Seborrheic dermatitis is a type of eczema that causes red, flaky, and "greasy" rashes in areas of the face and scalp that have many sebaceous glands. It is a common skin condition, and it is estimated that approximately one in 20 people have seborrheic dermatitis. It often begins after puberty, although some babies may develop it before three months of age. Itch is usually absent or mild. In individuals with darker skin, the affected areas may become both lighter and darker.

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Where does it occur on the skin?

The scalp is affected in almost all cases, with dry skin and white flakes. In the face, the rash typically appears around the nostrils, on the cheeks near the nose, and around the eyebrows. Other less common sites include the eyelids, ears, armpits, chest, and groin.

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What is the cause?

The cause of seborrheic dermatitis is a disturbed interaction between the immune system, a naturally occurring yeast on the skin (Malassezia), and the sebaceous glands. The dermatitis occurs where there is high sebum production, such as in the face and scalp. Experience has shown that treatment with antifungal agents reduces the symptoms. Individuals with immunodeficiency may be more prone to seborrheic dermatitis. Stress exacerbates the condition, and many people experience worsened symptoms during the Winter. Additionally, neurological conditions such as Parkinson's disease, epilepsy, or depression may contribute to the development of this type of dermatitis.

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How is it treated?

Seborrheic dermatitis is treated with medications that reduce the levels of yeast on the skin. These can include creams and shampoos. These are safe medications for long-term use.

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Skin treatment typically involves:

• Moisturizers that remove flakes and thickened skin. These can include creams containing salicylic acid, lactic acid, urea, or propylene glycol.
• Antifungal creams, such as those containing ketoconazole.
• Mild corticosteroid creams, such as hydrocortisone 1%, used for a limited period of 1-3 weeks.
• Tacrolimus or pimecrolimus, which are mild immunosuppressive ointments/creams and an alternative to corticosteroid creams.

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Scalp treatment can include:

• Medicated shampoos containing ketoconazole, ciclopirox, selenium sulfide, zinc pyrithione, tar, or salicylic acid, used several times per week. These shampoos should typically be left on the scalp for about 5-10 minutes before rinsing.
• Corticosteroids in the form of a liquid solution (liniment), which are particularly effective against itch
• Tacrolimus or pimecrolimus, which are mild immunosuppressive ointments/creams and an alternative to corticosteroid creams, but may be perceived as sticky by some individuals.

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Alternative treatments:

If seborrheic dermatitis is difficult to treat, oral antibiotics or isotretinoin may be considered. Medical phototherapy (UV-B rays) may also be attempted.

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Can seborrheic dermatitis resemble other conditions?

When there is flaking and oozing from the scalp, particularly in children, a fungal infection (tinea capitis) and bacterial infection should be considered. Sometimes, rashes on both the scalp and other parts of the body can resemble psoriasis or other types of eczema. A medical examination can usually determine the diagnosis.

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Can it be cured?

Treatment can improve the dermatitis and sometimes even eliminate it, but there is a tendency for it to return once the treatment is stopped.