Seborrheic Dermatitis

  • Medical Author:
    Gary W. Cole, MD, FAAD

    Dr. Cole is board certified in dermatology. He obtained his BA degree in bacteriology, his MA degree in microbiology, and his MD at the University of California, Los Angeles. He trained in dermatology at the University of Oregon, where he completed his residency.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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Seborrheic dermatitis facts

  • Seborrheic dermatitis is probably the single most common inflammatory skin condition affecting humans aside from acne vulgaris.
  • Seborrheic dermatitis is highly treatable but incurable.
  • The course of seborrheic dermatitis is characterized by spontaneous remissions and exacerbations.
  • Seborrheic dermatitis affects all ages.

What is seborrheic dermatitis?

Seborrheic dermatitis is a chronic inflammation of skin that typically waxes and wanes. Seborrheic dermatitis causes red scaling, occasionally with weepy, oozy eruption. Seborrheic dermatitis commonly involves portions of the scalp, brows, mid-face, ears, mid-chest, and mid-back. It is not unusual for it to affect the skin of infants and young children where it often involves the scalp (cradle cap) and the diaper area. Seborrheic dermatitis is also known as seborrhea.

Seborrheic dermatitis vs. psoriasis

Since both of these conditions can affect the scalp with an itchy scaling dermatitis, it can sometimes be difficult to distinguish one from the other. Aside from scalp involvement, psoriasis typically involves anatomically different areas of skin than seborrheic dermatitis. In addition, seborrheic dermatitis is an eczematous dermatitis producing a weepy, oozing appearance. Psoriasis produces papules and plaques of scaling red skin. A biopsy examination of the skin is often sufficient to precisely identify the cause.

Seborrheic dermatitis vs. dandruff

Dandruff is simply a sign of the excessive production of skin. It can be seen in a number of inflammatory skin diseases, including seborrhea and psoriasis.

Picture of seborrheic dermatitis along the hairline
Picture of seborrheic dermatitis along the hairline; photo courtesy of Gary W. Cole, MD, FAAD

Quick GuideFight Dandruff: How to Treat, Control, and Prevent Flakes

Fight Dandruff: How to Treat, Control, and Prevent Flakes

Seborrheic Dermatitis Treatment

Shampoos and over-the-counter products

When the rash affects your scalp, the use of nonprescription shampoos containing tar, selenium sulfide, ketoconazole, or zinc pyrithione are frequently sufficient to control most of your symptoms. Resistant scalp seborrhea or involvement of hairless skin is frequently treated with anti-inflammatory creams containing weak topical steroids like 1% hydrocortisone cream (available over the counter). Ketoconazole cream, a prescription medication, is also effective in controlling symptoms and signs. Stubborn cases may require more potent topical steroids.

What are risk factors for seborrheic dermatitis?

Although almost all patients with seborrheic dermatitis are generally healthy, there does seem to be an association with diseases of the central nervous system and AIDS (HIV).

What causes seborrheic dermatitis?

The causes of seborrheic dermatitis are poorly understood. Since this condition tends to occur in areas of heavy sebum production, it is felt that oily skin may be a factor leading to seborrheic dermatitis. In addition, it seems that many patients with seborrheic dermatitis have an abundant growth of a normal skin yeast (Pityrosporum or Malassezia) in the affected areas. The fact that topical antifungal medications are effective in controlling seborrheic dermatitis has led some to conclude fungi may play a role in causing this disease. Whether these normal members of the cutaneous microbiome play a causal role in seborrheic dermatitis remains to be determined. Patients with severe central nervous system disease (dementia and traumatic brain injuries) seem to have more trouble with seborrheic dermatitis. It is unclear if the nervous system plays a role in causing this type of seborrhea or that it is simply a lack of normal hygiene.

Is seborrheic dermatitis contagious?

Seborrheic dermatitis is not contagious.

What are seborrheic dermatitis symptoms and signs?

The rash itself is characteristically red and scaling but occasionally can become weepy and oozy. The scaling can be extensive enough to produce significant dandruff and can be the patient's major complaint.

The distribution of this rash is often of great help in making the diagnosis. In adults, areas commonly involved include the scalp, the outer ear, and external auditory canal, the forehead, the eyebrows, the eyelids, the cheeks adjacent to the nose, including the folds that extends from the nose to the sides of the mouth, and less commonly the armpits, the mid-chest, and mid-back regions. In babies, the rash causes a scalp eruption commonly called "cradle cap." It can also be more extensive and involve the diaper area as well. Although in both adults and children the rash may have no symptoms, it commonly causes itching, especially in the scalp.

Picture of seborrheic dermatitis on the forehead
Picture of seborrheic dermatitis on the forehead; photo courtesy of Gary W. Cole, MD, FAAD

What specialties of health care professionals diagnose and treat seborrheic dermatitis?

