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Seborrheic dermatitis

Dandruff; Seborrheic eczema; Cradle cap

Seborrheic dermatitis is a common inflammatory skin condition. It causes flaky, white to yellowish scales to form on oily areas such as the scalp, face, or inside the ear. It can occur with or without reddened skin.

Cradle cap is the term used when seborrheic dermatitis affects the scalp of infants.

Causes

The exact cause of seborrheic dermatitis is unknown. It may be due to a combination of factors:

  • Oil gland activity
  • Yeasts, called malassezia, which live on the skin, mainly in areas with more oil glands
  • Changes in skin barrier function
  • Your genes 

Risk factors include:

  • Stress or fatigue
  • Weather extremes
  • Oily skin, or skin problems such as acne
  • Heavy alcohol use, or using lotions that contain alcohol
  • Obesity
  • Nervous system disorders, including Parkinson disease, traumatic brain injury, or stroke
  • Having HIV/AIDS

Symptoms

Seborrheic dermatitis can occur on different body areas. It often forms where the skin is oily or greasy. Common areas include the scalp, eyebrows, eyelids, creases of the nose, lips, behind the ears, in the outer ear, and middle of the chest.

In general, symptoms of seborrheic dermatitis include:

  • Skin lesions with scales 
  • Plaques over large area
  • Greasy, oily areas of skin
  • Skin scales -- white and flaking, or yellowish, oily, and sticky dandruff
  • Itching -- may become more itchy if infected
  • Mild redness
  • Hair loss

Exams and Tests

Diagnosis is based on appearance and location of the skin lesions. Further tests, such as skin biopsy, are rarely needed.

Treatment

Flaking and dryness can be treated with over-the-counter dandruff or medicated shampoos. You can buy these at the drugstore without a prescription. Look for a product that says on the label it treats seborrheic dermatitis. Such products contain ingredients such as salicylic acid, coal tar, zinc, resorcin, ketoconazole, or selenium sulfide. Use the shampoo according to label instructions.

For severe cases, your health care provider will likely prescribe a shampoo, cream, ointment, or lotion containing either a stronger dose of the above medicines, or contain any of the following medicines:

  • Cicloprox
  • Sodium sulfacetamide
  • A corticosteroid
  • Tacrolimus or pimecrolimus (medicines that suppress the immune system)

Phototherapy, a medical procedure in which your skin is carefully exposed to ultraviolet light, may be needed.

Sunlight may improve seborrheic dermatitis. In some people, the condition gets better in the summer, especially after outdoor activities.

Outlook (Prognosis)

Seborrheic dermatitis is a chronic (life-long) condition that comes and goes, and it can be controlled with treatment.

Severity of seborrheic dermatitis can be lessened by controlling risk factors and paying careful attention to skin care.

Possible Complications

The condition may result in:

  • Psychological distress, low self-esteem, embarrassment
  • Secondary bacterial or fungal infections

When to Contact a Medical Professional

Call for an appointment with your provider if your symptoms don't respond to self-care or over-the-counter treatments.

Also call if patches of seborrheic dermatitis drain fluid or pus, form crusts, or become very red or painful.

Prevention

The severity of seborrheic dermatitis can be lessened by controlling the risk factors and by paying careful attention to skin care.

References

Borda LJ, Wikramanayake TC. Seborrheic dermatitis and dandruff: a comprehensive review. J Clin Investig Dermatol. 2015;3(2):10.13188/2373-1044.1000019. PMCID: 4852869 www.ncbi.nlm.nih.gov/pmc/articles/PMC4852869.

James WD, Berger TG, Elston DM. Seborrheic dermatitis, psoriasis, recalcitrant palmoplantar eruptions, pustular dermatitis, and erythroderma. In: James WD, Berger TG, Elston DM, eds. Andrews' Diseases of the Skin: Clinical Dermatology. 12th ed. Philadelphia, PA: Elsevier; 2016:chap 10.

Weidmann AK, Williams JDL, Coulson I. Seborrheic eczema. In: Lebwohl MG, Heymann WR, Berth-Jones J, Coulson I, eds. Treatment of Skin Disease: Comprehensive Therapeutic Strategies. 4th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 219.

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    Review Date: 5/2/2017

    Reviewed By: David L. Swanson, MD, Vice Chair of Medical Dermatology, Associate Professor of Dermatology, Mayo Medical School, Scottsdale, AZ. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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