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%) 

 

1st line: conservative care

• Bath the infant everyday 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%) 

 

• Advise that it is a chronic condition, long-term maintenance treatment maybe needed
• Use gentle soap-free wash on the skin and affected areas, 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

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 salicylic acid for several hours before applying shampoo
• Shampoo should be left on for 5 minutes before rinsing off

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

3rd line: consider short course (up to 2 weeks) of topical steroid

1st line: topical ketoconazole 2% (OD / BD for up to 4 weeks) + ketoconazole 2% shampoo as body wash

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