Seborrheic dermatitis

Seborrheic dermatitis: Despite its appearance, this skin disease is not caused by poor hygiene.

Seborrheic dermatitis: Overview

This is a very common skin disease that causes a rash. When this rash appears, it often looks like the one pictured above. The skin tends to have a:

• Reddish color.
• Swollen and greasy appearance.
• White or yellowish crusty scale on the surface.

One or more of these rashes can appear on the body. Sometimes, the affected skin itches.

Cradle cap: A type of seborrheic dermatitis

Many infants get cradle cap. This is a type of seborrheic dermatitis (seb-uh-ree-ick dur-muh-tahy-tis) that develops in babies. Scaly, greasy patches form on the baby’s scalp. The patches can become thick and crusty, but cradle cap is harmless. Cradle cap usually goes away on its own within a few months.

Babies also get seborrheic dermatitis in their diaper area and elsewhere. In the diaper area, the red rash often is mistaken for diaper rash. A few babies get seborrheic dermatitis that covers much of the body with red, scaly patches.

No matter where the seborrheic dermatitis forms, it tends to permanently disappear between 6 months and 1 year of age.

Seborrheic dermatitis is long-lasting in adults

When an adult gets seborrheic dermatitis, the condition can come and go for the rest of the person’s life. Flare-ups are common when the weather turns cold and dry. Stress also can trigger a flare-up. The good news is that treatment can reduce flare-ups and bring relief.

Seborrheic dermatitis: Signs and symptoms

The signs and symptoms of seborrheic dermatitis vary with age. The following describes how it affects people at different ages.

Adults and adolescents

Seborrheic dermatitis causes:

• Scaly patches on the skin.
• The skin beneath these patches is reddish.
• Although scaly, patches often look greasy or moist.
• Scales can flake off and tend to be yellowish to white.

In adults and adolescents, the skin can:

• Itch, especially on the scalp and in the ear canal.
• Burn.

Patches form where the skin is oily:

• Scalp.
• Ears (around and in the ear canal).
• Eyebrows (the skin beneath).
• Center of the face.
• Eyelids.
• Upper chest.
• Upper back.
• Armpits.
• Genitals.

Patches form where the skin is oily, such as on the scalp, face, and in the ear canals.

Infants

When an infant gets seborrheic dermatitis, it tends to form on the scalp and is known as cradle cap. Signs and symptoms of cradle cap include:

• Yellow, greasy scale on the scalp.
• A thick layer of scale can cover the entire scalp.
• Scale is often yellow to brownish in color.
• With time, the scale becomes flaky and easily rubs off.

In infants, seborrheic dermatitis also can form on the face, usually on a baby’s eyelids, around the nose, or ears. It also forms in the diaper area. In a few babies, seborrheic dermatitis covers most of the body.

Most infants seem unbothered by seborrheic dermatitis. Cradle cap sometimes itches.

Seborrheic dermatitis: Who gets and causes

What causes seborrheic dermatitis?

Researchers are still studying what causes this common skin disease. From what they have learned, it appears that the cause is complex. Many factors seem to work together to cause seborrheic dermatitis. These factors may include the yeast that normally lives on our skin, our genes, living in a cold and dry climate, stress, and a person’s overall health.

By studying seborrheic dermatitis, researchers have learned the following:

• It is not caused by poor personal hygiene.
• It is not an allergy.
• It does not harm the body.

Who gets seborrheic dermatitis?

People of all colors and ages get seborrheic dermatitis. You have a higher risk if any of the following apply to you.

Age

People in these two age groups are most susceptible:

• Infants 3 months of age and younger.
• Adults between 30 and 60 years of age.

Medical conditions

Your risk increases if you have any of these medical conditions:

• HIV (About 85 percent of people infected with HIV develop seborrheic dermatitis).
• Acne, rosacea, or psoriasis.
• Parkinson’s disease.
• Epilepsy.
• Stroke or heart attack (recovering from).
• Alcoholism.
• Depression.
• Eating disorder.

Medical treatments

If you are taking any of the following medicines, your risk for seborrheic dermatitis increases:

• Interferon.
• Lithium.
• Psoralen.

Seborrheic dermatitis is a condition that dermatologists frequently diagnose and treat.

If you think you might have seborrheic dermatitis, you should see a dermatologist for a diagnosis. This common skin condition can look like psoriasis, eczema, or an allergic reaction. Each of these skin diseases requires different treatment.

Diagnosis

A dermatologist diagnoses seborrheic dermatitis by:

• Reviewing the patient’s medical history.
• Examining the patient’s skin and looking closely at the rash.

Sometimes seborrheic dermatitis is a sign of an underlying medical condition. If your dermatologist suspects this, medical tests may be necessary.

Treatment

Although treatment cannot cure seborrheic dermatitis, treatment has benefits. Treatment can loosen and remove scale, prevent a skin infection, and reduce swelling and itch.

The type of treatment a dermatologist prescribes varies with age and where the seborrheic dermatitis appears on the skin.

Infants (scalp): Called cradle cap, this tends to completely disappear without treatment. If treatment is necessary, a dermatologist may recommend:

• Shampooing the baby’s scalp daily with a baby shampoo.
• Gently brushing away the scale, once scale starts to soften.
• Applying a medication to the infant’s scalp.

