Seborrheic Dermatitis

Seborrheic dermatitis is a common, non-contagious skin condition characterized by itchy red patches and greasy scales on the skin, often accompanied by white or yellow crusty flakes on the scalp. The term “seborrheic” refers to the sebaceous glands, which produce oil on the skin, while “derm” pertains to the skin itself. When the condition affects the scalp of teenagers or adults, it is commonly referred to as “dandruff” (pityriasis capitis), and in infants, it is known as “cradle cap.” While seborrheic dermatitis can appear, disappear with treatment, and flare up periodically, it is considered a lifelong condition. It requires ongoing management to control symptoms effectively.

Locations of Seborrheic Dermatitis

1. Infants (3 Months and Younger):
   • Cradle Cap: Infants often experience cradle cap, characterized by crusty yellow or brown scales on the scalp. This condition typically resolves before the age of one, although it may reappear during puberty. Parents may confuse seborrheic dermatitis with diaper rash in infants.
2. Adults:
   • Facial Areas: Seborrheic dermatitis commonly affects the face, particularly around the nose, eyebrows, eyelids, and behind the ears. It may also develop beneath facial hair, such as the beard or mustache.
   • Other body parts:
     • Middle Part of the Chest: Seborrheic dermatitis can occur in the central area of the chest.
     • Around the Navel: It may appear around the navel area.
     • Buttocks: The buttocks are another common location for seborrheic dermatitis.
     • Skin Folds: Seborrheic dermatitis may develop in skin folds under the arms, on the legs, and in the groin area.
     • Below the breasts: It can also manifest below the breasts in women.

Who is affected by seborrheic dermatitis?

This skin condition affects approximately 11% of the population and tends to manifest in specific demographics and conditions:

1. Age Groups:
   • It commonly occurs in infants younger than three months old, often presenting as a cradle.
   • Among adults, it most frequently affects individuals between the ages of 30 and 60.
2. Gender and Ethnicity:
   • Seborrheic dermatitis is more prevalent in men than in women.
   • It is more commonly observed in Caucasians compared to African Americans.
3. Skin Type:
   • Individuals born with naturally oily skin are more susceptible to seborrheic dermatitis.
4. Family History:
   • A family history of psoriasis increases the likelihood of developing seborrheic dermatitis.
5. Environmental Factors:
   • While weather does not directly cause seborrheic dermatitis, living in dry, cold regions can exacerbate symptoms.
6. Health Conditions:
   • Immunosuppressed individuals, such as organ transplant recipients, individuals with HIV, or those with lymphomas, are more prone to seborrheic dermatitis.
   • Certain psychiatric disorders, neurological diseases, congenital disorders, and spinal cord injuries can increase susceptibility to seborrheic dermatitis.
   • Individuals taking specific psychotropic medications like lithium, buspirone, haloperidol decanoate, and chlorpromazine are at higher risk.

Symptoms of Seborrheic Dermatitis

1. Dandruff: itchy white flakes of skin on the scalp that may fall onto the neck and shoulders when scratched.
2. Red Scales: Red scales may appear on the skin.
3. Cradle Cap (Infants): Crusty yellow scales on infants’ heads, known as cradle cap, which typically do not cause itching but may lead to inflammation and mild infections if scratched.
4. Blepharitis: Scaly redness on the edges of eyelids.
5. Pinkish Plaques: Thick skin with scales on both sides of the face.
6. Flaky Patches: Flaky patches resembling flower petals or rings may occur on the chest and hairline.
7. Redness in Folds: Redness in the folds and creases of the genitals, armpits, and beneath the breasts.
8. Inflamed Hair Follicles: Inflamed hair follicles on the cheeks and upper half of the trunk.

Causes of Seborrheic Dermatitis

1. Malassezia Yeast: Overgrowth of the Malassezia yeast, which is naturally present on the skin but may proliferate in some individuals.
2. Androgens increase levels of androgens, a hormone.
3. Skin Lipids: Elevated levels of skin lipids.
4. Inflammatory Reaction: An inflammatory response within the skin.
5. Family history: genetic predisposition, as seborrheic dermatitis may run in families.

