Seborrheic Dermatitis

What is seborrheic dermatitis?

Seborrheic dermatitis is a chronic, relapsing form of eczema that usually appears on the scalp but can occur anywhere there are a lot of oil-producing (sebaceous) glands like the chest, groin, beard region, and nose.¹ Sebaceous glands are near hair follicles that secrete oil to lubricate hair and skin. Seborrheic dermatitis can cause a variety of symptoms from dandruff to a rash on the affected area.¹

Infants often develop seborrheic dermatitis on their scalps, which is commonly referred to as cradle cap. It looks like scaly, greasy patches on their scalp.¹ In older children and adults, when seborrheic dermatitis is mild and develops on the scalp, it is called dandruff.²

For many infants and some adults, seborrheic dermatitis goes away on its own.² If symptoms don’t go away, there are many effective treatments to manage symptoms and stop seborrheic dermatitis flares in the future.²

What does seborrheic dermatitis look like and where does it appear on the body?

Seborrheic dermatitis appears as a rash that can be pink, red, purple, tan, brown or white, depending on your skin tone.²  It generally has a raised appearance and forms under body or facial hair in affected areas.² You might also have visible skin irritation, patchy or flaky white or yellow scales on top of greasy skin or a ring-shaped rash.^1,2

Seborrheic dermatitis typically affects the face and scalp, but can appear in oily skin elsewhere on the body except for the palms of your hands and soles of your feet.³ Common areas on your face for seborrheic dermatitis include on the eyelids, on the sides of the nose, in and around the eyebrows and near the ears.³ When seborrheic dermatitis appears near the scalp in adults and adolescents, it’s often referred to as facial seborrheic dermatitis.

It also commonly appears in areas with dense body hair such as your chest, beard area, armpits or groin.³ Symptoms might be worse under facial hair than they are on the scalp.

Where does seborrheic dermatitis appear in children?

Infants with seborrheic dermatitis most often have a form called cradle cap, which appears on their scalps as scaly, greasy patches.² Infants can also develop seborrheic dermatitis on their bottoms, where it can be mistaken for diaper rash.² It can also appear on the folds of their skin, chest or back.¹

Who gets seborrheic dermatitis?

It is estimated that 3% to 5% of the general population and 6.5% of African-Americans have seborrheic dermatitis.⁴ This type of eczema has been found to peak during certain ages in life, including:

• Infancy within the first year^1,2
• Adolescence and young adulthood when sebaceous glands are changing during and after puberty^1,2
• Between 30 and 60 years of age⁵

Certain medical conditions can also increase people’s risk of developing seborrheic dermatitis, including:

• Psoriasis²
• HIV^1,2
• Rosacea²
• Parkinson’s disease^1,2
• Epilepsy⁶
• Alcoholism¹
• Depression⁶
• Eating disorders⁶
• Stroke or heart attack⁶

Is seborrheic dermatitis contagious?

No, seborrheic dermatitis is not contagious.² You cannot “catch” it from another person. It is the result of environmental and genetic factors.

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What causes seborrheic dermatitis?

The exact cause of seborrheic dermatitis is unknown, but it is believed to be a combination of factors including genes, yeast that lives naturally on the skin, stress, chemical irritants and/or dry, cold weather that causes the skin to overproduce oil.^{1, 6} In infants, researchers believe seborrheic dermatitis is triggered in part by hormones from the mother.⁷

The trigger for seborrheic dermatitis is usually an inflammatory reaction to excess Malassezia yeast, also sometimes called pityrosporum, on the skin.^1,6 This yeast, an organism that normally lives on the skin’s surface, is the likely cause of seborrheic dermatitis.¹ The Malessezia overgrows and the immune system seems to overreact to it, leading to a fungal infection that results in skin changes.¹

Seborrheic dermatitis is not an allergy.⁶ It is caused by genetic and environmental factors.⁶

What triggers seborrheic dermatitis and causes a flare?

Common triggers for seborrheic dermatitis include:

• Stress⁸
• Recovery from a stressful life event, like losing a loved one or a heart attack⁶
• Hormonal changes or illness¹
• Harsh hair styling products, detergents, solvents, chemicals and soaps¹
• Cold, dry weather or a change in the season⁶
• Some medications, including psoralen, interferon and lithium⁶

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What are the symptoms of seborrheic dermatitis?