Most primary care physicians, pediatricians, internists, and family doctors are able to diagnose and treat seborrheic dermatitis. Occasionally, it may be necessary to refer patients to a dermatologist for a diagnosis.

How do health care professionals diagnose seborrheic dermatitis?

The diagnosis of seborrheic dermatitis is usually made clinically, meaning that the doctor recognizes it on the basis of its appearance. Occasionally, a scraping of skin scales treated with potassium hydroxide is examined using a microscope to exclude a fungal infection. A skin biopsy is rarely required for diagnosis.

What is the treatment for seborrheic dermatitis?

Treatment of hair-bearing areas, like the scalp, often includes the use of over-the-counter shampoos that may contain one or more of the following ingredients:

  • Tar
  • Ketoconazole (Nizoral requires a prescription)
  • Zinc pyrithione (Head & Shoulders)
  • Selenium sulfide (Selsun)
  • Salicylic acid

In addition, the application of a prescription-strength topical steroid lotion or solution of weak to moderate potency is effective such as desonide (Desonate, DesOwen, LoKara, Verdeso), betamethasone valerate (Valisone), hydrocortisone, and 0.025% triamcinolone (Aristocort, Aristocort HP, Kenalog, Triderm).

For non-hair-bearing areas, the application of a weak to moderately potent topical steroid or topical antifungal cream is frequently effective. The use of tacrolimus (Protopic) or pimecrolimus (Elidel) ointments can be effective but is quite an expensive alternative. Patients may also use ketoconazole-containing creams for the treatment of seborrheic dermatitis.

It needs to be stressed that since this condition is incurable but easily controlled; if the disease is active and the treatment is stopped, one should expect the seborrheic dermatitis to recur. One should also use effective medications just frequently enough to control the symptoms. Excessive treatment of apparently normal skin is economically wasteful as well as potentially risky.

Quick GuideFight Dandruff: How to Treat, Control, and Prevent Flakes

Fight Dandruff: How to Treat, Control, and Prevent Flakes

Are there home remedies for seborrheic dermatitis?

There is little compelling evidence that any of the following substances taken either orally or used topically are of any significant benefit in the control of seborrheic dermatitis: coconut oil, apple cider vinegar, tea tree oil, or biotin. On the other hand, 1% hydrocortisone, which is inexpensive and easily available without a prescription, is likely to be very effective in controlling seborrhea.

What are complications of seborrheic dermatitis?

There are few complications attributable to this condition. Most problems seem to be related to misdiagnosis or mistreatment. Rarely, certain superficial cutaneous (dermatophyte) fungal infections of the face and scalp can resemble seborrheic dermatitis. If dermatophyte infections are mistakenly treated with anti-inflammatory medications (topical steroids), more extensive involvement could be encouraged. The overuse of potent topical steroids in an ill-conceived attempt to cure this condition, especially on the face and armpits, can result in many undesirable skin changes including skin thinning. Severe seborrheic dermatitis can occasionally produce thinning or loss of hair, in great part probably related to excessive scratching. As the disease is controlled, regrowth is expected.

What is the prognosis of seborrheic dermatitis?

Since seborrheic dermatitis generally is not associated with any serious problems, one way of looking at prognosis would be optimistically. On the other hand, although treatment almost always results in an excellent response, it is unlikely to result in any durable, permanent resolution of the disease.

Is there a way to prevent seborrheic dermatitis?

Seborrheic dermatitis is not preventable.

REFERENCES:

Clark, Gary W., Sara M. Pope, and Khalid A. Jaboori. "Diagnosis and Treatment of Seborrheic Dermatitis." Am Fam Physician 91.3 (2015): 185-190.

Okokon, E.O., J.H. Verbeek, J.H. Ruotsalainen, O.A. Ojo, and V.N. Bakhoya. "Topical Antifungals for Seborrheic Dermatitis (Review)." Cochrane Database of Systematic Reviews 5 May 2, 2015.

Stefanaki, I., and A. Katsambas. "Therapeutic Update on Seborrheic Dermatitis." Skin Therapy Lett. 15.5 May 2010: 1-4.

Last Editorial Review: 8/9/2017

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Reviewed on 8/9/2017
References
REFERENCES:

Clark, Gary W., Sara M. Pope, and Khalid A. Jaboori. "Diagnosis and Treatment of Seborrheic Dermatitis." Am Fam Physician 91.3 (2015): 185-190.

Okokon, E.O., J.H. Verbeek, J.H. Ruotsalainen, O.A. Ojo, and V.N. Bakhoya. "Topical Antifungals for Seborrheic Dermatitis (Review)." Cochrane Database of Systematic Reviews 5 May 2, 2015.

Stefanaki, I., and A. Katsambas. "Therapeutic Update on Seborrheic Dermatitis." Skin Therapy Lett. 15.5 May 2010: 1-4.

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