Shampoos and other preparations for scalp

13.9 Shampoos and other preparations for scalp

13 FLUOROURACIL

and hair conditions

Indications superficial malignant and pre-malignant

Skin

skin lesions; other malignant disease (section 8.1.3) Cautions avoid contact with mucous membranes;

Dandruff is considered to be a mild form of seborrhoeic caution in handling—irritant to tissues

dermatitis (see also section 13.5.1). Shampoos contain- Contra-indications

ing antimicrobial agents such as pyrithione zinc (which pregnancy (Appendix 4); breast-

are widely available) and selenium sulphide may have feeding

beneficial effects. Shampoos containing tar extracts Side-effects local irritation (use a topical cortico-

may be useful and they are also used in psoriasis. Keto- steroid for severe discomfort associated with

conazole shampoo should be considered for more inflammatory reactions), photosensitivity; rarely

persistent or severe dandruff or for seborrhoeic erythema multiforme

dermatitis of the scalp. Dose

Apply thinly to the affected area once or twice daily; if Corticosteroid gels and lotions (section 13.4) can also . possible, cover malignant lesions with occlusive

be used.

dressing; max. area of skin treated at one time, Shampoos containing coal tar and salicylic acid may 500 cm ; usual duration of initial therapy, 3–4 weeks

also be useful. A cream or an ointment containing coal Note Alternative regimens may be in use in some settings

tar and salicylic acid is very helpful in psoriasis that affects the scalp (section 13.5.2). Patients who do not Efudix c (Valeant) A respond to these treatments may need to be referred to

Cream , fluorouracil 5%, net price 20 g = £17.72, 40 g exclude the possibility of other skin conditions. = £35.44 Excipients include hydroxybenzoates (parabens), polysorbate 60, pro-

Cradle cap in infants may be treated with coconut oil or

pylene glycol, stearyl alcohol

olive oil applications followed by shampooing.

13.9 Shampoos and other preparations for scalp and hair conditions BNF 57 See below for male-pattern baldness and also section

Psoriderm c (Dermal)

13.5 (psoriasis and eczema), section 13.10.4 (lice), and Scalp lotion (= shampoo), coal tar 2.5%, lecithin section 13.10.2 (ringworm).

0.3%, net price 250 mL = £4.96 Excipients include disodium edetate

Dose scalp psoriasis, use as necessary Ketoconazole (Non-proprietary) A

1 Shampoos

Cream —section 13.10.2 Selsun c (Chattem UK) Shampoo , ketoconazole 2%, net price 120 mL =

Shampoo , selenium sulphide 2.5%, net price 50 mL = £3.26

£1.44, 100 mL = £1.96, 150 mL = £2.75

Excipients include imidurea Excipients include fragrance Brands include Dandrazol

2% Shampoo , Nizoral Cautions avoid using 48 hours before or after applying hair Dose treatment of seborrhoeic dermatitis and dandruff apply

colouring, straightening or waving preparations twice weekly for 2–4 weeks (prophylaxis apply once every 1–2

Dose seborrhoeic dermatitis and dandruff, apply twice weekly weeks); treatment of pityriasis versicolor apply once daily for max.

for 2 weeks then once weekly for 2 weeks and then as necessary; 5 days (prophylaxis apply once daily for up to 3 days before sun

CHILD under 5 years not recommended; pityriasis versicolor, exposure); leave preparation on for 3–5 minutes before rinsing

section 13.10.2 [unlicensed indication]

1. Can be sold to the public for the prevention and treatment of T/Gel dandruff and seborrhoeic dermatitis of the scalp as a c (J&J) shampoo formulation containing ketoconazole max. 2%, in a

Shampoo , coal tar extract 2%, net price 125 mL = pack containing max. 120 mL and labelled to show a max.

