An Overview of Seborrheic Dermatitis

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Have you noticed red, flaky skin around your nose or in your eyebrows? How about on your scalp, especially over your forehead or ears? If the answer is yes, then you may have something called seborrheic dermatitis, or seborrhea—a chronic, inflammatory skin condition that affects the areas of the head and trunk that have sebaceous glands. In infants, this condition is known by what's likely more of a household name: cradle cap.

Symptoms

Symptoms most often appear on the scalp (dandruff), but seborrhea can also appear on other oily areas of the body like the eyebrows, nose, back, the upper portion of the chest, and in and around the ears.

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

  • Scaly white or yellow patches that flake off
  • Greasy and swollen skin
  • Redness or pink-colored patches (mostly on people with darker skin)
  • Itchiness and burning

Adults who have seborrhea often experience outbreaks that come and go.

Causes

There is no known cause of seborrheic dermatitis. One possibility is the yeast-like fungus Malassezia (Pityrosporum). It is normally present on oily areas of the body without causing problems. People with seborrhea, however, produce higher levels that can build up and irritate the skin, causing redness and flaking.

Seborrheic dermatitis is typically triggered by factors like:

  • Stress
  • Sickness
  • Hormonal changes
  • Weather (cold, dry air)
  • Medications (psoralen, interferon, and lithium)

Unlike other types of eczema, seborrhea is not caused by an allergy.

Seborrhea affects 3 percent of the general population and can occur at any age. It is more common in women, however, and often impacts patients with neurologic conditions (such as Parkinson's disease) and health conditions that compromise the immune system (such as HIV). Nearly 85 percent of people with AIDS experience seborrheic dermatitis.

Your risk also increases if you have one of the following health conditions:

  • Alcohol use disorder
  • Acne
  • Depression
  • Eating disorder
  • Epilepsy
  • Rosacea

Diagnosis

It usually just takes a medical history and physical exam to diagnose seborrheic dermatitis. Sometimes, however, since seborrhea can look like (or appear with) other skin conditions, your doctor may need to scrape a bit of skin and mix it with a chemical to test for a fungal infection.

A skin biopsy might also be used to rule out or confirm any other conditions that have similar symptoms.

Treatment

Seborrhea cannot be cured, but it can be controlled with proper maintenance, which often includes over-the-counter (OTC) treatments such as antifungal shampoos and topical steroids. Natural remedies may also be helpful. Many of the treatments that work for adults, including antiseborrheic or anti-dandruff shampoos and OTC steroid cream or lotion, can work for infants, too.

Soaps and Shampoos

Frequent washing with antifungal soap and shampoos gets rid of the oils in the affected areas and improves symptoms. For the body, look for a gentle, daily cleanser with 2% zinc pyrithione, and moisturize with a cream that contains salicylic acid and sulfur, or coal tar.

There are several good antifungal shampoos on the market that can be purchased without a prescription. Read the labels for the following ingredients:

  • Selenium sulfide (found in Selsun)
  • Pyrithione zinc (found in Head & Shoulders)
  • Sebulon, which is coal tar (found in Sebutone and Tegrin)
  • Ketoconazole (found in Nizoral)

All of these shampoos have a medicated smell. When you use one, lather the shampoo into your hair and scalp, leave it there for at least 10 minutes, and then rinse it off. These shampoos can be used on the face and other parts of the body as well; follow the same instructions, just be careful not to get it in your eyes.

Do this daily until the redness and flaking are controlled, then use the shampoo two to three times a week to keep symptoms from returning.

Topical Steroids 

Topical steroids reduce the inflammatory response, help control itching, and are safe to use on the face. You can buy hydrocortisone cream (1%) over the counter. Apply it twice a day to the affected area until the redness resolves.

Save the hydrocortisone only for flare-ups and use the anti-fungal shampoo for regular maintenance. Long-term steroid use can cause side effects like acne and thinning of the skin.

If you have tried over-the-counter treatments and still have symptoms (especially very thick flakes), consult your doctor who may need to recommend a stronger steroid or combination medication to help dissolve the dead skin.

Depending on the severity of your seborrhea, your doctor might recommend a stronger, prescription hydrocortisone, including Capex or Synalar (fluocinolone), Clobex or Cormax (clobetasol), or Desowen or Desonate (desonide).

If you are unable to take corticosteroids, or if they have been used for a prolonged period, you may be prescribed one of the following:

  • A topical calcineurin inhibitor (TCI), such as Protopic (tacrolimus) or Elidel (pimecrolimus). These non-corticosteroid medications are approved for children (ages 2 and older), as well as adults.
  • Oral antifungal agents (ketoconazole, itraconazole, and terbinafine) 

Natural Remedies

Many people also turn to natural remedies to help relieve symptoms and keep seborrhea at bay. Since research is still limited, it might be worth talking to your dermatologist before adding one of these to your self-care routine. Unless you have allergies, to say tree nuts, fish, or honey, it likely won't hurt you to give them a try.

Lifestyle Modifications

Beyond medication, controlling your triggers is a big part of preventing flares. Stress, for example, weakens your body’s immune system, making it difficult to deal with the build-up of Malassezia

Sun exposure is also helpful, as sunlight not only boosts your mood and immunity but also inhibits the growth of the yeast. Don't overdo it, however. When you do spend time in the sun, don't forget sunscreen if you plan to be outdoors for longer periods.

A few more lifestyle modifications to keep in mind:

  • Check the ingredients. Until your seborrheic dermatitis gets under control, it is smart to skip any shampoos, conditioners, or styling products (sprays, gels, dry shampoos) that contain alcohol, which can irritate your scalp.
  • Brush softly. Especially for babies with cradle cap, brushing the area regularly with a soft brush can help prevent the build-up of scales. Consider first rubbing in a little mineral oil into the scalp. Leave it on for 10 to 15 to help soften the scales before brushing, then shampoo the oil out thoroughly.
  • Stick with cotton clothing. Depending on the location of your symptoms, soft, breathable cotton clothing will help reduce skin irritation and allow your skin to breathe.
  • Keep it clean. Baby shampoo is a great gentle cleanser for adults, too. Use it nightly to wash away any scales on your eyelids.

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 ASAP. Together, you can come up with a plan to manage your symptoms and live a flake- and itchy-free life. 

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Article Sources

  • National Eczema Association. Seborrheic Dermatitis. https://nationaleczema.org/eczema/types-of-eczema/seborrheic-dermatitis.