What Is Seborrheic Dermatitis

Seborrheic (seb-o-REE-ik) dermatitis is a common skin condition that mainly affects your scalp. It causes scaly patches, red skin and stubborn dandruff. Seborrheic dermatitis can also affect oily areas of the body, such as the face, sides of the nose, eyebrows, ears, eyelids and chest.

Seborrheic dermatitis on the face

Cradle cap on dark skin

Seborrheic dermatitis of the scalp

Cradle cap on light skin

Seborrheic dermatitis may go away without treatment. Or you may need many repeated treatments before the symptoms go away. And they may return later. Daily cleansing with a gentle soap and shampoo can help reduce oiliness and dead skin buildup.

Seborrheic dermatitis is also called dandruff, seborrheic eczema and seborrheic psoriasis. For infants, the condition is known as cradle cap and causes crusty, scaly patches on the scalp.

Symptoms

Seborrheic dermatitis signs and symptoms may include:

• Skin flakes (dandruff) on your scalp, hair, eyebrows, beard or mustache
• Patches of greasy skin covered with flaky white or yellow scales or crust on the scalp, face, sides of the nose, eyebrows, ears, eyelids, chest, armpits, groin area or under the breasts
• Red skin
• Itching

The signs and symptoms may be more severe if you're stressed, and they tend to flare in cold, dry seasons.

When to see a doctor

See your doctor if:

• You're so uncomfortable that you're losing sleep or being distracted from your daily routines
• Your condition is causing embarrassment and anxiety
• You suspect your skin is infected
• You've tried self-care steps without success

Causes

Doctors don't yet know the exact cause of seborrheic dermatitis. It may be related to:

• A yeast (fungus) called malassezia that is in the oil secretion on the skin
• An irregular response of the immune system

Risk factors

A number of factors increase your risk of developing seborrheic dermatitis, including:

• Neurologic and psychiatric conditions, such as Parkinson's disease and depression
• A weakened immune system, such as seen in organ transplant recipients and people with HIV/AIDS, alcoholic pancreatitis and some cancers
• Recovery from stressful medical conditions, such as a heart attack
• Some medications

Diagnosis

Your doctor will likely be able to determine whether you have seborrheic dermatitis by examining your skin. He or she may scrape off skin cells for examination (biopsy) to rule out conditions with symptoms similar to seborrheic dermatitis, including:

• Psoriasis. This disorder also causes dandruff and red skin covered with flakes and scales. With psoriasis, usually you'll have more scales, and they'll be silvery white.
• Atopic dermatitis (eczema). This skin reaction causes itchy, inflamed skin in the folds of the elbows, on the backs of the knees or on the front of the neck. It often recurs.
• Tinea versicolor. This rash appears on the trunk but usually isn't red like seborrheic dermatitis patches.
• Rosacea. This condition usually occurs on the face and has very little scaliness.

Treatment

Medicated shampoos, creams and lotions are the main treatments for seborrheic dermatitis. Your doctor will likely recommend you try home remedies, such as over-the-counter dandruff shampoos, before considering prescription remedies. If home remedies don't help, talk with your doctor about trying these treatments.

• Creams, shampoos or ointments that control inflammation. Prescription-strength hydrocortisone, fluocinolone (Capex, Synalar), clobetasol (Clobex, Cormax) and desonide (Desowen, Desonate) are corticosteroids you apply to the scalp or other affected area. They are effective and easy to use, but should be used sparingly. If used for many weeks or months without a break, they can cause side effects, such as thinning skin or skin showing streaks or lines.
  
  Creams or lotions containing the calcineurin inhibitors tacrolimus (Protopic) and pimecrolimus (Elidel) may be effective and have fewer side effects than corticosteroids do. But they are not first-choice treatments because the Food and Drug Administration has concerns about a possible association with cancer. In addition, tacrolimus and pimecrolimus cost more than mild corticosteroid medications.
• Antifungal gels, creams or shampoos alternated with another medication. Depending on the affected area and the severity of your symptoms, your doctor might prescribe a product with 2 percent ketoconazole (Nizoral) or 1 percent ciclopirox. Or you doctor may prescribe both products to be used alternately.
• Antifungal medication you take as a pill. If your condition isn't improving with other treatments, your doctor may recommend an antifungal medication in pill form. These aren't a first choice for treatment because of possible side effects and drug interactions.

