these signs, contact your healthcare provider—you may need oral antibiotics like flucloxacillin while continuing your other treatments 1

Signs of Herpes Simplex Infection (Requires Immediate Treatment)

• Grouped blisters or punched-out sores 1
• Sudden worsening with fever 7
• Contact your healthcare provider immediately if you see these signs—you will need oral acyclovir 1

When to Seek Further Medical Attention

Contact your healthcare provider or request dermatology referral if: 1

• No improvement after 4 weeks of ketoconazole treatment
• The condition keeps coming back despite proper maintenance treatment
• You develop any of the warning signs listed above
• You are uncertain about the diagnosis

Additional Supportive Measures

For Severe Itching

• You may use sedating antihistamines (like diphenhydramine) at bedtime only for severe itching 1
• Non-sedating antihistamines (like cetirizine or loratadine) do not help seborrheic dermatitis and should not be used 1

Sun Protection

• Apply hypoallergenic sunscreen daily (at least SPF 30 with UVA/UVB protection containing zinc oxide or titanium dioxide) 1
• Wear protective clothing and hats when outdoors 1

Lifestyle Modifications

• Consider whether stress, hormonal changes, or nutritional deficiencies might be triggering your flares 5

Important Safety Information

• Do not use clobetasol shampoo continuously for more than 2-4 weeks without breaks to avoid skin thinning, visible blood vessels, and reduced effectiveness 1, 5
• If using clobetasol, implement "treatment-free periods" between courses 5
• Never use potent corticosteroids on your face for extended periods 1