Seborrheic Dermatitis: Symptoms, Complications, and More

Seborrheic dermatitis, also called seborrheic eczema, is a common condition that causes red patches with overlying greasy, yellow scales to appear on the skin, especially the scalp.

When adults or adolescents have seborrheic dermatitis on their scalp it's called dandruff. When infants do, it is referred to as cradle cap.

The causes of seborrheic dermatitis are unknown, but it's believed that one of the factors is an inflammatory response to Malassezia yeast on the skin.

Seborrheic dermatitis can develop at any age but most commonly develops in infants between 2 and 12 months of age, and then later in adults between the ages of 30 and 60.

This article explores the symptoms of seborrheic dermatitis, common treatments, and potential complications.

What Is Seborrheic Dermatitis?

Dermatitis means skin inflammation. Seborrheic dermatitis is a red, scaly form of dermatitis that usually affects the scalp or face.

Seborrheic dermatitis is common, affecting about 11% of people, and usually doesn't cause any harm beyond irritation.

It is not contagious, meaning that it cannot spread from person to person.

Seborrheic Dermatitis Symptoms in Adults

In adults, seborrheic dermatitis tends to be itchy and chronic, or ongoing, and may come and go for years with cycles of flare-ups.

The scaly patches on the skin are itchy, moist, and often yellowish in color.

Areas Affected by Seborrheic Dermatitis

Seborrheic dermatitis develops on areas of the skin that contain a large number of sebaceous (oil-producing) glands, such as the scalp and face. This includes the ears, eyebrows, and eyelids.

Other areas that may be affected by seborrheic dermatitis include the upper chest and back, armpits, and groin.

Skin Flakes, Including Dandruff

Seborrheic dermatitis causes white or yellowish flakes of dead skin.

You may first notice that flakes have formed on the scalp (dandruff) only after they fall off.

Dandruff typically sheds from the scalp into hair or onto your neck or shoulders. It can also sometimes occur in eyebrows.

Red Scales on the Skin

The inflamed skin tends to include patches of scales along with the skin flakes.

The skin underneath the the flaky, scaly patches is generally red.

Patches of Greasy Skin

Patches of greasy skin may occur beneath scaly, flaky skin.

Those with excessively oily skin may be more prone to seborrheic dermatitis.

Itching

Seborrheic dermatitis commonly causes itchiness and irritation.

Scratching can loosen flakes and also cause additional inflammation in the area.

Excessive scratching can also break the skin, leading to bleeding and increasing the risk of mild infections.

Blepharitis

Blepharitis is an inflammation of the eyelids. Seborrheic blepharitis can cause redness on the eyelids and dandruff-like scales on the eyelashes. It can make eyes feel itchy.

Pinkish Plaques on Face

Areas of thick, pinkish skin, called plaques, can occur on both sides of the face, such as beside the nose.

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Inflamed Hair Follicles

Sometimes seborrheic dermatitis can lead to inflamed hair follicles on the face or upper body.

In rare cases, seborrheic dermatitis can contribute to damaged hair follicles on the scalp and lead to temporary hair loss. The damage tends to occur from scratching.

Redness in Skin Folds

When seborrheic dermatitis occurs in skin folds and creases, it typically leads to patches of redness. This can happen in the armpits, genitals, or beneath breasts.

Seborrheic Dermatitis Symptoms in Infants

Many infants develop cradle cap. This type of seborrheic dermatitis causes crusty, scaly patches on the scalp.

It's also possible to get patches of seborrheic dermatitis in the diaper area.

Cradle Cap

Cradle cap causes thick patches to form on the baby's scalp, ears, or neck.

Like with adults, these patches are greasy and yellow to brown in color. Unlike with adults, cradle cap usually does not itch.

Cradle cap is typically harmless and usually goes away on its own within a few months. It typically does not persist past 8 to 12 months of age.

Patches on Diaper Area

In addition to the scalp and face, seborrheic dermatitis can affect the diaper area, including in skin folds. The skin may appear red and oily with yellowish patches.

This also typically resolves on its own.

What Causes Seborrheic Dermatitis?

The causes of seborrheic dermatitis are unclear, but researchers believe that it is likely due to several factors.

The following may contribute to the condition:

• Overgrowth of Malassezia yeast: This yeast is part of the group of organisms that normally live on the skin. It typically doesn't cause any trouble, but can when there is too much of it.
  
• Increased skin lipid levels, or natural compounds and fats
• Increased androgen levels, a type of hormone
• An inflammatory reaction that may happen in response to an excess of yeast, increased androgens, and/or increased skin lipids

Risk Factors for Seborrheic Dermatitis

There are many factors that may increase your risk of developing seborrheic dermatitis.