Lifestyle and home remedies

You may be able to control seborrheic dermatitis with lifestyle changes and home remedies. Many of these are available in over-the-counter (nonprescription) forms. You may need to try different products or a combination of products before your condition improves.

The best approach for you depends on your skin type, the severity of your condition, and whether your symptoms affect your scalp or other areas of your body. But even if your condition clears up, it is likely to come back at some point. Watch for the symptoms and resume treating the condition when it recurs.

Wash your scalp regularly

If regular shampoo doesn't help with dandruff, try over-the-counter dandruff shampoos. They are classified according to the active ingredient they contain:

• Pyrithione zinc (Dermazinc, Head & Shoulders)
• Selenium sulfide (Selsun Blue)
• Ketoconazole (Nizoral A-D)
• Tar (Neutrogena T/Gel, DHS Tar)
• Salicylic acid (Neutrogena T/Sal)

Use a product daily until your signs and symptoms begin to subside, and then use it one to three times a week as needed. Shampoo that contains tar can discolor light-colored hair, so you may want to use other products.

If one type of shampoo works for a time and then seems to lose its effectiveness, try alternating between two or more types. Be sure to leave your shampoo on for the full recommended time — this allows its ingredients to work. These shampoos may be rubbed gently on the face, ears and chest and rinsed off completely.

Other home remedies

The following over-the-counter treatments and self-care tips may help you control seborrheic dermatitis:

• Soften and remove scales from your hair. Apply mineral oil or olive oil to your scalp. Leave it in for an hour or so. Then comb or brush your hair and wash it.
• Wash your skin regularly. Rinse the soap completely off your body and scalp. Avoid harsh soaps and use a moisturizer.
• Apply a medicated cream. First try a mild corticosteroid cream on affected areas, keeping it away from the eyes. If that doesn't work, try the antifungal cream ketoconazole.
• Avoid styling products. Stop using hair sprays, gels and other styling products while you're treating the condition.
• Avoid skin and hair products that contain alcohol. These can cause the disease to flare up.
• Wear smooth-textured cotton clothing. This helps keep air circulating around your skin and reduces irritation.
• If you have a beard or mustache, shampoo facial hair regularly. Seborrheic dermatitis can be worse under mustaches and beards. Shampoo with 1 percent ketoconazole daily until your symptoms improve. Then switch to shampooing once a week. Or shaving might ease your symptoms.
• Gently clean your eyelids. If your eyelids show signs of redness or scaling, wash them each night with baby shampoo and wipe away scales with a cotton swab. Warm or hot compresses also may help.
• Gently wash your baby's scalp. If your infant has cradle cap, wash the scalp with nonmedicated baby shampoo once a day. Gently loosen the scales with a small, soft-bristled brush before rinsing out the shampoo. If scaling persists, first apply mineral oil to the scalp for a couple of hours.

Alternative medicine

Many alternative therapies, including those listed below, have helped some people manage their seborrheic dermatitis. But evidence for their effectiveness isn't conclusive. It's always a good idea to check with your doctor before adding any alternative medicines to your self-care routine.

• Tea tree oil. Tea tree oil, either alone or in a shampoo, may be used on the affected area. Some studies suggest that tea tree oil may trigger an allergic reaction.
• Fish oil supplements. These types of pills contain omega-3 fatty acids.
• Aloe vera. Apply to the affected area aloe vera gel, either in a product or directly from a cut leaf of the plant.

Preparing for your appointment

You'll probably first visit your primary care doctor. He or she may refer you to a doctor who specializes in skin disorders (dermatologist).

