What Is Seborrheic Dermatitis?

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Seborrheic dermatitis is a chronic inflammatory skin condition that mainly affects the scalp, causing red, itchy patches and persistent dandruff. It can affect other parts of the body that have a heavy concentration of sebaceous glands, including the face, chest, groin, and upper back. Seborrheic dermatitis is believed to be caused by imbalances in the skin's microbiome, as well as other genetic and environmental factors, and is not contagious.

Also Known As

  • Seborrhea
  • Seborrheic eczema
  • Cradle cap (in infants)

Symptoms

Seborrheic dermatitis manifests with dry, itchy patches of skin and stubborn dandruff. Although the scalp is most commonly involved, it can develop anywhere on the body where there is oily skin, including behind the ears, on the sides of the nose, near the eyelashes, in skin folds, or on the chest and upper back.

While seborrheic dermatitis can look similar to psoriasis, rosacea, atopic dermatitis, and superficial fungal infections, it has a few distinct symptoms, including:

  • Red, swollen, and oily skin
  • Scaly white or yellow patches that easily flake off
  • Thick crusting on the scalp
  • Oily dandruff that often sticks to hair shafts
  • Occasional hair loss from scratching and/or extreme inflammation

The location of dermatitis on the body is another tell-tale sign. Seborrheic dermatitis involves areas of skin where there are plenty of sebaceous glands, which secrete a waxy oil (sebum) that lubricates and protects the skin.

Unlike other forms of dermatitis, seborrheic dermatitis does affect areas of skin where sebaceous glands are either sparse or small, such as the legs, knees, arms, elbows, or abdomen.

In infants, seborrheic dermatitis most often affects the scalp and face but can sometimes develop in the diaper area and in folds of skin. While this can be distressing to parents, most cases don't cause pain or discomfort and generally resolve within the first year of life.

Seborrheic dermatitis isn't common during childhood but can return (or appear for the first time) during or after puberty. Adults with seborrheic dermatitis will often experience recurrent bouts interspersed with periods of remission.

Causes

The exact cause of seborrheic dermatitis remains elusive. Several factors have been implicated, but it is likely the result of multiple interrelated factors that contribute to its development.

Microorganisms

Seborrheic dermatitis is believed by some to be the result of an immune overreaction to a common fungus known as Malassezia. Malassezia resides on oily skin and usually causes no problems. However, in people with seborrheic dermatitis, its presence triggers an abnormal inflammatory response, causing redness and itching.

A number of other microorganisms have been implicated as contributing factors to seborrheic psoriasis, including a common bacteria known as Staphylococcus aureus.

Genetics

Other studies suggest that certain gene mutations can predispose a person to seborrheic dermatitis. It is believed that these mutations cause a deficiency of proteins meant to either control fungal overgrowth or maintain the integrity of the skin. Failure to do either of these things can contribute to the rise of seborrheic dermatitis.

Disease Triggers

Like all forms of dermatitis, seborrheic dermatitis occurs in episodic flares and can often be triggered by environmental and physiological factors, such as:

  • Stress
  • Illness
  • Cold, dry weather
  • Certain medications (most especially psoralen, interferon, and lithium)
  • Hormonal changes (such as occurs before menstruation and during pregnancy or menopause)

Seborrheic dermatitis can co-exist with other inflammatory conditions, like psoriasis, and share similar triggers.

HIV

Seborrheic dermatitis disproportionately affects people with HIV. Some studies suggest that anywhere from 30% to 80% of people living with HIV will develop the condition compared to only 2.35% to 11.3% of the general population.

While it may seem reasonable to assume that this is due to the suppression of the immune system—the defining feature of HIV infection—there is yet to be solid evidence that HIV causes an increase in Malassezia numbers.

Rather, it appears that HIV enables certain species of Malassezia to thrive, although scientists are not quite certain why. As immune function drops in people with HIV, the risk and severity of seborrheic dermatitis almost invariably increase.

In parts of the world where HIV infection rates are high, such as sub-Saharan Africa, seborrheic dermatitis is often an early indicator of HIV infection.

Others with compromised immune systems, such as organ transplant recipients and people undergoing cancer treatment, are also at an increased risk of seborrheic dermatitis.

Risk Factors

Seborrheic dermatitis can occur at any age, although it is most common in adults 30 to 60 and infants under 3 months. While men are more affected than women, women tend to experience it more severely. Your risk also increases if you have any of the following health conditions:

Diagnosis

Seborrheic dermatitis is typically diagnosed by the appearance of the lesions and dandruff as well as a review of your medical history and risk factors. Less commonly, a KOH prep test⁠—involving a scraping of skin mixed with a potassium hydroxide (KOH) reagent⁠—may be used to establish the presence of fungus.

