Seborrheic Dermatitis

What is seborrheic dermatitis?

Seborrheic dermatitis is a common, noncontagious, easy-to-manage skin condition. This type of dermatitis causes itchy red patches and greasy scales on your skin along with white or yellow crusty or powdery flakes on your scalp.

“Seborrheic” refers to the “sebaceous” glands while “derm” means “skin.” It’s called “dandruff” (pityriasis capitis) when it’s on a teenager’s or adult’s scalp, and “cradle cap” when it’s on a baby’s.

Seborrheic dermatitis can occur in other areas of your body. These are areas with the most sebaceous (oil) gland activity: your upper back and chest, face/forehead, the creases at the base of your nose, behind your ears, navel (belly button), eyebrows, under your breasts and in the creases/bends of your arms, legs and groin.

Seborrheic dermatitis is a lifelong condition that appears, disappears with treatment, and flares up from time to time.

Who gets seborrheic dermatitis?

About 11% of the population has seborrheic dermatitis. It occurs most often in infants younger than three months old and in adults ages 30 to 60. It is more common in men than in women, and in Caucasians more than African Americans.

If you are born with naturally oily skin, you are more likely to get this type of dermatitis. A history of psoriasis in your family makes you vulnerable as well. If you live in a dry, cold region, the weather doesn’t cause the seborrheic dermatitis, but it does make it worse.

If you have these health issues, you’re more prone to seborrheic dermatitis:

Immunosuppressions:

• Organ transplant recipients.
• Adult Hodgkin’s Lymphoma.
• Adult Non-Hodgkin’s Lymphoma.
• HIV (human immunodeficiency virus).

Psychiatric disorders:

• Depression.

Neurological diseases:

• Parkinson’s disease.
• Tardive Dyskinesia.
• Epilepsy.
• Facial nerve palsy.
• Spinal cord injury.

Congenital disorders:

• Down syndrome.

You’re also more prone to seborrheic dermatitis if you take these psychotropic medications:

• Lithium.
• Buspirone.
• Haloperidol decanoate.
• Chlorpromazine.

What are the symptoms of seborrheic dermatitis?

• Itchy white flakes of skin on your scalp (dandruff). When scratched, the flakes come loose, mix in with your hair, or fall onto your neck and shoulders.
• Red scales on your skin.
• Crusty yellow scales on infants’ heads (cradle cap). Cradle cap shouldn’t itch, but scratching may cause additional inflammation in the area and break the skin, leading to bleeding or mild infections.
• Blepharitis (scaly redness on the edges of your eyelids).
• Pinkish plaques (thick skin) of scales on both sides of your face.
• Flaky patches on your chest and at your hairline that are shaped like a flower petal or a ring.
• Redness in the folds and creases of your genitals, armpits and beneath your breasts.
• Inflamed hair follicles on your cheeks and the upper half of your trunk.

What are the causes of seborrheic dermatitis? What aggravates it?

Researchers aren’t sure of the exact cause of seborrheic dermatitis. They think there may be many causes. Factors that are thought to play a role include:

• A type of yeast called Malassezia, which is present on everyone’s skin, but overgrow in some people.
• An increased level of androgens (a hormone).
• An increased level of skin lipids.
• An inflammatory reaction.
• Family history (dermatitis runs in the family).

Other factors that trigger or worsen seborrheic dermatitis include:

• Stress.
• Cold and dry climate.
• Oily skin.
• Using alcohol-based lotions.
• History of other skin disorders, including rosacea, psoriasis and acne.

Does the weather make seborrheic dermatitis worse?

Dry air during the winter months will make your seborrheic dermatitis worse.

The dermatitis behaves best during the summertime. The sun’s UV-A and UV-B light have been shown to kill the type of yeast that overgrows on the skin of people who get seborrheic dermatitis. Just watch out for sunburns!

Do certain foods trigger or reduce seborrheic dermatitis?