Regardless of where seborrheic dermatitis appears on the body, common symptoms include:

• Flaking skin or dandruff^1,2,3
• Burning or itching³
• Patchy or flaky white or yellow scales on top of greasy skin^1,2,3
• A light or dark brown rash, depending on skin tone^1,2,3
• Ring-shaped rash for those with petaloid seborrheic dermatitis⁹
• Itchiness^1,2,3
• Crust over lesions^1,3

With seborrheic dermatitis, the affected skin sometimes crusts over and lesions containing sebum can form. Erythema, or redness of the skin caused by inflammation, may also be experienced.¹ Sometimes, symptoms will go away on their own or with changes in your skincare and hair regimens.^1,2

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How is seborrheic dermatitis diagnosed?

Dermatologists can usually diagnose seborrheic dermatitis with a skin exam and medical history. They might also do a biopsy or blood test to help diagnose you.¹⁰ A skin biopsy is when a small piece of your skin is removed and studied in a lab.

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How is seborrheic dermatitis treated?

Seborrheic dermatitis might go away without treatment.² If symptoms persist for longer than two weeks, you should consider talking to a healthcare provider about treatment options. Most adults with this condition will need a treatment plan to manage symptoms. Treatments for this skin condition are aimed at removing scales, reducing itch and calming the inflammation that’s causing redness and swelling.¹⁰ Dermatologists usually begin treating mild cases with a topical antifungal cream or medicated shampoo, such as a prescription anti-fungal shampoo or over-the-counter dandruff products.¹⁰

Depending on the severity of your case, you might be able to treat this form of eczema by eliminating triggering products or soaps. If it appears on your scalp, this could mean swapping your shampoo for a medicated version that your dermatologist recommends or an over-the-counter dandruff shampoo.^8,10 Some shampoos might not work for people with skin of color with tightly coiled hair because they are too drying.¹⁰

If the hairline is affected, consider a dandruff shampoo and hair products designed for sensitive skin. Some of the best nonprescription dandruff shampoos include those with:

• Pyrithione zinc and selenium sulfide¹
• Ketoconazole 1%¹
• Tar¹
• Tea tree oil¹
• Salicylic acid¹

Your dermatologist might also recommend that you use these special shampoos on other areas of your body besides your scalp to treat your seborrheic dermatitis.¹⁰ However, dandruff shampoo is not recommended for treating an infant for cradle cap.¹⁰

In infants, using an emollient such as mineral oil or petroleum jelly, to gently loosen scales is usually all that’s needed.¹¹ Washing your baby’s hair more frequently will also help.¹¹ Do not scratch or pick at the rash on your child, as it may cause an infection.¹¹

For adults, using appropriate products with a proper skincare routine for seborrheic dermatitis can help keep symptoms under control.⁸ Wash affected areas daily with a gentle, pyrithione zinc-containing or ketoconazole cleanser and follow up with a lotion or moisturizer.⁸

What are treatment options for moderate to severe seborrheic dermatitis?

If lifestyle and skincare routine changes don’t work, it might be time to consider other prescription options for more severe cases.

If your dermatologist suspects a fungal infection is contributing to your seborrheic dermatitis, they might prescribe an antifungal topical cream, gel or foam, usually containing ketoconazole.¹⁰

If your condition is more severe, intermittent use of a topical corticosteroid, additional steroids or calcineurin inhibitor may be required.¹⁰ Other treatments for severe cases include hydrocortisone ointments, such as pimecrolimus or tacrolimus, roflumilast foam, or oral medications.¹⁰ Some dermatologists also use light therapy to help clear up a seborrheic dermatitis rash.¹⁰

Allergist and immunologist Dr. Anna Fishbein and eczema parent Silena Gaines discuss the value of communication in between doctor’s visits.

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Does seborrheic dermatitis lead to skin cancer?

Seborrheic dermatitis is not precancerous. If you have this form of eczema, it does not increase your chance of getting skin cancer.

Does seborrheic dermatitis lead to hair loss?

Hair loss is not a direct symptom of seborrheic dermatitis.¹² For most mild cases, if there is hair loss it is due to excessive scratching of the scalp.¹² However, severe seborrheic dermatitis can lead to hair loss due to inflammation of the scalp.

What are complications of seborrheic dermatitis?

African Americans and those with skin of color might experience petaloid seborrheic dermatitis, a more severe form where lesions form around the hairline and skin discoloration (often lighter in color) happens.⁹ Usually, the discolored skin manifests in a ring-shaped rash.⁹