Please let me know all of Coco's previous therapies. Steroids would be contraindicated when fighting malasseziasis (yeast infection). When addressing this infection any underlying cause (allergies, endocrinopathy (hormonal disorder such as hypothyroidism), or keratinization defect (as seen with seborrhea)) must be identified and corrected.
For mild cases, topical therapy alone is often effective. Coco should be bathed every 2-3 days with shampoo that contains 2% ketoconazole, 1% ketoconazole/2% chlorhexidine, 2% miconazole, 2% to 4% chlorhexidine, or 1% selenium disulfide. Shampoos that have two active ingredients provide better efficacy. Treatment should be continued until the lesions resolve and follow-up skin cytology (microscopic exam of a small sample of Coco's skin surface) reveals no organisms (~4 weeks).
The treatment of choice for moderate to severe cases is ketoconazole or fluconazole at 10 mg/kg orally with food every 24 hours. Treatment should be continued as stated above.
Alternatively, treatment with terbinafine at 5-10 mg/kg orally daily or itraconazole (Sporanox) at 5-10 mg/kg daily for a month may be effective.
The prognosis is good if the underlying cause can be identified and corrected. Otherwise, regular once- or twice-weekly antiyeast shampoo baths may be needed to prevent relapse.
Please respond with further questions or concerns if you wish.