Seborrheic Dermatitis Symptoms, Causes & Treatment Options

Seborrheic dermatitis is a recurring, scaly rash that is the result of inflammation of the oil-producing sebaceous glands. It is not life-threatening, and many treatment options exist for individual flares.

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Contents

  1. Overview
  2. Symptoms
  3. Potential Causes
  4. Treatment, Prevention and Relief
  5. When to Seek Further Consultation
  6. References

What Is Seborrheic Dermatitis?

Summary

Seborrheic dermatitis is a common rash that occurs most commonly as a red, oily, flaky scaling area around the nose, eyebrows, eyes, or on the scalp. Seborrheic dermatitis also causes the common conditions of dandruff and cradle cap. It affects individuals of all ages, from infancy to old age, and may recur throughout life. Individual flare-ups may be precipitated by the weather, life stressors, hormones, diet, or underlying diseases. Common treatments for seborrheic dermatitis flares include keratolytics like salicylic acid, antifungal agents like ketoconazole, and topical steroids to reduce inflammation. Many of these treatments are available as shampoos specifically for dandruff.

Recommended care

Seborrheic Dermatitis Symptoms

Main symptoms

Seborrheic dermatitis can present differently in different individuals, and on different parts of the body. Some common features of adult-type seborrheic dermatitis are listed below:

  • Scaling: Small patches of skin become pale as they lift away, then flake off completely. Dandruff is a common example of scaling caused by seborrheic dermatitis.
  • Characteristic locations: Seborrheic dermatitis classically occurs in areas that are rich in oil-producing sebaceous glands, like the scalp, the edges of the nose (nasolabial folds), the eyebrows, the areas around the eyes (blepharitis), and in skin folds like armpits and areas beneath the breast.
  • Redness or pinkness: Often, seborrheic dermatitis will cause a red or pink color beneath the scaling in its characteristic locations.
  • Less itchy: Unlike other common red flaky rashes (like atopic dermatitis or skin allergies), seborrheic dermatitis may be only mildly itchy, or not itchy at all.
  • Increased oil: Seborrheic dermatitis occurs in areas rich in oil-producing sebaceous glands, and it may actually increase oil production in these areas.

Other symptoms

Seborrheic dermatitis also comes in several other varieties including dandruff and infantile “cradle cap,” described below.

  • Dandruff: Most people are familiar with dandruff, but not everyone knows that it is a form of seborrheic dermatitis and not just caused by dry skin.
  • Cradle cap: Cradle cap is the name for infantile seborrheic dermatitis of the scalp, which presents as greasy, diffuse scaling of the scalp.
  • Other infantile forms: Seborrheic dermatitis may also affect the faces, armpits, and groin folds of infants.

Seborrheic Dermatitis Causes

Seborrheic dermatitis occurs when the oil glands on the scalp, face, and trunk (called sebaceous glands), and the skin around them become inflamed. The cause of this inflammation is incompletely understood but it is thought to be related to an overgrowth of a type of yeast, called Malassezia. Malassezia yeast normally grown harmlessly on human skin, and everyone probably has some amount of this microbe living on their skin. When too much Malassezia yeast is growing on the skin, however, it is thought to form waste products (metabolites) that can cause an inflammatory reaction [1].

Who is susceptible

It is also uncertain why certain people are susceptible to seborrheic dermatitis, and others aren’t. It is thought that genetics play a role. Other factors, listed below may predispose individuals to outbreaks of seborrheic dermatitis.

  • Naturally oily skin
  • Weakened immune system
  • Family history: Those with a family history of seborrheic dermatitis may be more likely to get it themselves.

Causes of flare-ups

Seborrheic dermatitis can occur in infants, young adults, and the elderly. Factors listed below may have some effect on when outbreaks occur:

  • Hormones
  • Diet
  • Stress [2]
  • Weather: Cold and dry weather, in particular, can precipitate a seborrheic dermatitis flare-up [3].
  • Certain medical conditions: For example, HIV, Parkinson’s disease, and rosacea may predispose people to developing seborrheic dermatitis [3].

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Treatment Options, Relief, and Prevention for Seborrheic Dermatitis

Treatment

Seborrheic dermatitis is likely to recur many times throughout an individual’s life – no definitive, permanent cure exists. Many treatments can help to end individual flare-ups though, by removing scale, and reducing swelling and itch, usually in the space of just several days or weeks.

  • Keratolytics: These treatments help to remove scale and reduce the production of scale. Examples of keratolytics include salicylic acid, lactic acid, urea, propylene glycol, tar (T-gel), and zinc pyrithione (Nioxin), and these can be found in many over-the-counter preparations.
  • Topical antifungal agents: These agents will help to decrease the amount of yeast overgrowth, which helps to shorten flare-ups and prevent new flare-ups. Examples of topical antifungals include ketoconazole, ciclopirox shampoo, zinc pyrithione, and selenium sulfide (Selsun blue).
  • Topical corticosteroids: Topical steroids like hydrocortisone (Cortizone) and triamcinolone can help to reduce inflammation, redness, and itch during seborrheic dermatitis flare-ups.
  • Topical calcineurin inhibitors: These medications reduce inflammation using a mechanism different from the topical steroids. Examples include topical tacrolimus and pimecrolimus.
  • Shampoos: For dandruff-specific care, some of the above keratolytics and anti-fungal agents are available as shampoos. Available agents include ketoconazole (Nizoral), selenium sulfide (Selsun), coal tar (T-gel), and salicylic acid (T/Sal).
  • Cleaning with a non-soap cleanser: Cleaning with a gentle non-soap cleanser like Cetaphil may help to speed the end of a flare-up.
  • Natural therapies: Tea tree oil may help if a natural solution is desired.
  • For infants: In the case of infantile seborrheic dermatitis, washing with a gentle cleanser, brushing gently to remove scale, use of white petrolatum jelly, and topical antifungals (listed above) are all good options.

Prevention

Recurrence of seborrheic dermatitis is common, and it is important to take a proactive approach to prevent subsequent flares. Some strategies for preventing seborrheic dermatitis flares are suggested below:

  • Washing: Clean the face and other affected areas daily with a gentle soap or non-soap cleanser to maintain healthy oil levels.
  • Exfoliation: Reducing the buildup of dead skin through exfoliation may help to prevent flare-ups.
  • Antifungals and other medications: After a flare, you may want to use medications like antifungals or keratolytics intermittently, even if skin appears healthy, to prevent future flares.
  • Dandruff shampoo: After a dandruff flare subsides, use a similar strategy, washing with dandruff shampoo one to three times per week, even if symptoms have subsided.
  • Avoid irritating styling products and cosmetics, especially those containing alcohol. Toners, astringents, and tonics may all contain drying, irritating alcohols.
  • Shampoo facial hair: Individuals with beards or mustaches should regular shampoo facial hair using anti-dandruff shampoo to prevent seborrheic dermatitis beneath or around facial hair.
  • Eyelid wash: Those who have experienced seborrheic dermatitis blepharitis can wash the eyelids with baby shampoo to prevent another flare [4].

When to Seek Further Consultation for Seborrheic Dermatitis

If you are concerned that you have seborrheic dermatitis, you should see a dermatologist for definitive diagnosis and treatment. There is no single reliable diagnostic test for seborrheic dermatitis, so it is best to have an expert consultant.

Your dermatologist can determine the best treatment strategy for seborrheic dermatitis and can help you plan to prevent further flare-ups.

A dermatologist will also be able to investigate if seborrheic dermatitis has occurred due to a more serious underlying condition, and can guide further treatment decisions [4].