Seborrheic Dermatitis is a common, chronic skin condition that primarily affects the scalp, causing red, flaky, and itchy patches.
Let’s begin with some 101: What is seborrheic dermatitis? Seborrheic dermatitis is a common skin condition that affects millions of people. It’s a chronic form of eczema and is one of the most common skin disorders in the world, affecting up to 70 percent of infants and approximately 11.6 percent of the general population. In infants, the condition is called cradle cap. It primarily affects the scalp, though other parts of the body can also be affected.
Seborrheic dermatitis, sometimes called "seborrhea," typically occurs in areas of the body with oily skin. It is commonly found on the scalp, ears and ear canals, face, eyelids, eyebrows, chest, back, armpits, and genitals — all regions rich in sebaceous glands. This condition leads to scaly, flaky, and itchy skin and is often noticeable in the creases of these areas.
The most common symptoms of seborrheic dermatitis are:
Scaly patches that develop on the skin and scalp
Dry patches on the scalp
A red skin rash that appears under scales
Yellow and white flakes that fall from the affected skin (aka dandruff)
Yellow scabs on scalp
Yellow scales or crusts
Dry or greasy scales
Skin plaques (raised lesions)
Symptoms of seborrheic dermatitis can also mimic other skin conditions, so it’s best to see a dermatologist who can help you discern exactly what’s going on with your skin.
The causes of seborrheic dermatitis are still largely undetermined. Research suggests that genetics, climate, stress levels, sebum, and the growth of certain types of yeast on the skin all play a role.
According to the National Eczema Foundation, seborrheic dermatitis can be triggered by an inflammatory reaction in response to an overgrowth of yeast found naturally on the skin, Malassezia, also sometimes called pityrosporum.
Allergies and hygiene do not appear to play a role in developing seborrheic dermatitis.
Although seborrheic dermatitis can affect anyone at any time in life, it’s most common in infants three months or younger, and adults between the ages of 30 and 60. You may have a higher risk of developing seborrheic dermatitis if you have a medical condition or use certain types of medication. We’ll cover the conditions, medications, and other risk factors for developing seborrheic dermatitis next.
Many people with seborrheic dermatitis are completely healthy. However, there are some conditions, medications, and other factors that may make a person more likely to develop seborrheic dermatitis. According to the American Academy of Dermatology, the following are risk factors for seborrheic dermatitis.
Some neurological disorders, such as Parkinson’s disease and epilepsy
HIV infection
Immunodeficiency
Having had an accident that affects the brain or injures your spinal cord
Lymphoma (a type of cancer)
A mood disorder like depression
Down syndrome
Anorexia nervosa and other eating disorders
Heavy alcohol consumption
Rosacea or psoriasis
Stroke or heart attack (recovering from)
Organ transplant
The National Eczema Association also lists these additional risk factors for seborrheic dermatitis:
Stress
Recovery from a stressful life event
Hormonal changes or illness
Harsh detergents, solvents, chemicals and soaps
Certain medications, including psoralen, interferon, and lithium
You may also be more likely to develop seborrheic dermatitis in the winter months or if you live in a cold, dry climate, as this kind of weather triggers flare-ups, or if you have certain skin conditions and scalp conditions, such as acne, psoriasis, and rosacea.
A dermatologist typically diagnoses seborrheic dermatitis. Typically, during an evaluation for seborrheic dermatitis, a healthcare professional will do some or all of the following:
Medical History: The doctor will ask about your symptoms, how long you’ve had them, and any factors that seem to trigger or worsen them (like certain foods or changes in weather).
Physical Examination: The doctor will examine the affected areas of your skin and scalp closely. They will look for characteristic signs of seborrheic dermatitis, such as scaly, greasy patches and redness.
Skin Scraping: In some cases, the doctor might gently scrape off a small sample of the affected skin to examine under a microscope. This can help rule out other conditions with similar symptoms, such as atopic dermatitis, psoriasis, or fungal infections.
Biopsy: Your dermatologist may perform a skin biopsy, in which a small piece of skin is removed and sent to the lab for analysis. This helps to rule out other conditions but is not required to diagnose seborrheic dermatitis.