Although there are theories out there, true experts have yet to find that food causes or reduces seborrheic dermatitis. Diet does not affect dandruff.

What's the difference between seborrheic dermatitis and psoriasis?

Psoriasis and seborrheic dermatitis can mimic each other. Both are patches of red skin with flakes. Both can be found on your scalp and back.

Psoriasis is an inflammatory skin disease that affects 2% to 4% of the population. The scales of psoriasis are often thicker than that of seborrheic dermatitis. The edges of those scales are very well-defined. On the scalp, psoriasis scales are closer to a silver color than white or yellow.

There is a condition called sebopsoriasis where seborrheic dermatitis and psoriasis overlap. In that case you have the symptoms of both: both white flakes and silver flakes, both on the scalp or back, both itchy.

If you’re concerned about whether you have psoriasis or seborrheic dermatitis, consult your healthcare provider. Treatment for one may not work as treatment for the other.

Does seborrheic dermatitis cause hair loss?

No, seborrheic dermatitis does not cause hair loss.

Is seborrheic dermatitis related to acne?

Seborrheic dermatitis and acne can appear at the same time, in the same places on your body. Both are affected by oils in your skin. People who have acne are more likely to have dandruff.

How is seborrheic dermatitis diagnosed?

Seborrheic dermatitis is an easy condition to diagnosis because of its appearance on the affected skin and where it appears on your body. No blood, urine or allergy tests are needed. Your dermatologist may perform a skin biopsy to rule out other diseases if your condition does not respond to treatment.

How is seborrheic dermatitis treated?

In teenagers and adults, seborrheic dermatitis usually doesn’t disappear on its own without treatment. Type of treatment depends on the area of the body that is affected and how severe your condition is.

The goal of treatment is to reduce the visible signs of seborrheic dermatitis and itching and redness. Treatment includes use of over-the-counter products and prescription products. Prescription products include topical antifungals, calcineurin inhibitors and corticosteroids. Ongoing maintenance treatment is often needed. You may need to use a combination of these treatments:

Scalp Treatment

Cradle cap (infants)

• Cradle cap usually clears up without treatment when the child is between eight and 12 months old. It may be treated daily with a mild baby shampoo.
• Massage or brush the scalp with a soft brush several times a day and after each shampoo. Be careful not to cause a break in the skin, which can lead to infection.
• If the problem continues, or the baby seems uncomfortable and scratches the scalp, contact your pediatrician or dermatologist. He or she may prescribe a prescription shampoo or lotion.
• Other areas of affected skin may be treated with a gentle steroid lotion.

Adolescents and adults:

For mild cases, look for over-the-counter dandruff shampoos that contain selenium, zinc pyrithione or coal tar. Shampoo with it twice a week or as directed on the label of the product. For long-term control, your healthcare provider may prescribe antifungal shampoos that contain ciclopirax (Loprox®) or ketoconazole (Nizoral®). These shampoos are used from daily to two or three times a week for several weeks until the dandruff has cleared, then once every week to two weeks to prevent flare-ups. Your healthcare provider will give you specific directions for use.

For moderate to severe cases, your healthcare provider may prescribe a shampoo containing betamethasone valerate (Luxiq®), clobetasol (Clobex®), fluocinolone (Capex®) or fluocinolone solution (Synalar®). Shampoo your hair as directed. Some products are used daily, others are used twice daily for two weeks then two times a week.

Ask your healthcare provider about what side effects to watch for while using these shampoos.

Face and Body

Treatments for seborrheic dermatitis of the face and body include topical antifungals, corticosteroids and calcineurin inhibitors.

Topical antifungals include ciclopirox, ketoconazole or sertaconazole. These products, available in creams, foams or gels, are usually applied to the affected areas twice daily for up to eight weeks and then as needed.

