Seborrheic Dermatitis
A common inflammatory skin condition affecting areas rich in sebaceous glands, particularly the scalp and face
Quick Facts
- Type: Inflammatory Skin Condition
- ICD-10: L21
- Prevalence: 3-5% of population
- Onset: Any age, peaks at 30-60
Overview
Seborrheic dermatitis is a common, chronic inflammatory skin condition that primarily affects areas of the body rich in sebaceous (oil) glands. These areas include the scalp, face (particularly around the nose, eyebrows, and behind the ears), chest, and back. The condition is characterized by red, scaly, and itchy patches that can significantly impact quality of life.
The exact cause of seborrheic dermatitis is not fully understood, but it's believed to involve a combination of factors including an overproduction of skin oils, an overgrowth of Malassezia yeast (naturally present on the skin), and an inflammatory response. The condition is not contagious and cannot be spread from person to person.
Seborrheic dermatitis affects approximately 3-5% of the general population and can occur at any age, though it has two peak periods: infancy (where it's often called "cradle cap") and adulthood (particularly between ages 30-60). In infants, the condition usually resolves on its own within the first year of life. In adults, it tends to be a chronic condition with periods of flare-ups and remission.
While seborrheic dermatitis can be frustrating and aesthetically concerning, it's generally not a serious health condition. However, it can cause significant discomfort and self-consciousness, particularly when it affects visible areas like the face and scalp. With proper treatment and management, most people can effectively control their symptoms and maintain good quality of life.
Symptoms
The symptoms of seborrheic dermatitis can vary in severity and location, but typically involve inflammation and scaling of the skin. Symptoms may fluctuate, with periods of improvement followed by flare-ups, often triggered by stress, illness, or environmental factors.
Primary Skin Symptoms
Scalp-Specific Symptoms
Facial Symptoms
Symptoms by Location
Scalp:
- Dandruff ranging from mild flaking to thick, adherent scales
- Red, inflamed scalp with greasy appearance
- Itching that may be intense
- Temporary hair loss in severely affected areas
- Burning or stinging sensation
Face:
- Red, scaly patches around the nose (nasolabial folds)
- Inflammation of eyebrows and eyelids
- Scaling behind the ears and in the ear canals
- Beard area involvement in men
- Central forehead involvement
Body:
- Red, scaly patches on the chest
- Upper back involvement
- Underarm and groin area inflammation
- Areas under breasts in women
Symptom Severity Levels
- Mild: Light scaling, minimal redness, occasional itching
- Moderate: Visible red patches, moderate scaling, regular itching
- Severe: Extensive inflammation, thick scales, intense itching, possible secondary infection
Associated Symptoms
- Burning or stinging sensation
- Skin sensitivity to skincare products
- Embarrassment or self-consciousness
- Sleep disturbance due to itching
- Secondary bacterial infections from scratching
Causes
The exact cause of seborrheic dermatitis is not fully understood, but research suggests it results from a complex interaction of multiple factors. Understanding these contributing factors can help in both treatment and prevention strategies.
Primary Contributing Factors
Malassezia Yeast Overgrowth:
- Malassezia is a yeast naturally present on everyone's skin
- In people with seborrheic dermatitis, this yeast may overgrow
- The yeast feeds on skin oils, producing irritating byproducts
- These byproducts trigger an inflammatory response
- Different Malassezia species may be involved
Sebaceous Gland Activity:
- Overproduction of sebum (skin oil) creates a favorable environment
- Hormonal fluctuations can increase oil production
- Areas with more sebaceous glands are more commonly affected
- Composition of sebum may be altered in affected individuals
Immune System Response:
- Abnormal inflammatory response to normal skin flora
- Genetic predisposition to inflammatory skin conditions
- Compromised skin barrier function
- Altered immune surveillance of the skin
Genetic Factors
- Family history of seborrheic dermatitis increases risk
- Genetic variations affecting immune response
- Inherited differences in skin barrier function
- Genetic predisposition to other inflammatory conditions
Hormonal Influences
- Androgens: Male hormones that increase oil production
- Puberty: Hormonal changes triggering onset
- Pregnancy: Hormonal fluctuations affecting symptoms
- Menopause: Hormonal changes influencing condition
Environmental and Lifestyle Factors
- Climate: Cold, dry weather often worsens symptoms
- Stress: Physical and emotional stress can trigger flare-ups
- Diet: Certain foods may influence inflammation
- Skincare products: Harsh or inappropriate products
- Hygiene habits: Over-washing or under-washing
Medical Conditions
Certain health conditions increase the risk of developing seborrheic dermatitis:
- Neurological conditions: Parkinson's disease, epilepsy
- Immunocompromised states: HIV/AIDS, organ transplant recipients
- Mental health conditions: Depression, eating disorders
- Chronic illnesses: That affect immune function
- Alcoholism: Associated with increased risk
Medications
Certain medications may trigger or worsen seborrheic dermatitis:
- Immunosuppressive drugs
- Lithium
- Interferon
- Some cholesterol-lowering medications
- Certain antipsychotic medications
Risk Factors
Several factors can increase the likelihood of developing seborrheic dermatitis or experiencing more severe symptoms. Understanding these risk factors can help with prevention and early intervention strategies.
