BNF for Children 2011-2012

584 13.9 Shampoos and other preparations for scalp conditions BNFC 2011–201213 Skinthe product is in contact with the scalp and by theirirritant nature.Oils and ointments are very useful for scaly, dry scalpconditions; if a greasy appearance is cosmetically unacceptable,the preparation may be applied at night andwashed out in the morning. Alcohol-based lotions arerarely used in children; alcohol causes painful stingingon broken skin and the fumes may exacerbate asthma.Itchy, inflammatory, eczematous scalp conditions maybe relieved by a simple emollient oil such as olive oil orcoconut oil (arachis oil (ground nut oil, peanut oil) isbest avoided in children under 5 years). In more severecases a topical corticosteroid (section 13.4) may berequired. Preparations containing coal tar are used forthe common scaly scalp conditions of childhood includingseborrhoeic dermatitis, dandruff (a mild form ofseborrhoeic dermatitis), and psoriasis (section 13.5.2);salicylic acid is used as a keratolytic in some scalppreparations.Shampoos containing antimicrobials such as seleniumsulphide or ketoconazole are used for seborrhoeicdermatitis and dandruff in which yeast infection hasbeen implicated, and for tinea capitis (ringworm of thescalp, section 13.10.2). Bacterial infection affecting thescalp (usually secondary to eczema, head lice, or ringworm)may be treated with shampoos containing antimicrobialssuch as pyrithione zinc, cetrimide, orpovidone–iodine.In neonates and infants, cradle cap (which is also a formof seborrhoeic eczema) can be treated by massagingcoconut oil or olive oil into the scalp; a bland emollientsuch as emulsifying ointment can be rubbed onto theaffected area once or twice daily before bathing and amild shampoo used.Shampoos1Ketoconazole (Non-proprietary) ACream—section 13.10.2Shampoo, ketoconazole 2%, net price 120 mL =£3.53Excipients include imidureaBrands include Dandrazol c 2% Shampoo, Nizoral cDoseSeborrhoeic dermatitis and dandruffTreatment, apply twice weekly for 2–4 weeks; prophylaxis,apply once every 1–2 weeks; leave preparation onfor 3–5 minutes before rinsingPityriasis versicolorTreatment, apply once daily for max. 5 days; prophylaxis,apply once daily for up to 3 days before sun exposure;leave preparation on for 3–5 minutes before rinsing1. Can be sold to the public for the prevention and treatment ofdandruff and seborrhoeic dermatitis of the scalp as ashampoo formulation containing ketoconazole max. 2%, in apack containing max. 120 mL and labelled to show a max.frequency of application of once every 3 daysAlphosyl 2 in 1 c (GSK Consumer Healthcare)Shampoo, alcoholic coal tar extract 5%, net price125 mL = £1.81, 250 mL = £3.43Excipients include hydroxybenzoates (parabens), fragranceDoseDandruffUse once or twice weekly as necessaryPsoriasis, seborrhoeic dermatitis, scaling and itchingUse every 2–3 daysCapasal c (Dermal)Shampoo, coal tar 1%, coconut oil 1%, salicylic acid0.5%, net price 250 mL = £4.69Excipients none as listed in section 13.1.3DoseScaly scalp disorders including psoriasis, seborrhoeicdermatitis, dandruff, and cradle capApply daily as necessaryCeanel Concentrate c (Ferndale)Shampoo, cetrimide 10%, undecenoic acid 1%, netprice 150 mL = £3.40, 500 mL = £9.80Excipients none as listed in section 13.1.3DoseScalp psoriasis, seborrhoeic dermatitis, dandruffApply 3 times in first week then twice weeklyDermax c (Dermal)Shampoo, benzalkonium chloride 0.5%, net price250 mL = £5.69Excipients none as listed in section 13.1.3DoseSeborrhoeic scalp conditions associated with dandruffand scalingApply as necessaryMeted c (Alliance)Shampoo, salicylic acid 3%, sulphur 5%, net price120 mL = £3.80Excipients include fragranceNote may be difficult to obtainDoseScaly scalp disorders including psoriasis, seborrhoeicdermatitis, and dandruffApply at least twice weeklyPentrax c (Alliance)Shampoo, coal tar 4.3%, net price 120 mL = £3.80Excipients none as listed in section 13.1.3Note may be difficult to obtainDoseScaly scalp disorders including psoriasis, seborrhoeicdermatitis, and dandruffApply at least twice weeklyPsoriderm c (Dermal)Scalp lotion (= shampoo), coal tar 2.5%, lecithin0.3%, net price 250 mL = £4.74Excipients include disodium edetateDoseScalp psoriasisUse as necessarySelsun c (Chattem UK)Shampoo, selenium sulphide 2.5%, net price 50 mL =£1.44, 100 mL = £1.96, 150 mL = £2.75Excipients include fragranceCautions avoid using 48 hours before or after applying haircolouring, straightening or waving preparationsDoseSeborrhoeic dermatitis and dandruffChild 5–18 years apply twice weekly for 2 weeks thenonce weekly for 2 weeks and then as necessaryPityriasis versicolor [unlicensed indication]Child 5–18 years apply to affected area and leave on for10 minutes before rinsing off; apply once daily for 7 days;repeat course if necessaryNote diluting with a small amount of water prior toapplication can reduce irritation