One of the main ones is having a family history of dandruff.

Additional risk factors for developing seborrheic dermatitis or experiencing flare-ups include:

• Oily skin means that there is more natural oil that offers a place for yeast to grow.
• Stress often precedes flare-ups. The reason behind this isn't fully understood, but it's possible that your body's chemical responses to stress make you more prone to an inflammatory reaction to yeast.
• Cold, dry weather can make the scalp prone to itchiness and flaking.
• Hormonal changes may worsen seborrheic dermatitis or contribute to flares.
• Use of alcohol-based skin products or harsh cleansers or soaps may irritate skin.
• History of acne, psoriasis, rosacea, or other skin disorders can mean skin inflammation, scaly skin, or excess oil.
• Certain medications, such as psoralen used to treat skin conditions, interferon, or the mood-stabilizer lithium for bipolar disorder can make you more prone to flare-ups.
  

How Seborrheic Dermatitis Is Diagnosed

A skin specialist called a dermatologist or another healthcare provider will review your medical history and perform a physical exam. They can usually diagnose seborrheic dermatitis based on its appearance.

There are other common skin conditions that can cause symptoms similar to those seen in seborrheic dermatitis. These include:

• Psoriasis: A skin condition in which the immune system mistakenly attacks healthy skin cells, causing patches anywhere on the body
• Rosacea, a chronic condition characterized by redness and bumps on the face
• Allergic contact dermatitis, or an allergic skin reaction after coming in contact with an allergen
• Tinea versicolor fungal infection, which is caused by yeast in the Malassezia family
• Pityriasis rosea, an itchy round or oval-shaped rash that typically resolves on its own

Less commonly, a widespread rash that can mimic the patches of seborrheic dermatitis may be due to secondary syphilis. This is a worsening of primary syphilis, the sexually transmitted bacterial infection that usually begins as a sore at the infection site.

Facial seborrheic dermatitis may also resemble the classic "butterfly rash" seen in systemic lupus erythematosus (SLE), a disorder in which the immune system damages connective tissues and the lining of blood vessels throughout the body.

To differentiate among these conditions, a dermatologist may perform the following tests:

• Skin scraping/KOH test is used to check for fungal infections. Your healthcare provider will use a tool to scrape off a small amount of skin that then gets mixed with KOH (potassium hydroxide). The KOH destroys the skin cells so that only fungus, if present, is left.
• Biopsy: Your healthcare provider may scrape or cut off a sample of skin to examine it under a microscope and check for conditions such as psoriasis.
• Blood or urine tests: In addition to skin tests, blood or urine test may be used to check for signs of SLE. Blood tests can also check for syphilis.
  

Treatment Options

The type of treatment your doctor recommends will depend on how severe the seborrheic dermatitis is, where it's located, and whether or not it responds well to common treatments.

Over-the-Counter Treatments

If seborrheic dermatitis is on the scalp and mild, OTC dandruff shampoos with one or more of the following ingredients can be helpful for both treating and preventing seborrheic dermatitis in adults:

• OTC-strength ketoconazole, found in Nizoral shampoo
  
• Zinc pyrithione, found in Head & Shoulders and DermaZinc
• Selenium sulfide, found in Selsun Blue
• Salicylic acid, found in Neutrogena T/Sal
• Coal tar, found in Neutrogena T/Gel and DHS Tar

Dandruff products are designed to reduce oil and scale buildup and kill yeast that may be associated with development of the condition.

It's typically recommended that OTC dandruff shampoos be used daily or several times a week during flare-ups and at least once or twice a week afterward as a preventative. Although, it's not a cure, so flare-ups can still happen.

Cradle cap usually resolves on its own by washing the skin with gentle baby shampoo and using a soft brush or comb to gently release flakes. If it doesn't clear up, see your child's pediatrician, who can evaluate whether an over-the-counter (OTC) or prescription treatment may be needed.

For mild flare-ups on other skin areas, such as your neck or chest, OTC-strength hydrocortisone creams or gels may be helpful.

Prescription Medications

If you have severe flare-ups, the seborrheic dermatitis is on your face, or if OTC treatments weren't effective, your doctor may prescribe one or more of the following types of medications:

• Antifungal shampoos, lotions, foams, or gels, such as Loprox (ciclopirax) or Nizoral (ketoconazole), to help reduce yeast
• Topical corticosteroids, such as Capex (fluocinolone), which are applied to the skin or scalp or used as a shampoo to reduce inflammation
• Calcineurin inhibitors, such as Protopic (tacrolimus) or Elidel (pimecrolimus), which can be used temporarily to reduce inflammation caused by certain types of immune cells

Antifungal treatments are typically tried first. Topical corticosteroids or calcineurin inhibitors may be added on a short-term basis, if needed. For example, you may take them for a week or two during a flare-up.