Demographic Risk Factors
- Age: Two peak periods - infancy and ages 30-60
- Gender: Slightly more common in men than women
- Ethnicity: May be more common in certain ethnic groups
- Geographic location: Higher prevalence in certain climates
Medical Risk Factors
- Family history: Genetic predisposition to the condition
- Other skin conditions: Atopic dermatitis, psoriasis
- Oily skin: Naturally high sebum production
- Acne: History of acne or current acne
- Rosacea: Facial inflammatory condition
Neurological Risk Factors
- Parkinson's disease
- Epilepsy
- Traumatic brain injury
- Stroke
- Spinal cord injuries
Immunological Risk Factors
- HIV/AIDS: Significantly increased risk and severity
- Organ transplant recipients: Due to immunosuppressive medications
- Cancer patients: Undergoing chemotherapy
- Autoimmune conditions: Various inflammatory disorders
Lifestyle Risk Factors
- Stress: Chronic stress or high-stress lifestyle
- Sleep deprivation: Inadequate or poor-quality sleep
- Alcohol consumption: Excessive drinking
- Smoking: Tobacco use
- Poor diet: High in processed foods and sugar
Environmental Risk Factors
- Climate: Cold, dry weather or sudden temperature changes
- Low humidity: Dry indoor environments
- Air pollution: Urban environments with poor air quality
- Chemical exposure: Harsh detergents or solvents
Skincare and Hygiene Risk Factors
- Use of harsh skincare products
- Frequent use of alcohol-based products
- Over-washing or aggressive scrubbing
- Infrequent hair washing
- Use of heavy, occlusive moisturizers
Hormonal Risk Factors
- Puberty and adolescence
- Pregnancy and postpartum period
- Menopause
- Hormonal imbalances
- Use of certain hormonal medications
Occupational Risk Factors
- Jobs involving chemical exposure
- Work in dusty or dirty environments
- Frequent hand washing requirements
- High-stress occupations
- Shift work affecting sleep patterns
Diagnosis
Seborrheic dermatitis is primarily diagnosed through clinical examination by a healthcare provider, typically a dermatologist. The diagnosis is usually straightforward based on the characteristic appearance and distribution of symptoms.