Topical corticosteroids include betamethasone valerate, desonide, fluocinolone or hydrocortisone. These products come in creams, lotions, foams, gels, ointments, oil or solution. They are taken once or twice a day. Your healthcare provider might prescribe these products if antifungal products aren’t successful in clearing your seborrheic dermatitis or for treating flare-ups. Corticosteroids can cause a thinning of your skin and should not be used continuously for weeks and months at a time without a break. Topical calcineurin inhibitors are an alternative to corticosteroids. These products include pimecrolimus cream (Elidel®) or tacrolimus ointment (Protopic®). They are applied to the affected area twice daily. If your case is severe, your healthcare provider may prescribe an oral (pill) antifungal agent or phototherapy (a specific wavelength of ultraviolet light to decrease inflammation in the skin).

Ask your healthcare provider about the side effects of these medications and what to watch for. Follow your provider’s instructions about how to take these medications. You and your healthcare provider will work closely together to select products and develop a treatment plan that will be most helpful to treat your unique case of seborrheic dermatitis.

How can I reduce my risk of seborrheic dermatitis?

There’s little that can be done to prevent seborrheic dermatitis. Cradle cap is a natural, harmless condition. It can be simply treated at home. If you are a teenager or an adult with seborrheic dermatitis, you might be more prone if you have higher than normal levels of androgens, a higher level of lipids in your skin or have an overgrowth of the yeast that is always present on your skin’s surface.

Some simple healthy things you can do to reduce your risk include getting plenty of rest, controlling your emotional stress and getting a daily small doses (minutes) of sunshine (UV light). Stay away from the midday sun.

Always follow your healthcare provider’s instructions for using medicated shampoos and skin products. Under treatment or inappropriate treatment can result in flare-ups of your condition and return visits to your healthcare provider.

What can I expect if I have seborrheic dermatitis?

Cradle cap happens in most babies. It’s generally a harmless condition that doesn’t cause pain, itching or discomfort. It appears within the first weeks to months of life and is rarely seen after 12 months of age in most babies. It can be easily managed with simple at-home care.

In adolescents and adults, seborrheic dermatitis of the scalp (dandruff) or the face and body is a condition that comes and goes throughout life. Fortunately, it can be controlled with treatment. The condition improves quickly with regular treatment.

See your healthcare provider if your condition doesn't respond to self-treatment, or if the affected area becomes painful, forms crusts, or drains fluid or pus.

How do I take care of myself?

If you have seborrheic dermatitis of the scalp, you can try some of the over-the-counter dandruff shampoos. If one shampoo doesn’t work, look at the active ingredient and try another product with a different active ingredient (see treatment section). Shampoos should remain on your scalp for at least five minutes before rinsing off.

If you think you have seborrheic dermatitis on your face or body, see your healthcare provider or dermatologist. They will examine you to determine the extent and severity of your condition. You will work together to develop the best treatment approach to get your condition under control and manage flare-ups. Follow all instructions and never hesitate to call your healthcare provider if you have questions or concerns.

When should I see my healthcare provider?

You should see a dermatologist if your symptoms get worse or you experience a flare-up. Your healthcare provider may need to change your dosage, add a different medication to your treatment regimen or change medications.

What questions should I ask my healthcare provider?

• Do my symptoms indicate seborrheic dermatitis, eczema, atopic dermatitis or psoriasis?
• What over-the-counter treatment or combination of treatments would work best for me?
• Is there a specific brand of dandruff shampoo, cream or lotion that you recommend?
• Is there a prescription shampoo, cream or lotion you can prescribe? (If your at-home remedies aren’t working.)
• How often should I see a dermatologist regarding this condition?
• What should I do if I have an allergic reaction to a shampoo/cream/lotion?
• Is my acne treatment covered by my insurance? (Many cosmetic procedures are not covered by insurance.)

Although seborrheic dermatitis is itchy and uncomfortable, it does not harm your health. The condition can be managed with treatment. Itchy skin and white flakes on your black shirts shouldn’t be a normal part of your day!