Depending on your symptoms and other factors, your provider will typically suggest one or several of the following options for the treatment of seborrheic dermatitis:
Medicated shampoos. Most cases of seborrheic dermatitis can be treated using over-the-counter dandruff shampoos designed to eliminate scale, prevent fungal growth, and reduce scalp inflammation. Your healthcare provider may recommend a dandruff shampoo containing one or more ingredients that act as antifungal agents. This includes ketoconazole, pyrithione zinc, selenium sulfide, chloroxine, and coal tar.
Antifungal creams. You may need to apply an antifungal cream to the affected areas of your skin. This type of medication prevents fungi growth, which can irritate the skin and contribute to seborrheic dermatitis symptoms. Several topical antifungal medications are commonly used to treat seborrheic dermatitis, including ketoconazole, itraconazole, ciclopirox, and bifonazole.
Oral antifungal medications. Your healthcare provider may prescribe an oral antifungal medication if you have severe seborrheic dermatitis or don’t experience any improvements from topical antifungal creams.
Corticosteroid creams. Your healthcare provider may prescribe a topical corticosteroid if you have inflamed skin. This treatment reduces inflammation and eases symptoms such as itchiness, redness (erythema), and discomfort. Several corticosteroids or steroid lotions, including hydrocortisone, valerate, desonide, fluocinolone, and betamethasone, treat seborrheic dermatitis. These medications can cause side effects, and as such, they’re typically only prescribed for short-term use.
Topical calcineurin inhibitors. These are sometimes prescribed as an alternative to corticosteroids. These products generally include pimecrolimus cream (Elidel®) or tacrolimus ointment (Protopic®) and are applied to the affected area two times a day.
If you’re prescribed medication to treat seborrheic dermatitis, following your healthcare provider’s instructions is very important. Take your medication for the entire treatment period, even if you notice an improvement in your symptoms relatively early.
You may need to use a combination of medication and medicated shampoo to control your symptoms and clear your flaking skin for optimal results.
Follow the instructions provided with your shampoo. Many shampoos need to be used daily at first, after which you may be able to use them on an as-needed basis to control your symptoms.
Seborrheic dermatitis doesn’t cause hair loss directly — in fact, it has no known effect on the most common type of hair loss, male pattern baldness (androgenic alopecia).
That said, seborrheic dermatitis can cause temporary hair loss if your skin becomes extremely irritated or if you frequently scratch your itchy scalp.
Excessive scratching can damage your hair follicles — the tiny structures inside the skin from which hairs grow. When these follicles are injured, they may stop producing new hairs, making your scalp look overly thin or causing patchy hair loss.
Seborrheic dermatitis may also cause hair loss by encouraging certain types of fungi to multiply on your skin. Skin affected by seborrheic dermatitis tends to have high levels of sebum — an oil produced by the skin. When your skin has an excessive amount of sebum, fungi and other pathogens can multiply quickly.
One common fungus genus, Malassezia, can grow on your scalp and cause you to shed hair. Hair loss caused by Malassezia yeast is generally not permanent. However, it can noticeably impact your appearance, especially when left untreated.
Using minoxidil (the active ingredient in Rogaine®) can help regrow the hair you’ve lost.
Because it’s often a hereditary condition, it’s hard to prevent seborrheic dermatitis completely. But there are things you can do to make a flare-up less intense. Here are some ways to prevent seborrheic dermatitis:
Take lukewarm or cold showers, as hot water can irritate skin.
Use fragrance-free soaps.
Try a medicated shampoo or a dandruff shampoo that contains zinc pyrithione to help prevent a scaly scalp, like our dandruff detox shampoo with pyrithione zinc 1% and salicylic acid).
Keep skin hydrated with a moisturizer, as moisturized skin is less prone to flare-ups.
Make sure your hair and skin care products are alcohol-free.
Avoid being around harsh chemicals like drying paint, new carpeting, and cleaning products, as they can trigger a flare-up in some people.
Protect your skin and scalp from the cold by wearing a hat or creating a barrier with petroleum jelly.
Manage stress, as stress can lead to flare-ups.
Wear loose-fitting, soft cotton clothing where you have seborrheic dermatitis.
Use a mineral sunscreen containing zinc oxide or titanium dioxide. Heat and sun can trigger seborrheic dermatitis, but chemical sunscreen can also trigger it, so a mineral option is best.
Seborrheic dermatitis is a common skin condition affecting millions of people. It’s not harmful to your health, but it can be uncomfortable and distressing. If you want to treat or manage your seborrheic dermatitis, it’s best to see a dermatologist who can help determine the right treatment plan.