£3.18, 250 mL = £4.78 frequency of application of once every 3 days

Excipients include fragrance, hydroxybenzoates (parabens), imidurea,

c Alphosyl 2 in 1 tetrasodium edetate (GSK Consumer Healthcare) Dose scalp psoriasis, seborrhoeic dermatitis, dandruff, apply as Shampoo , alcoholic coal tar extract 5%, net price

necessary

125 mL = £1.81, 250 mL = £3.43 Excipients include hydroxybenzoates (parabens), fragrance Dose dandruff, use once or twice weekly as necessary; psoriasis,

Other scalp preparations seborrhoeic dermatitis, scaling and itching, use every 2–3 days

Cocois c

Capasal c (Dermal)

Section 13.5.2

Shampoo , coal tar 1%, coconut oil 1%, salicylic acid Etrivex 0.5%, net price 250 mL = £4.91 c Excipients none as listed in section 13.1.3

Section 13.4

Dose scaly scalp disorders including psoriasis, seborrhoeic dermatitis, dandruff, and cradle cap, apply daily as necessary

Polytar c (Stiefel)

Ceanel Concentrate c (Ferndale) Liquid , arachis (peanut) oil extract of coal tar 0.3%, Shampoo , cetrimide 10%, undecenoic acid 1%, phe-

cade oil 0.3%, coal tar solution 0.1%, oleyl alcohol 1%, nylethyl alcohol 7.5%, net price 150 mL = £3.40,

tar 0.3%, net price 250 mL = £2.23 500 mL = £9.80

Excipients include fragrance, imidurea, polysorbate 80 Excipients none as listed in section 13.1.3

Dose scalp disorders including psoriasis, seborrhoea, eczema, Dose scalp psoriasis, seborrhoeic dermatitis, dandruff, apply 3

pruritus, and dandruff, apply 1–2 times weekly times in first week then twice weekly

Polytar Plus c (Stiefel) Clinitar c (CHS)

Liquid , ingredients as Polytar c liquid with hydrolysed , coal tar extract 2%, net price 100 g = £2.50 Excipients Shampoo

animal protein 3%, net price 500 mL = £3.91

include polysorbates, fragrance Excipients include fragrance, imidurea, polysorbate 80 Dose scalp psoriasis, seborrhoeic dermatitis, and dandruff, apply

Dose scalp disorders including psoriasis, seborrhoea, eczema, up to 3 times weekly

pruritus, and dandruff, apply 1–2 times weekly

Skin Dermax c (Dermal)

Shampoo 13 , benzalkonium chloride 0.5%, net price

250 mL = £5.95 Excipients none as listed in section 13.1.3

Hirsutism

Dose seborrhoeic scalp conditions associated with dandruff and scaling, apply as necessary

Hirsutism may result from hormonal disorders or as a

c Meted side-effect of drugs such as minoxidil, corticosteroids, (Alliance) anabolic steroids, androgens, danazol, and progesto- Shampoo , salicylic acid 3%, sulphur 5%, net price

gens.

120 mL = £3.80 Excipients include fragrance

Weight loss can reduce hirsutism in obese women. Dose scaly scalp disorders including psoriasis, seborrhoeic

dermatitis, and dandruff, apply at least twice weekly Women should be advised about local methods of hair

removal, and in the mildest cases this may be all that is Pentrax c (Alliance)

required.

Shampoo , coal tar 4.3%, net price 120 mL = £3.80 Excipients none as listed in section 13.1.3 Eflornithine, an antiprotozoal drug, inhibits the enzyme Dose scaly scalp disorders including psoriasis, seborrhoeic

ornithine decarboxylase in hair follicles. Topical eflor- dermatitis, and dandruff, apply at least twice weekly

nithine can be used as an adjunct to laser therapy for facial hirsutism in women. Eflornithine should be dis-

Polytar AF c (Stiefel) continued in the absence of improvement after treat- Shampoo , arachis (peanut) oil extract of coal tar

ment for 4 months. 0.3%, cade oil 0.3%, coal tar solution 0.1%, pine tar

Co-cyprindiol (section 13.6.2) may be effective for 0.3%, pyrithione zinc 1%, net price 250 mL = £6.52 Excipients include fragrance, imidurea

moderately severe hirsutism. Metformin (section Dose scaly scalp disorders including psoriasis, seborrhoeic

6.1.2.2) is an alternative in women with polycystic dermatitis, and dandruff, apply 2–3 times weekly for at least 3

ovary syndrome [unlicensed indication]. Systemic treat- weeks

ment is required for 6–12 months before benefit is seen.

BNF 57

13.10 Anti-infective skin preparations 647