Seborrheic Dermatitis

Seborrheic dermatitis (pronounced seb-o-REE-ik dur-muh-TAI-tuhs) causes scaly, flaky and itchy patches on your skin. It often shows up on parts of your body with a lot of oil glands, like your face and scalp. It’s a common skin problem.

When it happens on a teen’s or adult’s scalp, it’s usually called dandruff. In babies, it’s called cradle cap.

Seborrheic dermatitis is a lifelong condition. It can come and go over time with flare-ups. There’s no cure, but there are over-the-counter (OTC) and medicated treatment options that can help you manage it.

Seborrheic dermatitis symptoms

Symptoms may include:

• Dry or greasy scalp scaling (dandruff)
• White to yellow flaking
• Itchy skin
• Thick, scaly patches of skin (plaques)
• Small, dark or yellow to red raised bumps
• Hair shedding from scratching in affected areas (but not permanent hair loss)

Babies may have a thick, yellow, crusted scalp rash (cradle cap) and/or a diaper rash.

Where does seborrheic dermatitis affect my skin?

This condition usually shows up in areas of your body that have more oil (sebaceous) glands. It can affect your:

• Belly button
• Ears (behind them)
• Eyebrows
• Face and forehead
• Head and scalp
• Nose (creases on the sides)
• Upper back and chest
• Skin folds in your arms, legs and groin area
• Skin under your breasts

Seborrheic dermatitis causes

Researchers aren’t sure of the exact cause. But studies show that too much yeast on your skin could cause it. There’s a type of yeast called Malassezia that lives on everyone’s skin. It’s usually harmless. But when there’s too much of it, a skin reaction happens.

The yeast grows well in oily areas of your body. It makes a substance that turns oil into a fatty acid. Your skin doesn’t like this fatty acid and reacts to it, causing discoloration, itching and flakes. Over time, this weakens your skin’s outer barrier. It makes it easier for the yeast to keep growing and for moisture to escape.

What can trigger seborrheic dermatitis?

You might notice symptoms get worse if you’re:

• Around harsh chemicals (paint or cleaning products)
• Developing an infection
• In the sun for too long
• In cold, dry weather
• Stressed out
• Using alcohol-based skincare products

Is seborrheic dermatitis contagious?

No, it isn’t contagious. It doesn’t spread from person to person.

Risk factors of seborrheic dermatitis

You may be more at risk of developing this condition if you have:

• A biological family history of dermatitis
• A history of other skin disorders, including rosacea, psoriasis and acne
• A medication side effect (dopamine antagonists, immunosuppressants, PUVA, lithium)
• HIV, AIDS or a compromised immune system
• Naturally oily skin
• Neurological disorders like Parkinson’s disease

It’s also more common among:

• Males
• Infants (2 to 12 months)
• Adolescents
• Adults (after age 30)

Complications of seborrheic dermatitis

Scratching your skin can break it open, which may lead to bleeding and infections.

Living with a long-term skin condition can be hard, especially if the patches show up on visible parts of your body. This can affect your self-esteem. If you need help coping, consider talking to a mental health provider for support.

How doctors diagnose seborrheic dermatitis

Your provider will look at your skin to make a diagnosis. The patches (plaques) are usually easy to recognize, so they don’t need to do any testing.

But if you don’t get better with treatment, your provider may order a skin biopsy. This is to make sure it isn’t another condition.

What can be mistaken for seborrheic dermatitis?

It’s important to see a healthcare provider if you notice changes to your skin. They can make a clear diagnosis. The following may look like seborrheic dermatitis:

• Candidiasis
• Impetigo
• Lupus erythematosus
• Psoriasis
• Rosacea

Seborrheic dermatitis treatment

Seborrheic dermatitis usually doesn’t go away on its own. Treatment depends on where it is on your body and how serious it is. The goal is to reduce flakes and itching. You may need to keep using treatments to prevent flare-ups.

Scalp treatment for teens and adults

If you have a mild case of dandruff on your scalp, you can try an OTC dandruff shampoo. Look for ones with:

• Selenium
• Zinc
• Coal tar

For long-term management, your healthcare provider might prescribe stronger antifungal shampoos. These include:

• Ciclopirox
• Ketoconazole

If your case is moderate to severe, your provider may suggest shampoos with steroids like:

• Betamethasone valerate
• Clobetasol
• Fluocinolone

Your provider will give you instructions on how often to use these. You should also talk to your provider about side effects and what to look out for while using these shampoos.

Face and body treatments

If you have seborrheic dermatitis on your face or body, there are different treatment options:

• Topical antifungal products: These help fight fungus. Common options include clotrimazole and ketoconazole.
• Topical corticosteroids: These reduce swelling and discoloration. Hydrocortisone is a common option.
• Topical calcineurin inhibitors: This is another treatment if corticosteroids aren’t right for you. You might try pimecrolimus cream or tacrolimus ointment.
• Antifungal medicines: You can take these pills by mouth to reduce symptoms. Examples include itraconazole, fluconazole and terbinafine.
• Phototherapy: A special ultraviolet light directed at your skin may lessen symptoms (but only when prescribed by your healthcare provider).

Your provider will tell you how often to use your medicine and exactly how to apply it. Some medicines come as a cream or ointment that you put on your skin. Others are pills that you take by mouth. Your provider will also explain what side effects to watch for.

When should I see my healthcare provider?

Talk to your provider if your symptoms get worse or you have a flare-up. They may need to change your dose, add another medicine or try a different treatment.

You should also see a provider if:

• Your skin becomes painful, swollen or starts to drain fluid (a sign of infection)
• Over-the-counter treatments aren’t helping
• The condition affects your daily life or mental health

What questions should I ask my healthcare provider?

You may want to ask your 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?
• 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?

What can I expect if I have seborrheic dermatitis?

Seborrheic dermatitis usually comes and goes. It isn’t dangerous and doesn’t harm your overall health. It’s manageable. Once you start treatment, symptoms usually improve quickly.

But if itching and scaling don’t go away with OTC options, see your provider. They may prescribe stronger medications to help.

How do I take care of myself?

If you have seborrheic dermatitis on your 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. Shampoos should stay 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’ll offer an exam to determine the extent and severity of your condition. You’ll work together to develop the best treatment approach to manage flare-ups.

Follow all instructions and never hesitate to call your healthcare provider if you have questions or concerns.

How can I reduce my risk of seborrheic dermatitis?

There isn’t much you can do to completely prevent seborrheic dermatitis. Some healthy things you can do to lower your risk include:

• Get plenty of rest
• Try to manage your stress
• Get a little bit of sunshine each day (just a few minutes, but not during midday when the sun is strongest)
• Follow a good skincare routine

Always stick to your healthcare provider’s instructions when using medicated shampoos and skin products. This can make managing your condition easier to prevent flare-ups.