If there is any doubt about the cause, other tests (including skin biopsies and blood tests) may be used to rule out other conditions with similar features. In addition to psoriasis, rosacea, and atopic dermatitis, ringworm (tinea capitis) and systemic lupus erythematosus may be included in the differential diagnosis.

Treatment

Seborrheic dermatitis cannot be cured, but it can be controlled. This typically involves appropriate skincare and the use of topical and oral drugs to either control fungal overgrowth or reduce inflammation.

Home Remedies

While there are numerous alternative remedies said to treat seborrheic dermatitis, few have robust scientific evidence to support their use. These include aloe vera, apple cider vinegar, coconut oil, tea tree oil, and fish oil supplements.

One of the more well-studied remedies is raw honey. Not only does honey have antimicrobial and anti-inflammatory properties, but it is also known to inhibit the growth of S. aureus and act as a humectant (meaning that it keeps the skin hydrated).

Lifestyle Modifications

Sun exposure is also helpful as it not only boosts your mood but also inhibits the growth of Malassezia. But don't overdo it. Always use sunscreen and limit your daily exposure to 30 minutes maximum.

Among some of the other lifestyle tips to consider:

  • Avoid skin and hair products containing alcohol.
  • Wear soft, non-abrasive cotton clothing.
  • Brush softly, especially for babies with cradle cap.
  • Keep well hydrated to reduce skin dryness.
  • Use a humidifier to moisturize the air, especially sleeping.
  • Avoid using adult skin and hair products on babies.

Daily Skincare

Choose soaps and shampoos that can reduce the amount of oil on the skin without stripping them away completely. For the body, look for a gentle, daily cleanser with 2% zinc pyrithione. For the scalp, opt for a good antifungal shampoo containing either selenium sulfide (found in Selsun Blue), pyrithione zinc (Head & Shoulders), coal tar (Sebutone or Tegrin), or ketoconazole (Nizoral A-D shampoo).

Moisturize regularly to keep the skin soft and well-hydrated, especially after bathing, showering, or washing your face. Over-the-counter moisturizers containing ceramides are especially useful, including brands like CeraVe, Aveeno, and Eucerin. Avoid those that contain fatty acid esters or polysorbates, which can "feed" Malassezia and encourage fungal growth.

Over-the-Counter (OTC) Medications

One of the more common over-the-counter (OTC) remedies is 1% hydrocortisone cream, a mild form of topical steroid. It is applied to lesions once or twice daily to treat acute flares and is not intended for ongoing use. Treatment is generally limited to five to 14 days to avoid side effects (such as irreversible skin thinning, skin discoloration, or spider veins).

Prescriptions

If OTC medications are unable to control your symptoms, stronger topical or oral drugs may be prescribed by your doctor. Options include:

  • Prescription topical steroids, like Synalar ointment (fluocinolone acetonide) or Desonate gel (desonide), can usually rein in localized inflammation.
  • Antifungal creams like Nizoral ointment (2% ketoconazole) or Loprox cream (0.77% ciclopirox), can help alleviate Malassezia overgrowth.
  • Topical calcineurin inhibitors, specifically Protopic (tacrolimus) or Elidel (pimecrolimus), can temper an overactive immune response.
  • Oral antifungals, like terbinafine or ketoconazole, are less commonly used due to the risk of side effects (including diarrhea, nausea, and vomiting).
  • Oral isotretinoin is a vitamin A derivative typically used when all other treatments fail. Side effects, including hair loss, weight loss, and birth defects, limit the use of isotretinoin to only the most severe cases.

Though the treatment of seborrheic dermatitis in people with HIV is no different than anyone else, HIV therapy can help restore immune function and reduce the risk of opportunistic skin conditions by as much as 50%.

Coping

The redness, flaking, and itching that come with seborrheic dermatitis can be frustrating to deal with. Even though the condition isn't usually serious, it can undermine the quality of your life and prevent you from going out into public out of embarrassment or shame.

If you have these feelings or experience persistent anxiety or depression, don't keep it to yourself; let your dermatologist know. In some cases, your doctor may be able to step up treatment, using stronger drugs or more aggressive lifestyle modifications to provide sustained relief.

It is also important to remember that stress is a major trigger for acute flares. It sometimes helps to explore mind-body therapies like mindfulness meditation, yoga, progressive muscle relaxation (PMR), or guided imagery. Regular exercise can help elevate moods, in part by stimulating the feel-good hormone endorphin.

if isolated or depressed, make every effort to reach out for support. This not only includes trusted friends or family members but online support groups on social media platforms or the National Eczema Association website.

A Word From Verywell

While seborrheic dermatitis is chronic, it can be controlled. If over-the-counter products and lifestyle modifications aren’t working and you are experiencing frequent flares, make an appointment with your dermatologist as soon as possible. Together, you can come up with a plan to better manage your symptoms and prevent acute flares.

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