Treatment of scalp seborrheic dermatitis and psoriasis with an ointment of40% urea and 1% bifonazole

Seventy-one patients (52 patients with psoriasis capitis and 19 with scalp seborrheic dermatitis) enrolled in this open-label study, All had stable di sease for at least 6 months. Patients who were allergic to imidazoles, were pregnant or breastfeeding, or were aged less than 18 years were excluded. Only psoriatic patients with scalp involvement alone or whose body surface area involvement was less than 25% were included, All patients reported inc omplete response to previous topical therapies (used alone or in combinatio n: corticosteroids, salicylic acid, tar, anthralin, and ketoconazole shampo o) and had a washout period of at least 1 month. The patients applied 40% urea plus 1% bifonazole in an ointment base nightl y, They were instructed to apply a fixed amount (1 cm in length =0.32 g) of ointment for each 10 cm(2) of involved area. Each morning, 1% bifonazole s hampoo was applied for 5 min and rinsed with water; 10-20 min later, one dr op of 1% bifonazole solution per 10 cm(2) area was applied to the scalp. Th is treatment regimen was repeated daily for 7 days. If clearance was not ac hieved in the first week, the regimen was continued for one more week. After this initial treatment (for 7 or 14 days), maintenance therapy with o nce-weekly application of the regimen was continued for up to 3 months, In addition, during this follow-up period, the scalp was washed in 2-day inter vals with the shampoo alone, which was left on for 5 min and then washed of f. On each visit (weeks 0, 1, 2 and 12), the scalp was evaluated for redness, scaling, and pruritus and each parameter was scored as absent (0), mild (1) , moderate (2), or severe (3). On each visit, the scalp's condition was sco red as follows: worsening (-1), no improvement (0), mild (0-25%) improvemen t (1), moderate (25-50%) improvement (2), marked (50-75%) improvement (3), and (> 75%) cleared (4).