Here's some information to help you get ready for your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may free up time to go over any points you want to spend more time on. Your doctor may ask:

• What are your symptoms, and when did you first notice them?
• Is this the first time you've had these symptoms, or have you had them before?
• How severe are your symptoms? Are they about the same all the time, getting worse, or sometimes better and sometimes worse?
• Have you tried any at-home treatments, such as creams, gels or shampoos?
• How often do you use these treatments?
• Does anything seem to help?
• Does anything seem to make your symptoms worse?
• What medications, vitamins or supplements are you taking?
• Have you been under stress lately or experienced major life changes?

What you can do in the meantime

An over-the-counter (nonprescription) antifungal cream or anti-itch cream can be helpful. If your scalp is affected, a nonprescription antifungal shampoo may ease your symptoms. Try not to scratch or pick at the affected area, because if you irritate your skin or scratch it open, you increase your risk of infection.

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What Is Seborrheic Dermatitis?

That red, itchy rash on your scalp that has flaky scales could be seborrheic dermatitis, or seborrhea. It's a common skin disease that looks similar to psoriasis, eczema, or an allergic reaction. And it can appear on your body as well as your scalp.

Causes

We don't know what exactly causes seborrheic dermatitis. It seems to be a combination of things, including:

• Stress
• Your genes
• A yeast that normally lives on skin
• Certain medical conditions and medicines
• Cold, dry weather

It doesn't come from an allergy or being unclean.

Newborns and adults aged 30-60 are more likely to get seborrheic dermatitis. It's more common in men than women and in people with oily skin. These medical conditions can also raise your risk:

• Acne
• AIDS
• Alcoholism
• Depression
• Eating disorders
• Epilepsy
• Heart attack or stroke recovery
• Parkinson's disease
• Psoriasis
• Rosacea

Symptoms

Dandruff and cradle cap are common names for seborrheic dermatitis. Babies 3 months and younger often get cradle cap: crusty yellow or brown scales on their scalp. It usually goes away before they're a year old, although it can come back when they reach puberty.

You might get seborrheic dermatitis on your face, especially around your nose, on your eyelids, or behind your ears. It can show up on your body, too:

• In the middle part of the chest
• Around the navel
• On buttocks
• In skin folds under arms and on legs
• In the groin
• Below breasts

On babies, seborrheic dermatitis might be mistaken for diaper rash.

Skin can itch, burn, or look red. The scales that flake off could be white or yellowish and look moist or oily.

Because it can look like other skin conditions, you should see your family doctor to get a diagnosis and the right treatment. The dermatologist will ask about your medical history and look at your skin. You may need other tests if the doctor thinks it's related to another medical condition.

Treatment

Sometimes, seborrheic dermatitis will clear up by itself. More often, it's a lifelong issue that clears and flares. It can last for years at a time, but you can usually control it with good skin care.

Adults with seborrheic dermatitis on their scalp can use an over-the-counter dandruff shampoo that contains one of these key ingredients:

• Coal tar
• Ketoconazole
• Salicylic acid
• Selenium sulfide
• Zinc pyrithione

For infants with cradle cap, shampoo their scalp daily with warm water and baby shampoo. If that doesn't help, talk to your pediatrician about medicated shampoos before you try one. A dandruff shampoo could irritate your baby's scalp. To soften thick patches first, rub mineral oil onto the area and brush gently with a baby hairbrush to help peel the scales off.

On the face and body, keep the affected areas clean -- wash with soap and water every day. Sunlight may stop the growth of the yeast organisms that inflame the skin, so being outdoors and outdoor exercise could help make the rash go away. Always be sure to wear sunscreen.

Other treatments include:

• Antifungal products
• Corticosteroid lotions
• Prescription-strength medicated shampoos
• Sulfur products

Often the best results come from a combination of treatments, both medication and lifestyle.

Work with your doctor or pediatrician if you're using a treatment other than shampoo, since there could be side effects, especially if you use it for longer or more often than prescribed.

If your seborrheic dermatitis doesn't get better, or if the area becomes painful, red, swollen, or starts to drain pus, see your doctor.