Clinical Assessment
Medical History:
- Detailed symptom description and timeline
- Family history of skin conditions
- Previous treatments attempted and their effectiveness
- Potential triggers and exacerbating factors
- Current medications and skincare routine
- Associated medical conditions
Physical Examination:
- Visual inspection: Assessment of affected areas
- Distribution pattern: Typical locations (scalp, face, chest)
- Lesion characteristics: Red, scaly patches with greasy appearance
- Scale type: Oily, yellowish scales vs. dry, white flakes
- Severity assessment: Extent and intensity of inflammation
Diagnostic Criteria
Healthcare providers look for these characteristic features:
- Location: Areas rich in sebaceous glands
- Appearance: Red, scaly patches with greasy scales
- Symmetry: Often bilateral and symmetric
- Scale characteristics: Yellowish, greasy, or white flaky
- Chronic nature: Persistent or recurrent symptoms
Laboratory Tests
Usually not necessary, but may be performed in certain cases:
- KOH test: To rule out fungal infections
- Bacterial culture: If secondary infection suspected
- Biopsy: Rarely needed, only if diagnosis unclear
- Patch testing: If allergic contact dermatitis suspected
Differential Diagnosis
Conditions that may be confused with seborrheic dermatitis:
- Psoriasis: Thicker, silvery scales, different distribution
- Atopic dermatitis: Different age groups, different locations
- Contact dermatitis: History of exposure, different pattern
- Rosacea: Central facial distribution, different characteristics
- Tinea versicolor: Fungal infection with different appearance
- Systemic lupus erythematosus: Malar rash, systemic symptoms
Severity Assessment
Healthcare providers may use scoring systems to assess severity:
- Mild: Minimal erythema, light scaling, small affected areas
- Moderate: Moderate redness, visible scaling, multiple areas affected
- Severe: Intense inflammation, thick scaling, extensive involvement
Special Considerations
Infantile Seborrheic Dermatitis (Cradle Cap):
- Diagnosis based on age and characteristic appearance
- Usually appears within first 3 months of life
- Typically mild and self-limiting
- Differentiate from atopic dermatitis
HIV-Associated Seborrheic Dermatitis:
- More severe and extensive than typical cases
- May be one of the first signs of HIV infection
- Often resistant to standard treatments
- May require HIV testing if risk factors present
Monitoring and Follow-up
- Regular assessment of treatment response
- Monitoring for side effects of medications
- Evaluation of lifestyle factors and triggers
- Adjustment of treatment plan as needed
- Education about long-term management
Treatment Options
Treatment of seborrheic dermatitis focuses on reducing inflammation, controlling yeast overgrowth, and managing symptoms. Treatment plans are tailored to the individual's age, severity of symptoms, and affected areas.
Topical Antifungal Medications
Primary treatment targeting Malassezia yeast overgrowth:
- Ketoconazole: 2% cream or shampoo, highly effective
- Ciclopirox: 1% cream or shampoo, anti-inflammatory properties
- Selenium sulfide: 2.5% shampoo for scalp involvement
- Zinc pyrithione: Available in over-the-counter shampoos
- Terbinafine: Cream for body areas
Topical Corticosteroids
For inflammation control, used short-term:
- Low-potency steroids: Hydrocortisone 1% for face
- Medium-potency steroids: For body areas
- Application guidelines: Twice daily for 2-4 weeks maximum
- Caution: Avoid long-term use on face due to side effects
Calcineurin Inhibitors
Non-steroidal anti-inflammatory alternatives:
- Tacrolimus ointment: 0.03% or 0.1%
- Pimecrolimus cream: 1%
- Benefits: No skin atrophy risk, safe for long-term use
- Ideal for: Facial and eyelid involvement
Medicated Shampoos
Essential for scalp treatment:
- Antifungal shampoos: Ketoconazole, ciclopirox
- Anti-seborrheic shampoos: Selenium sulfide, zinc pyrithione
- Coal tar shampoos: For severe scaling
- Salicylic acid shampoos: Help remove scales
- Usage: 2-3 times weekly, leave on for 5-10 minutes
Alternative and Adjunct Treatments
Natural and Herbal Remedies:
- Tea tree oil: Diluted preparations with antifungal properties
- Aloe vera gel: Soothing and anti-inflammatory
- Honey: Antimicrobial and moisturizing properties
- Probiotics: May help modulate immune response
Light Therapy:
- Narrowband UV-B phototherapy
- May be helpful for extensive or resistant cases
- Requires specialized equipment and supervision
Treatment by Location
Scalp Treatment:
- Medicated shampoos as primary treatment
- Antifungal solutions for severe cases
- Gentle scalp massage to remove scales
- Avoid harsh brushing or scratching
Facial Treatment:
- Gentle antifungal creams
- Low-potency corticosteroids short-term
- Calcineurin inhibitors for maintenance
- Gentle, fragrance-free cleansers
Body Treatment:
- Antifungal creams or lotions
- Medicated body washes
- Appropriate strength corticosteroids
- Moisturizers to prevent dryness
Pediatric Treatment
Infantile Seborrheic Dermatitis (Cradle Cap):
- Gentle baby shampoos with soft brushing
- Mineral oil to soften scales before washing
- Mild topical antifungals if needed
- Usually resolves without treatment
- Avoid adult medications
Maintenance Therapy
- Regular use of medicated shampoos
- Intermittent antifungal treatments
- Gentle skincare routine
- Stress management
- Trigger avoidance
Treatment Monitoring
- Regular follow-up appointments
- Assessment of treatment response
- Monitoring for side effects
- Adjustment of therapy as needed
- Education about long-term management
Refractory Cases
For severe, resistant cases:
- Combination therapy approaches
- Systemic antifungal medications
- Evaluation for underlying conditions
- Referral to dermatology specialist
- Consider alternative diagnoses
Prevention
While seborrheic dermatitis cannot always be prevented due to genetic and constitutional factors, several strategies can help reduce the risk of flare-ups and manage the condition effectively.