Antifungals may be used several times a week or daily during a flare-up. Your healthcare provider may recommend some continued use, such as once or twice a week, to help prevent flare-ups.

Diet and Lifestyle Changes

Try to shower soon after you exercise so that excess sweat and oil won't have a chance to build up and potentially contribute to your seborrheic dermatitis.

It may also be helpful to get plenty of sleep and eat an overall healthy diet.

A 2019 study found that eating a Western-style diet that is high in processed foods was associated with more seborrheic dermatitis, whereas eating eating more fruit was associated with less seborrheic dermatitis.

Processed foods include processed meats, such as hot dogs and deli meats, and fried foods like French fries.

You may also want to focus on healthy fats, such as omega-3 fatty acids found in fatty fish such as salmon.

Omega-3s may have anti-inflammatory properties that preliminary research suggests may be helpful for inflammatory skin conditions. Although, the research focused on another type of dermatitis and not seborrheic dermatitis specifically.

Natural Treatments

Research on natural treatments for seborrheic dermatitis is lacking, but there are some supplements and topical options that some people use:

• Fish oil supplements contain omega-3 fatty acids, making them a possible option.
• Tea tree oil can have antifungal and anti-inflammatory properties. You can find it in some shampoos or facial washes, or you can add the essential oil to your existing products or a carrier oil like coconut oil. Use about 3 drops per 1 ounce of shampoo or carrier oil. Always test a small amount on your skin first.
• Aloe vera gel may have some anti-inflammatory and anti-itch properties.
• Apple cider vinegar that's diluted in water is also sometimes used as a scalp treatment due to its potential anti-itch and antifungal benefits.
  

Complications of Seborrheic Dermatitis

Infants do not usually develop complications from cradle cap. Complications from seborrheic dermatitis in adults are uncommon, but possible.

In adults, especially those with more severe cases, a secondary bacterial or fungal infection may occur if seborrheic dermatitis is left untreated. This is because the skin tends to be open or damaged, which invites germs in.

These infections can cause increased redness, tenderness, and oozing or weeping of the patch and the surrounding skin.

Another potential complication of seborrheic dermatitis is related to the side effects of treatment. In adults, seborrheic dermatitis is often a chronic condition that requires on-and-off treatment to reduce inflammation and symptoms.

While low-dose topical corticosteroid therapy is an effective medication for treating seborrheic dermatitis, long-term use can cause side effects like thinning of the skin and dilated blood vessels, or telangiectasias.

This is why healthcare providers generally prefer milder agents to start, such as antifungal creams or medicated shampoos.

The psychological impact of seborrheic dermatitis can also be profound in some people. Adolescents and adults, in particular, may feel distress or embarrassment about the appearance of their skin, leading to low self-esteem.

Coping

Maintaining a consistent treatment and self-care plan can help you successfully manage the condition and feel more in control during flare-ups.

Experiment with different routines to see what works best for your scalp and skin, and what fits well with your day-to-day life.

If you are feeling really anxious or distressed about your skin, discuss it with your healthcare provider. You may need a more aggressive treatment for the seborrheic dermatitis to help improve your quality of life.

It's also important to remember that this is a common condition and you are not alone. You may want to consider joining a support group through organizations such as the National Eczema Association.

When to See a Doctor

It's usually not necessary to see a healthcare provider for mild seborrheic dermatitis, but severe or persistent symptoms are worth getting checked out.

If the redness and irritation persists and doesn't improve with treatment, it may be a different condition.

If you have any signs of a secondary infection, like increased pain, redness, drainage or fever, contact a healthcare provider right away.

When to Take Your Infant to the Doctor

Infants should see a healthcare provider if they have a widespread rash that isn't improving, or if they have any of the signs of infection, like pain, fever, drainage, or swelling.

In addition, the American Academy of Dermatology recommends that infants see a dermatologist for persistent rashes on the body or in the diaper area.

Summary

Seborrheic dermatitis is a common skin condition that causes red patches with overlying greasy, yellow scales and flaky skin.

It usually occurs on the scalp as dandruff or cradle cap, but it can occur in many other areas such as the face or skin folds.

Seborrheic dermatitis usually clears up on its own for infants.

In adolescents and adults, it tends to be chronic and itchy with periods of flare-ups. There's no cure, but it's usually easy to manage with treatments, such as OTC dandruff shampoos or prescription medications.