Seborrheic Dermatitis

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Images of Dermatitis, Seborrheic

Overview

Seborrheic dermatitis, also known as seborrhea, is a common non-contagious condition of skin areas containing oil glands (the face, scalp, and upper trunk). In seborrheic dermatitis, extra skin cells are produced (leading to flaking) and sometimes inflammation develops (leading to redness and itching). It varies in severity from mild dandruff of the scalp to scaly, red patches on the skin. A type of yeast normally found on the skin, Pityrosporum ovale, lives in these oil-rich skin regions and plays a role in this condition. Seborrheic dermatitis seems to worsen with stress, winter, and infrequent shampooing. Although there is no "cure" for seborrheic dermatitis, you can usually control it with medicated shampoos.

Who's at risk?

Children are more likely to have seborrhea in the first year of life and during the teenage years (adolescence).

Signs and Symptoms

The scalp is itchy and sheds white, oily skin flakes. One or more of the following areas has patches of red, scaly skin:

  • Scalp or hairline
  • Forehead
  • Eyebrows or eyelids
  • Creases of the nose and ears
  • Ear canals
  • Breastbone
  • Midback
  • Groin or armpit
In people with darker skin, some of the affected areas may look lighter in color. Seborrheic dermatitis may be:
  • Mild – only some flaking and redness in a few small areas
  • Moderate – several areas affected with bothersome redness and itch
  • Severe – large areas of redness and severe itch that do not improve with self-care measures

Self-Care Guidelines

Most outbreaks of seborrheic dermatitis are easy to control with non-prescription measures you can do at home, including:

  • Frequent (daily) shampooing or a longer lather time.
  • Consider shampoos containing ketoconazole, selenium sulfide, 2% pyrithione zinc, salicylic acid, or tar-based shampoos. Sometimes one shampoo will work well for a while and then become less helpful; then it may help to switch to a different type.
  • Eyelid changes (blepharitis) can often be improved by gentle cleaning of the eyelid edges by the lashes with a cotton swab (eg, a Q-Tip®) and baby shampoo.
If the scalp is covered with widespread, dense sheets of skin (scale), it may first be removed by applying warm mineral oil or olive oil to the scalp and washing several hours later with a detergent such as a dishwashing liquid or a tar-based shampoo.

Some over-the-counter creams will help if the medicated shampoo does not work well. These are often added to the shampoo until you notice improvement, and then they can be discontinued, to be used again temporarily when needed. These include:
  • Creams that reduce the Pityrosporum ovale yeast (clotrimazole, miconazole, terbinafine).
  • Hydrocortisone cream, which may work rapidly, but this may be less helpful if used over a long period of time.

When to Seek Medical Care

See your child's doctor or a dermatologist if the condition does not improve with self-care measures.

Treatments Your Physician May Prescribe

  • Corticosteroid creams or solutions
  • Topical sulfur or sulfacetamide products
  • Ketoconazole shampoo or cream
  • Tacrolimus or pimecrolimus cream
  • Lithium succinate ointment

Trusted Links

Clinical Information and Differential Diagnosis of Dermatitis, Seborrheic

References

Bolognia, Jean L., ed. Dermatology, pp.215-218. New York: Mosby, 2003.

Freedberg, Irwin M., ed. Fitzpatrick's Dermatology in General Medicine. 6th ed, pp.1198, 1200, 1374. New York: McGraw-Hill, 2003.