Other factors causing this skin condition are:

1. Stress: Emotional stress can exacerbate symptoms.
2. Climate: Cold and dry climates may worsen the condition.
3. Oily Skin: Excessively oily skin can contribute to seborrheic dermatitis.
4. Alcohol-based Lotions: Using alcohol-based lotions may aggravate the condition.
5. History of Skin Disorders: Individuals with a history of skin disorders such as rosacea, psoriasis, or acne may be more prone to seborrheic dermatitis.

Diagnosis of Seborrheic Dermatitis

Diagnosing this skin condition involves a thorough evaluation by your doctor, encompassing your medical history and a physical examination of your skin. To confirm the diagnosis and rule out other skin conditions, your doctor may perform the following:

1. Medical History: Your doctor will inquire about your medical history, including any previous skin conditions, symptoms you’ve experienced, and any factors that may contribute to your skin issues.
2. Physical Examination: Your doctor will visually inspect your skin, paying close attention to areas commonly affected by this skin condition, such as the scalp, face, and body. They will look for characteristic signs such as redness, scaling, and inflammation.
3. Skin Scraping: In some cases, your doctor may scrape off a small sample of skin from the affected area for microscopic examination. This procedure helps rule out other skin conditions and confirm the presence of seborrheic dermatitis.

Differential Diagnosis:

During the diagnostic process, your doctor will also consider other skin conditions that may present with similar symptoms, including:

• Psoriasis: characterized by silvery-white scales, often on the elbows and knees, and potential nail changes. It’s possible to have both psoriasis and seborrheic dermatitis simultaneously.
• Eczema (atopic dermatitis): typically manifests as inflamed skin, commonly affecting the head, elbows, or knees.
• Rosacea often coexists with dermatitis, causing a red rash without significant scaling, typically on the face. Rosacea may have periods of remission and exacerbation.
• Allergic Reaction: If the rash is itchy and persists despite treatment, an underlying allergy could be the culprit.
• Systemic Lupus Erythematosus (SLE): Certain stages of this condition can present with a distinctive butterfly-shaped rash across the face.

Treatment of Seborrheic Dermatitis

Seborrheic dermatitis in teenagers and adults typically doesn’t resolve on its own and requires treatment. The type of treatment depends on the affected area of the body and the severity of the condition. The primary goal of treatment is to alleviate the visible signs of this skin condition, including itching and redness. Treatment options range from over-the-counter products to prescription medications.

Scalp Treatment:

• Cradle Cap (Infants):
  • Cradle cap usually resolves without treatment between eight and 12 months of age.
  • It may be managed with the daily use of a mild baby shampoo.
  • Gently massaging or brushing the scalp several times a day can help, but avoid causing breaks in the skin.
  • If the condition persists or causes discomfort for the baby, consult a pediatrician or dermatologist, who may prescribe a prescription shampoo or lotion.
• Adolescents and adults:
  • For mild cases, over-the-counter dandruff shampoos containing selenium, zinc pyrithione, or coal tar can be effective. Use them twice a week or as directed.
  • Healthcare providers prescribe shampoos. Your healthcare provider may recommend using a medicated shampoo containing either 2% ketoconazole (Nizoral®) or 1% ciclopirox (Loprox) to manage seborrheic dermatitis. However, it’s important to note that ketoconazole can potentially worsen dryness, especially if you have tightly coiled or chemically treated hair. In such cases, it’s advisable to limit the use of ketoconazole shampoo to once a week and accompany it with a moisturizing conditioner to alleviate dryness.For other medicated shampoos, you can typically use them once a day or two to three times a week for several weeks, as directed. It’s recommended to allow the shampoo to sit on your scalp for a few minutes before rinsing it off. Once your symptoms subside, you can reduce the frequency of use to once every week or two to help prevent a recurrence of symptoms. Following these instructions can help effectively manage seborrheic dermatitis while minimizing potential side effects such as dryness.