Skincare and Hygiene Practices
- Gentle cleansing: Use mild, fragrance-free cleansers
- Regular washing: Wash affected areas regularly but not excessively
- Proper drying: Gently pat skin dry, avoid aggressive rubbing
- Avoid harsh products: Skip alcohol-based or heavily fragranced products
- Moisturize appropriately: Use light, non-comedogenic moisturizers
Hair and Scalp Care
- Regular shampooing: Wash hair 2-3 times per week minimum
- Medicated shampoos: Use antifungal shampoos preventively
- Gentle brushing: Use soft brushes, avoid aggressive scrubbing
- Avoid oily products: Limit heavy styling products and oils
- Clean brushes and combs: Regular cleaning of hair tools
Lifestyle Modifications
- Stress management: Practice relaxation techniques, exercise, meditation
- Adequate sleep: Maintain 7-9 hours of quality sleep
- Healthy diet: Reduce processed foods, increase omega-3 fatty acids
- Regular exercise: Moderate physical activity to reduce stress
- Limit alcohol: Reduce or eliminate alcohol consumption
Environmental Controls
- Humidity control: Maintain 40-50% humidity indoors
- Temperature regulation: Avoid extreme temperature changes
- Air quality: Use air purifiers, avoid polluted environments
- Sun protection: Moderate sun exposure may help, but use sunscreen
- Avoid irritants: Stay away from harsh chemicals and smoke
Dietary Considerations
- Anti-inflammatory foods: Fish, leafy greens, berries
- Probiotics: Yogurt, kefir, fermented foods
- Zinc-rich foods: Nuts, seeds, legumes
- Limit trigger foods: High-sugar, high-fat foods
- Stay hydrated: Adequate water intake
Trigger Avoidance
- Identify and avoid personal triggers
- Monitor flare-up patterns
- Seasonal adjustments to routine
- Avoid touching or scratching affected areas
- Use fragrance-free, hypoallergenic products
Medical Management
- Regular check-ups: Monitor condition with healthcare provider
- Medication compliance: Follow prescribed treatment regimens
- Early intervention: Treat flare-ups promptly
- Manage comorbidities: Control associated medical conditions
- Stay informed: Keep up with new treatment options
Seasonal Prevention
Winter Prevention:
- Use humidifiers to combat dry air
- Increase moisturizing frequency
- Protect skin from cold wind
- Avoid overheating indoors
Summer Prevention:
- Manage increased sweating
- Use appropriate sun protection
- Stay hydrated
- Shower after swimming in chlorinated pools
Long-term Prevention Strategies
- Develop a consistent skincare routine
- Build healthy lifestyle habits
- Create a supportive environment at home
- Educate family members about the condition
- Maintain realistic expectations about management
When to See a Doctor
While seborrheic dermatitis is often manageable with over-the-counter treatments, certain situations warrant professional medical evaluation and care.
