How to Tell the Difference Between Nummular Eczema and Ringworm
It’s often difficult to distinguish between nummular eczema and ringworm, so it’s always best to be evaluated by a dermatologist, say experts.
Published On: Oct 2, 2023
Last Updated On: Oct 2, 2023
This latest edition of Ask the Ecz-perts focuses on how to handle seborrheic dermatitis under beards. Our experts discuss how seborrheic dermatitis affects facial hair, how to treat seborrheic dermatitis in your beard and sensitive facial skin, what to avoid if you have seborrheic dermatitis and a beard or mustache, and whether you can prevent seborrheic dermatitis under mustaches and beards.
Our experts include: Dr. Joy Wan, dermatologist and assistant professor of dermatology at the Johns Hopkins University School of Medicine in Baltimore, Maryland; and Dr. Benjamin Ungar, dermatologist and director of the Alopecia Center of Excellence and director of the Rosacea & Seborrheic Dermatitis Clinic at Mount Sinai in New York.
Dr. Joy Wan: Seborrheic dermatitis can affect facial hair because it often occurs in areas where facial hair also grows, for example the sideburns or beard region.
Dr. Benjamin Ungar: Seborrheic dermatitis can very commonly affect facial skin in the beard area. Although it doesn’t affect facial hair, per se, it can lead to beard dandruff in addition to significant itching in the areas with facial hair.
Dr. Wan: You will often see a rash that can be pink, red, purple, tan/brown or sometimes even white (or hypopigmented) involving the skin under the facial hair. There is also usually flaking skin, or dandruff, within the facial hair. Sometimes itch will also be another symptom of seborrheic dermatitis.
Dr. Ungar: Signs of seborrheic dermatitis under facial hair include dandruff, flaking, itching and redness. It’s important to note that these signs may reflect different conditions too, so evaluation by a dermatologist is advised.
Dr. Wan: The presence of dandruff in the beard is often a sign of seborrheic dermatitis. When it is mild and shows up as just dandruff flakes, it is likely a mild form of seborrheic dermatitis. However, the beard dandruff can also be accompanied by the rash and/or itch of seborrheic dermatitis as well.
Dr. Ungar: Beard dandruff can be considered as a less inflammatory form of seborrheic dermatitis where the primary manifestation is flaking, with less prominent redness and itching.
Dr. Wan: Seborrheic dermatitis can sometimes be worse in areas of facial hair or also extend beyond where the facial hair is. For example, seborrheic dermatitis can often involve the eyebrows but also between the eyebrows. Similarly, seborrheic dermatitis may be visible beyond the borders of the facial hair. However, similar to the scalp, seborrheic dermatitis involving areas of facial hair will also show up as flaking scales within the hair and as a pink, red, purple or discolored rash underneath the facial hair.
Dr. Ungar: In general, I think it’s reasonable to think of seborrheic dermatitis in areas of facial hair as similar to seborrheic dermatitis on the scalp. Because it involves the face, there may also be other areas of facial skin that are red and scaly or flaky as well, although this can also certainly happen in people with seborrheic dermatitis of the scalp too.
Dr. Wan: Not necessarily. Just as there are ways that we can treat seborrheic dermatitis on the scalp, there are treatments we can take to treat seborrheic dermatitis on the face. While shaving your beard or mustache can sometimes help, it does not always resolve the seborrheic dermatitis because the underlying skin may still be prone to developing seborrheic dermatitis. While there will be less visible flaking skin within the facial hair, the underlying inflammation of the skin due to seborrheic dermatitis may continue to cause a rash and itch in the affected area.
Dr. Ungar: Seborrheic dermatitis of the face can typically be treated successfully even without shaving facial hair.
Dr. Wan: You should make sure to shampoo the facial hair regularly, which will help to minimize the scaling and dandruff. If regular shampoo does not help, then dandruff shampoos may be helpful. If stronger medicated shampoos are needed, prescription shampoos can be considered. In addition to shampoos, medicated creams or lotions are also used to treat seborrheic dermatitis on the face. These include antifungal creams or lotions (because some yeasts are thought to trigger or exacerbate seborrheic dermatitis) as well as anti-inflammatory creams or lotions (such as topical steroids or topical calcineurin inhibitors).
Dr. Ungar: Currently, mainstays of treatment for seborrheic dermatitis in the beard area consist of antifungal treatments, which can be applied as a liquid, shampoo or low-potency topical steroids, which are available in liquid forms as well. Additionally, over the counter anti-dandruff shampoos can also often be very helpful. Given that facial skin is sensitive, overuse of topical steroids is not advised, and there are currently ongoing studies for different nonsteroidal anti-inflammatory treatments that may become available options for treatment in the near future.
Dr. Wan: One should be careful to use gentle products to care for their beard or mustache, as different styling products may further irritate the skin and/or cause the seborrheic dermatitis to flare up.
Dr. Ungar: If you have seborrheic dermatitis and a beard or mustache, I view it less about what you should avoid and more about seeking care from a dermatologist. With appropriate treatment, you won’t have to worry about avoiding things.
Dr. Wan: You may not be able to prevent it completely but if there are known triggers for your seborrheic dermatitis, then avoiding those triggers can be helpful to limit flares. Triggers vary from person to person, but some triggers may include stress, sweat, irritating products, hot showers/baths and cold/dry weather.
Dr. Ungar: Currently, there are no ways to prevent seborrheic dermatitis from developing to begin with, but with proper treatment, it can be kept under very good control.
Dr. Joy Wan is a dermatologist and assistant professor of dermatology at the Johns Hopkins University School of Medicine in Baltimore, MD.
Dr. Benjamin Ungar is a dermatologist and director of the Alopecia Center of Excellence and director of the Rosacea & Seborrheic Dermatitis Clinic at Mount Sinai in New York.
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