Face and Body Treatment:

• Topical Antifungals:
  • Products containing ciclopirox, ketoconazole, or sertaconazole in creams, foams, or gels are applied twice daily for up to eight weeks, then as needed.
• Topical Corticosteroids:
  • Corticosteroids like betamethasone valerate, desonide, fluocinolone, or hydrocortisone come in various forms, such as creams, lotions, foams, gels, or ointments. They are applied once or twice daily.
  • Healthcare providers may prescribe these if antifungal products are ineffective or for treating flare-ups. However, prolonged use should be avoided due to potential side effects such as skin thinning.
• Topical Calcineurin Inhibitors:
  • Alternatives to corticosteroids include pimecrolimus cream (Elidel®) or tacrolimus ointment (Protopic®), applied twice daily.
• Severe Cases:
  • For severe cases, oral antifungal agents or phototherapy (specific ultraviolet light wavelengths) may be recommended.

Follow-Up and Monitoring:

• It’s essential to discuss potential side effects with your healthcare provider and adhere to their instructions for medication use.
• Regular follow-ups will ensure the effectiveness of treatment and allow adjustments if necessary.
• Your healthcare provider will work closely with you to select the most suitable products and develop a treatment plan tailored to your unique condition.

Home Remedies for Seborrheic Dermatitis

While lifestyle changes and home remedies can aid in managing this skin condition, it’s crucial to consult your doctor before attempting any alternative therapies, especially if you’re considering dietary supplements.

1. Oil Treatment for Scalp Scales:
   • Apply mineral oil, peanut oil, or olive oil to your scalp and leave it on for 1 to 3 hours.
   • Afterward, gently comb or brush your hair to remove loosened scales.
   • Follow up by washing your hair.
2. Gentle Skin Cleansing:
   • Use warm water, not hot, when washing your skin.
   • Opt for a gentle soap or non-soap cleanser to avoid aggravating the condition.
   • Thoroughly rinse off the cleanser and pat your skin dry.
   • Apply a moisturizer while your skin is still damp to lock in moisture.
3. Avoidance of Hair-Styling Products:
   • Refrain from using hair sprays, gels, or other styling products that may exacerbate symptoms.
4. Avoid products with alcohol:
   • Choose skin and hair products that are free from alcohol, as these can worsen seborrheic dermatitis.
5. Eyelid Cleansing:
   • Cleanse scaly eyelids daily using a mixture of a few drops of baby shampoo diluted in warm water.
   • Gently wipe away scales with a cotton swab.
   • Alternatively, applying warm, damp cloths to your eyelids can also help alleviate symptoms.
6. Aloe Application:
   • Apply aloe gel to affected areas of the skin.
   • You can either opt for skin products containing aloe or directly use aloe extracted from the leaf of an aloe plant.

Prevention

Reducing Your Risk:

• Understanding Cradle Cap: Cradle cap, a common occurrence in babies, is a natural and harmless condition that typically resolves with simple at-home care. Unfortunately, there are no specific preventive measures for this condition.
• Factors Contributing to Teenagers and Adults: Adolescents and adults with seborrheic dermatitis may be more prone to flare-ups if they have elevated levels of androgens, increased lipid levels in the skin, or an overgrowth of the yeast naturally present on the skin’s surface.

Healthy Lifestyle Practices:

• Adequate Rest: Ensure you get plenty of rest, as it plays a crucial role in maintaining overall health and supporting skin function.
• Stress Management: Managing emotional stress is essential, as stress can exacerbate various skin conditions, including seborrheic dermatitis. Incorporate stress-reduction techniques such as mindfulness, meditation, or engaging in hobbies you enjoy.
• Sun Exposure: Moderate exposure to sunlight, particularly in the form of UV light, for short durations daily may help reduce the risk of seborrheic dermatitis. However, it’s essential to avoid the midday sun when UV rays are at their strongest to prevent skin damage.

Follow the healthcare provider’s instructions:

• Proper Use of Medications: Always adhere to your healthcare provider’s instructions when using medicated shampoos and skin products. Proper treatment is crucial to managing the condition effectively. Under-treatment or inappropriate use of medications can lead to flare-ups and may necessitate additional visits to your healthcare provider.

