I use two different shampoos, I use ciclopirox prescription and a mild shampoo such as head and shoulders bare. Alternating the two.
Typical Formulary
Topical Creams, Ointments, and Lotions
2% salicylic acid + 2% sulfur in sorbolene cream or emulsifying ointment [32]
2% ketoconazole cream
1% clotrimazole + 1% hydrocortisone cream
10% sulfacetamide + 5% sulfur lotion [33]
Betamethasone dipropionate 0.05% lotion
0.03% and 0.1% tacrolimus ointment
Shampoos
1% zinc pyrithione
1% to .5% selenium sulfide
2% ketoconazole
1% ciclopirox
5% coal tar + 2% salicylic acid
0.1% and 0.03% tacrolimus
Oral Medication
Itraconazole
Fluconazole
Terbinafine
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Differential Diagnosis
Important considerations in the differential diagnosis of ASD include:
Scalp
Psoriasis: Mostly nonpruritic and tends to affect the occipital and frontal regions, whereas SD tends to affect the vertex and parietal regions
Eczema (contact): Due to the use of different shampoos and hair dye
Darier disease: Yellowish-brown clusters of rough dome-shaped papules in seborrheic distribution; acanthosis; peculiar odor
Face
Psoriasis: Rarely occurs in isolation; pitted nails
Lupus erythematosus (LE): Discoid LE is associated with skin atrophy and scarring alopecia
Rosacea: Look for erythema and telangiectasia; may cause meibomianitis along the posterior lid line
Acne vulgaris: Look for comedones (hallmark feature)
Staphylococcal blepharitis (anterior lash line)
Eczema (contact): Eyelids commonly involved (versus irritant eczema [dry, scaly skin] or allergic eczema [swollen, vesicular skin rash])
Darier disease: Nail changes
Trunk
Psoriasis: Sharply-defined red plaques with a loose, silvery lamella scale
Pityriasis rosea: Herald spot; collarette scale; Christmas tree distribution
Pityriasis versicolor: Not symmetrical; hypo- or hyperpigmentation
Subacute LE: Photosensitive distribution
Eczema (nummular): Intense pruritus
Tinea corporis: Raised leading edges and central clearing; uncommon in infants
Erythema annulare centrifugum: Recurrent polycyclic lesions that slowly expand and disappear
Darier disease: Greasy wart-like papules and plaques
Grover disease (transient acantholytic dermatosis): Acanthosis
Drug reaction: Drug history (neuroleptic; immunosuppressant; PUVA; lithium)
Parapsoriasis: Elderly; very slow growing; resistant to treatment
Pemphigus foliaceus: Fragile, painful blisters; Nikolsky sign is positive
Secondary syphilis: Lesions on the palms and soles; a history of chancre
Intertriginous Areas
Psoriasis (inverse): Sharply-defined border
Dermatitis (Contact) Itchy; vesicular
Tinea cruris: Advancing border; very uncommon in infants
Erythrasma: Coral-red fluorescence under Wood Lamp
Candidiasis: Satellite lesions; obesity; a history of immunodeficiency
Hailey-Hailey disease (familial benign pemphigus): Acanthosis
Important considerations in the differential diagnosis of ISD include:
While managing seborrheic dermatitis, it's important to use warm (not hot) water when washing your scalp. Tea tree oil and aloe vera are natural options that may provide some benefit for symptom management. However, be cautious with natural products - especially essential oils and fragrances, as these can potentially Show Full Answer