Infants (skin beyond the scalp): This, too, will clear. If treatment is needed, a dermatologist may prescribe a medicine that can be applied to the child’s skin.

Adolescents and adults (scalp and rest of body): After infancy, seborrheic dermatitis usually does not go away without treatment. For the best results, a dermatologist will consider many factors before creating a treatment plan. Treatment may include:

• Dandruff shampoos.
• Medicine to apply to the skin for short periods of time.
• Barrier-repair cream.

Dandruff shampoos can be helpful on the skin as well as the scalp. Your dermatologist can explain how to use these shampoos on the skin.

Often the best results come from combining two or more treatments. Your dermatologist can create a treatment plan to meet your needs. Most plans include medication and skin care.

Always follow your dermatologist’s instructions. Using a treatment more often than prescribed or longer than prescribed can cause side effects.

Outcome

Infant: Seborrheic dermatitis often completely disappears by 6 months to 1 year of age. It can return when the child reaches puberty.

Adolescent or adult: A few people see seborrheic dermatitis clear without treatment. More often, seborrheic dermatitis lasts for years. It tends to clear and flare without warning. Treatment often is necessary to control it.

Seborrheic dermatitis: Tips for managing

Dermatologists recommend the following to help keep seborrheic dermatitis under control.

Infants: Cradle cap

Many babies develop this rash on their scalps. Cradle cap normally goes away by 6 to 12 months of age. Until the rash disappears, the following can help:

What you need:

• Baby shampoo
• Comb or brush

Directions

1. Shampoo the baby’s scalp daily with a baby shampoo. This helps soften the scale.
2. Once the scale starts to soften, gently brush it away.

Infants: Diaper area and elsewhere

If your baby may have seborrheic dermatitis in the diaper area or elsewhere, it is best to see a dermatologist for a diagnosis. This common rash can look a lot like eczema, psoriasis, or an allergic reaction. Each of these conditions requires a different treatment plan.

Adults and adolescents: Scalp

On the scalp, many people can get relief by a dandruff shampoos.

When using a dandruff shampoo, always read and follow the directions on the bottle. Some shampoos you need to leave on scalp for a few minutes.

What you need

• Shampoo (without dandruff control)
• Dandruff shampoo

If you are African American, follow the plan for African American hair, shown below.

Directions

1. On day 1, use the dandruff shampoo, and continue to use it every other day.
2. On day 2, use your regular shampoo, using it every other day.

As the seborrheic dermatitis lessens, you can decrease how often you use the dandruff shampoo, using it only 1 or 2 times a week. 

Not getting relief?

Trying a dandruff shampoo with a different active ingredient may help. The active ingredients in dandruff shampoos are:

• Zinc pyrithione
• Salicylic acid and sulfur
• Coal tar
• Selenium sulfide
• Ketoconazole

African Americans: How to control seborrheic dermatitis on your scalp

What you need

• Dandruff shampoo(See a dermatologist for a product recommendation.)

Directions

1. Shampoo once a week using the dandruff shampoo

Adults and adolescents: Skin care

What you need

• Soap (or cleanser) that contains 2% zinc pyrithione
• Fragrance-free moisturizer
• Scale softener, such as a cream that contains coal tar or salicylic acid and sulfur

Petroleum jelly is NOT recommended if you have seborrheic dermatitis. Using it tends to worsen seborrheic dermatitis.

Directions

Dermatologists recommend the following to remove scale from your skin:Wash your skin daily, as follows:

• Wet your skin thoroughly.
• Wash, using the soap that contains 2% zinc pyrithione.
• Rinse well.
• Apply a fragrance-free moisturizer after every shower and bath.

If you need more help softening the scale, apply a scale-softening cream that contains salicylic acid and sulfur or coal tar. When using these, follow the instructions on the product.

When to see a dermatologist

Seborrheic dermatitis can be stubborn. If these tips fail to bring relief, you should see a dermatologist. Some people need the expertise of a dermatologist to control seborrheic dermatitis.

  © 2019 American Academy of Dermatology. All rights reserved. Reproduction or republication strictly prohibited without prior written permission. Use of these materials is subject to the legal notice and terms of use located at https://www.aad.org/about/legal

References:

Habif TP, Campbell JL, et al. “Seborrheic dermatitis.” In: Dermatology DDxDeck.China, Mosby Elsevier: 2006, p. 40.Plewig G Jansen T. “Seborrheic Dermatitis.” In: Wolff K, Goldsmith LA, Katz SI, et al. editors. Fitzpatrick’s Dermatology in General Medicine, 7th ed. United States of America, McGraw Hill Medical; 2008. p.219-25.

Habif TP, Campbell JL, et al. “Seborrheic dermatitis.” In: Dermatology DDxDeck.China, Mosby Elsevier: 2006, p. 40.

Plewig G Jansen T. “Seborrheic Dermatitis.” In: Wolff K, Goldsmith LA, Katz SI,et al. editors.Fitzpatrick’s Dermatology in General Medicine, 7th ed. United States of America, McGraw Hill Medical; 2008. p.219-25.