Outlook/Prognosis

Understanding what to expect with this skin condition:

• Cradle Cap in Babies: Most babies experience cradle cap, a form of seborrheic dermatitis, which typically appears within the first weeks to months of life. This condition is harmless and generally doesn’t cause any discomfort. Fortunately, it usually resolves on its own by around 12 months of age with simple at-home care.
• Seborrheic Dermatitis in Adolescents and Adults: For adolescents and adults dealing with seborrheic dermatitis on the scalp (commonly known as dandruff) or on the face and body, it tends to be a recurring condition throughout life. However, the good news is that it can be effectively managed with treatment. With regular treatment, symptoms often improve quickly.

Living With Seborrheic Dermatitis:

• Scalp Symptoms: If you’re experiencing seborrheic dermatitis on your scalp, over-the-counter dandruff shampoos can be helpful. If one shampoo doesn’t provide relief, try another brand with a different active ingredient, as outlined in the treatment section. Remember to leave the shampoo on your scalp for at least five minutes before rinsing it off.
• Face or Body Symptoms: If you suspect seborrheic dermatitis on your face or body, it’s advisable to consult your healthcare provider or dermatologist for an examination to determine the extent and severity of the condition. Together, you can develop an effective treatment plan to control the condition and manage flare-ups. Always adhere to the instructions provided, and don’t hesitate to reach out to your healthcare provider if you have any questions or concerns.

When to Seek Medical Attention

It’s important to see a dermatologist if:

• Your symptoms worsen.
• You experience a flare-up.
• Your current treatment isn’t providing relief.
• Your healthcare provider may need to adjust your treatment regimen, change your medication, or add different medications to effectively manage your condition. Regular follow-ups and open communication with your healthcare provider are essential for managing seborrheic dermatitis effectively.

Seborrheic Dermatitis FAQs

What is the impact of weather on seborrheic dermatitis?

• Winter Months: Dry air during the winter can exacerbate seborrheic dermatitis, making symptoms worse.
• Summertime: Seborrheic dermatitis tends to improve during summertime due to the sun’s UV-A and UV-B light, which have been found to have a beneficial effect by killing the yeast that overgrows on the skin. However, it’s essential to avoid sunburns.

What is the effect of diet on seborrheic dermatitis?

• No Clear Connection: While there are theories suggesting a link between diet and seborrheic dermatitis, experts have not found conclusive evidence to support the idea that certain foods trigger or alleviate the condition. Diet does not significantly impact dandruff or seborrheic dermatitis.

Distinguish between seborrheic dermatitis and psoriasis.

• Similar Appearance: Both psoriasis and seborrheic dermatitis can present with red patches of skin and flakes, often affecting the scalp and back.
• Psoriasis: Psoriasis is an inflammatory skin disease affecting a percentage of the population. The scales of psoriasis tend to be thicker than those of seborrheic dermatitis, with well-defined edges. On the scalp, psoriasis scales may appear silver in color.
• Sebopsoriasis: This is a condition where seborrheic dermatitis and psoriasis overlap, causing symptoms of both, including white and silver flakes and itchiness.
• Consultation with Healthcare Provider: If you’re unsure whether you have psoriasis or seborrheic dermatitis, it’s advisable to consult your healthcare provider. Treatment for one condition may not be effective for the other.

Can seborrheic dermatitis cause hair loss?

• No Direct Connection: Seborrheic dermatitis itself does not cause hair loss.

What is the relationship between seborrheic dermatitis and acne?

• Co-occurrence: Seborrheic dermatitis and acne can occur simultaneously in the same areas of the body, as both conditions are influenced by the oils present in the skin. Individuals with acne are more likely to experience dandruff or seborrheic dermatitis.

Sources

1. UpToDate
2. Mayo Clinic
3. Journal of Clinical and Investigative Dermatology
4. University of Central Florida
5. American Academy of Family Physicians
6. American Academy of Dermatology
7. Cleveland Clinic
8. HealthyChildren.org