The evolving role of therapeutic shampoos for targeting symptoms of inflammatory scalp disorders.

Scalp lesions are common among patients with psoriasis, seborrheic dermatitis and a number of other inflammatory and fungal conditions. Topical corticosteroids are a mainstay of treatment for many scalp dermatoses and they significantly reduce erythema, scaling and pruritus. Conventional corticosteroid formulations such as cream and ointments are often difficult or time consuming for patients to apply and may produce undesirable cosmetic effects. Medicated shampoos provide a more convenient alternative for patients who require topical administration of corticosteroids for scalp conditions. Tar shampoos have long been used to treat psoriasis and are effective for the long-term maintenance of remission in patients who respond to therapy. Antifungal shampoos are effective for the treatment of seborrheic dermatitis and other mycotic conditions. A shampoo formulation containing fluocinolone acetonide, 0.01% is also approved for the treatment of seborrheic dermatitis. One superpotent corticosteroid shampoo (clobetasol propionate 0.05%; Clobex Shampoo) is approved in the United States (U.S.) for once-daily treatment of psoriasis of the scalp. The results of a 2007 pilot study also demonstrated that clobetasol propionate shampoo improved the signs and symptoms of seborrheic dermatitis. These findings suggest that high-potency corticosteroid shampoos may provide an important option for topical corticosteroid therapy in dermatologic conditions affecting the scalp.