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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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 be called 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 brows, 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

How is seborrheic dermatitis diagnosed?

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 a shampoo that may contain one or more of the following ingredients:

  • Tar
  • Antifungal antibiotic
  • Zinc pyrithione
  • Selenium sulfide

In addition, the application of a 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.

It needs to be stressed that since this condition is incurable but easily controllable; 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 enough to control the symptoms. Excessive treatment of apparently normal skin is economically wasteful as well as potentially risky.

Medically Reviewed by a Doctor on 3/18/2016

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