Dermatitis, Seborrheic

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Overview

Seborrheic dermatitis, also known as seborrhea, is a very common skin condition that causes flaking of the skin. The scalp and other oil-rich areas of the skin (including the eyebrows, face, and places where the skin creases, such as armpits and groin) are most often affected by seborrheic dermatitis. In babies, the condition is called cradle cap; in teens and adults, it is usually called dandruff, though, technically, there are many types of dandruff. The skin tends to look red and oily, and the flakes are white or yellow. The flaking seems to be caused by a normal skin yeast that overgrows under certain conditions, including wintertime, stress, and infrequent shampooing. There is no cure for seborrheic dermatitis, but the flaking can be controlled with medicated shampoos.

Who's at risk?

Seborrheic dermatitis occurs in about 3–5% of the teen and adult populations and a much greater percentage (perhaps half ) of the baby population. It is very uncommon in children. Seborrheic dermatitis is seen in all races and both sexes, though it may be more common in men. For reasons that scientists are not yet able to explain, people with some nervous system disorders, such as Parkinson's disease, and some people with HIV often have a more severe form of seborrheic dermatitis.

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: the scalp, hairline, forehead, eyebrows, eyelids, creases of the nose and ears, ear canals, beard areas, breastbone, midback, groin, or armpit.
  • In those with darker skin, some of the affected areas may look lighter in color.
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, severe itch, and unresponsive to self-care measures

Self-Care Guidelines

Most cases of seborrheic dermatitis are easy to control with non-prescription home measures. These include:

  • Frequent (daily) shampooing or a longer lather time.
  • Consider shampoos containing ketoconazole, selenium sulfide, 2% pyrithione zinc, salicylic acid, or tar-based shampoos.
  • Discontinuation of hairspray, gel, mousse, and other hairstyling products.
  • Stress reduction and a healthy diet, especially with adequate B vitamins, zinc, omega-3 fatty acids, and reduction of sugar- and yeast-containing foods such as bread, beer, and wine.
  • Get a little (not too much!) sun, which seems to suppress the growth of the yeast Pityrosporum.
  • Eyelid changes (blepharitis) can often be managed by gentle cleaning of the edges of the eyelid by the lashes with a Q-Tip® and baby shampoo.
If a regular daily shampoo fails, consider an over-the-counter dandruff shampoo. There are several types of dandruff shampoo, and one may work better than another. Sometimes one will work well for a time and then become less helpful; then, it may help to switch to a different type.

If the scalp is covered with widespread, dense scale, the scale 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 shampoo.

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

When to Seek Medical Care

Seek medical help if there is no response to self-care measures.

Treatments Your Physician May Prescribe

  • Corticosteroid creams or solutions
  • Sulfur or sulfacetamide products topically
  • Ketoconazole shampoo or cream
  • Tacrolimus or pimecrolimus cream
  • Topical lithium succinate ointment

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.