Initial Diagnosis
- First-time symptoms to confirm diagnosis
- Persistent scaling and redness on scalp or face
- Symptoms that don't improve with over-the-counter treatments
- Uncertainty about the diagnosis
- Multiple areas of the body affected
Worsening Symptoms
- Increasing redness, swelling, or inflammation
- Symptoms spreading to new areas
- Severe itching affecting sleep or daily activities
- Development of thick, adherent scales
- Hair loss in affected areas
Signs of Complications
- Secondary bacterial infection: Increased warmth, pus, or fever
- Severe inflammation: Intense redness and swelling
- Eczematous changes: Cracking, oozing, or crusting
- Cellulitis: Spreading skin infection
- Lymph node swelling: In neck or behind ears
Treatment Failure
- No improvement after 4-6 weeks of appropriate treatment
- Rapid recurrence after stopping treatment
- Multiple failed treatment attempts
- Side effects from current medications
- Need for stronger prescription medications
Special Circumstances
- Infants: Severe or persistent cradle cap
- Immunocompromised patients: Any skin changes
- Elderly patients: New onset or sudden worsening
- Pregnancy: Safe treatment options needed
- Extensive involvement: Large areas of body affected
Quality of Life Impact
- Significant embarrassment or self-consciousness
- Social or professional impact
- Sleep disturbance due to itching
- Interference with daily activities
- Emotional distress or depression
Dermatology Referral
Consider specialist referral for:
- Difficult-to-diagnose cases
- Treatment-resistant seborrheic dermatitis
- Unusual presentation or distribution
- Multiple skin conditions present
- Need for specialized treatments
- Consideration of systemic therapy
Emergency Situations
Seek immediate medical attention for:
- Signs of severe bacterial infection with fever
- Rapid spreading of infection
- Severe allergic reaction to treatments
- Systemic symptoms (fever, malaise)
- Eye involvement with vision changes
Regular Follow-up
- Monitor treatment response
- Adjust therapy as needed
- Screen for complications
- Update on new treatment options
- Address concerns and questions
Pediatric Considerations
- Severe or persistent symptoms in infants
- Signs of secondary infection
- Failure to respond to gentle treatments
- Concerns about normal development
- Need for age-appropriate therapies
Frequently Asked Questions
No, seborrheic dermatitis is not contagious. You cannot catch it from someone else or spread it to others. It's an inflammatory condition related to individual factors like genetics, immune response, and skin characteristics.
Currently, there is no permanent cure for seborrheic dermatitis in adults. However, the condition can be effectively managed with appropriate treatment, and many people experience long periods of remission. In infants, it often resolves completely by the first year of life.
Seborrheic dermatitis is a chronic condition that tends to recur because the underlying factors (genetic predisposition, yeast sensitivity, oil production) remain. Stress, illness, weather changes, and hormonal fluctuations can trigger flare-ups even after successful treatment.
While diet doesn't directly cause seborrheic dermatitis, some people notice that certain foods (high sugar, processed foods, dairy) may worsen their symptoms. An anti-inflammatory diet rich in omega-3 fatty acids and probiotics may help some individuals manage their condition.
Long-term use of topical corticosteroids, especially on the face, can cause side effects like skin thinning, stretch marks, and rebound inflammation. They should be used short-term as directed by a healthcare provider. Calcineurin inhibitors are safer alternatives for long-term maintenance.
Seborrheic dermatitis can cause temporary hair loss in affected areas, usually due to inflammation and scratching. The hair typically regrows once the inflammation is controlled. Permanent hair loss is rare but can occur with severe, chronic inflammation.
Most people with scalp seborrheic dermatitis benefit from washing their hair 2-3 times per week with medicated shampoos. Daily washing may be too harsh, while infrequent washing can allow oil and yeast buildup. Your dermatologist can recommend the best frequency for your specific case.
Yes, stress is a well-recognized trigger for seborrheic dermatitis flare-ups. Stress can affect immune function, hormone levels, and inflammatory responses, all of which can worsen the condition. Stress management techniques often help reduce the frequency and severity of flare-ups.
References
- Borda LJ, Wikramanayake TC. Seborrheic Dermatitis and Dandruff: A Comprehensive Review. J Clin Investig Dermatol. 2015;3(2):10.13188/2373-1044.1000019.
- Dessinioti C, Katsambas A. Seborrheic dermatitis: etiology, risk factors, and treatments: facts and controversies. Clin Dermatol. 2013;31(4):343-351.
- Clark GW, Pope SM, Jaboori KA. Diagnosis and treatment of seborrheic dermatitis. Am Fam Physician. 2015;91(3):185-190.
- Kastarinen H, Oksanen T, Okokon EO, et al. Topical anti-inflammatory agents for seborrheic dermatitis of the face or scalp. Cochrane Database Syst Rev. 2014;(5):CD009446.
- Peter RU, Richarz-Barthauer U. Successful treatment and prophylaxis of scalp seborrheic dermatitis and dandruff with 2% ketoconazole shampoo. Br J Dermatol. 1995;132(3):441-445.