| Category Name | Content |
| Name | Dandruff Treatment with Ketoconazole Shampoo or Foam (Extina) |
| Uses | Management of dandruff and seborrheic dermatitis symptoms, including flaking, itching, redness, and scalp irritation. |
| Route Of Administration | Topical application (shampoo or foam). |
| Frequency Of Use | Shampoo: Every 3 days for 8 weeks. Foam: Twice daily for 4 weeks. |
| Concentration(s) | Ketoconazole 1% or 2% Shampoo, Ketoconazole 2% Foam (Extina). |
| Maximum Dosage (Day, Wk) | Shampoo: No more than every other day. Foam: No more than twice daily. |
| Contraindications | Pregnancy, breastfeeding, allergy to ketoconazole or antifungal medications, current oral antifungal or immunosuppressive therapy, scalp wounds or open sores, chronic inflammatory scalp conditions. |
| Possible Side Effects | Mild scalp irritation, dryness, redness, rare allergic reactions, hair texture changes, or skin discoloration. |
| Compatibility With Other Treatments/Drugs | Avoid concurrent use with oral antifungal medications or other scalp treatments that may cause irritation. |
| Allergies | Assess for hypersensitivity to ketoconazole or antifungal medications. |
| Administration Time | Shampoo: Apply to wet hair, lather generously, leave on scalp for 3-5 minutes, then rinse thoroughly. Foam: Apply to affected areas and massage until absorbed, twice daily. |
| Dosing/Settings | Ketoconazole 1% or 2% Shampoo: Use every 3 days for 8 weeks. Ketoconazole 2% Foam: Apply twice daily for 4 weeks. |
| Test Spot Requirement | Not required, but recommended for first-time users with sensitive skin. |
| Pre-Treatment Guidelines | Avoid harsh hair treatments, excessive sun exposure, and tight headwear. Ensure scalp is dry before applying foam. |
| Provider Clearance Guidelines | Defer if pregnant, breastfeeding, or taking oral antifungal or immunosuppressive therapy. Assess for active skin conditions before prescribing. |
| Pre-Treatment Screening Workflow | 1. Pregnancy or breastfeeding? (If YES, defer). 2. Taking oral antifungals or immunosuppressants? (If YES, defer). 3. Scalp wounds, open sores, or chronic inflammatory conditions? (If YES, defer). 4. Allergy to ketoconazole? (If YES, defer). |
| What To Do If Adverse Reaction Occurs | Discontinue treatment if severe irritation or allergic reaction occurs. If symptoms worsen, re-evaluate for alternative treatment. |
| Clinic Implementation Guidelines | Confirm patient consent. Educate on correct usage, expected results, and when to discontinue or seek medical attention. |
| Photographic Documentation Protocol | Not required. |
| Post-Treatment Care | Continue regular hair washing with a gentle shampoo. Avoid excessive scratching or picking of the scalp. If symptoms persist, reassess treatment options. |
| Additional Documentation Requirements | Signed consent, allergy review, prescription details, and documentation of patient instructions. |