Seborrheic (seb-o-REE-ik) dermatitis is a common skin condition that mainly affects your scalp. It causes scaly patches, red skin and stubborn dandruff. Seborrheic dermatitis can also affect oily areas of the body, such as the face, upper chest and back.

Seborrheic dermatitis doesn't affect your overall health, but it can be uncomfortable and cause embarrassment. It isn't contagious, and it's not a sign of poor personal hygiene.

Seborrheic dermatitis is usually a long-term condition. You may need many repeated treatments before the symptoms go away. And they may return later. You may be able to manage flare-ups by recognizing seborrheic dermatitis symptoms and using a combination of self-care steps and medications.

Seborrheic dermatitis is also called dandruff, seborrheic eczema and seborrheic psoriasis. For infants, it's known as cradle cap.

Seborrheic dermatitis symptoms include:

  • Skin flakes (dandruff) on your scalp, hair, eyebrows, beard or mustache
  • Patches of greasy skin covered with flaky white or yellow scales or crust on the scalp, ears, face, chest, armpits, scrotum or other parts of the body
  • Red skin
  • Redness or crusting of the eyelids (blepharitis)
  • Possibly itching or stinging

When to see a doctor

See your doctor if:

  • You're so uncomfortable that you're losing sleep or being distracted from your daily routines
  • Your condition is causing embarrassment and anxiety
  • You suspect your skin is infected
  • You've tried self-care steps without success

Doctors don't yet know the exact cause of seborrheic dermatitis. But it may be related to:

  • A yeast (fungus) called malassezia that is in the oil secretion on the skin
  • An inflammatory response related to psoriasis
  • The season, with episodes tending to be worse in early spring and winter

A number of factors increase your risk of developing seborrheic dermatitis, including:

  • Neurological and psychiatric conditions, such as Parkinson's disease and depression
  • A weakened immune system, such as seen in organ transplant recipients and people with HIV/AIDS, alcoholic pancreatitis and some cancers
  • Congestive heart failure
  • Endocrine disease that leads to obesity, such as diabetes
  • Some medications
  • Scratching or otherwise damaging the skin on your face

You'll probably first visit your primary care doctor. He or she may refer you to a doctor who specializes in skin disorders (dermatologist).

Here's some information to help you get ready for your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may free up time to go over any points you want to spend more time on. Your doctor may ask:

  • What are your symptoms, and when did you first notice them?
  • Is this the first time you've had these symptoms, or have you had them before?
  • How severe are your symptoms? Are they about the same all the time, getting worse, or sometimes better and sometimes worse?
  • Have you tried any at-home treatments, such creams, gels or shampoos?
  • How often do you use these treatments?
  • Does anything seem to help?
  • Does anything seem to make your symptoms worse?
  • What medications, vitamins or supplements are you taking?
  • Have you been under stress lately or experienced major life changes?

What you can do in the meantime

An over-the-counter (nonprescription) antifungal cream or anti-itch cream can be helpful. If your scalp is affected, a nonprescription antifungal shampoo may ease your symptoms. Try not to scratch or pick at the affected area, because if you irritate your skin or scratch it open, you increase your risk of infection.

Your doctor may scrape off skin cells for examination (biopsy) to rule out conditions with some symptoms similar to seborrheic dermatitis, including:

  • Psoriasis. This disorder also causes dandruff and red skin covered with flakes and scales. With psoriasis, usually you'll have more scales, and they'll be silvery white.
  • Atopic dermatitis (eczema). This skin reaction causes itchy, inflamed skin in the folds of the elbows, on the backs of the knees or on the front of the neck. It often recurs.
  • Rosacea. This condition usually occurs on the face and has very little scaliness.

Medicated shampoos, creams and lotions are the main treatments for seborrheic dermatitis. Your doctor will likely recommend you try home remedies, such as over-the-counter dandruff shampoos, before considering prescription remedies. If home remedies haven't helped, talk with your doctor about trying these treatments:

  • Creams, shampoos or ointments that control inflammation. Prescription-strength hydrocortisone, fluocinolone or desonide (Desowen, Desonide) are corticosteroids you apply to the scalp or other affected area. They're effective and easy to use. But if used for many weeks or months without a break, they can cause side effects, such as thinning skin or skin showing streaks or lines.
  • Antifungal shampoo alternated with a stronger medication. Ketoconazole shampoo may be effective when alternated with a clobetasol scalp product (Temovate) twice weekly.
  • Antifungal medication you take as a pill. Your doctor may recommend the antifungal medication terbinafine (Lamisil). This option is not often used because it can have serious side effects, such as allergic reactions and liver problems.
  • Medications that affect your immune system. Creams or lotions containing the calcineurin inhibitors tacrolimus (Protopic) and pimecrolimus (Elidel) may be effective and have fewer side effects than corticosteroids do. But they are not first-choice treatments because of a potential increased risk of cancer. In addition, they cost more than mild corticosteroid medications.
  • Cream or gel that fights bacteria. You apply metronidazole (Metrolotion, Metrogel) as a cream or gel once or twice daily until you see improvement.
  • Light therapy with medication. This treatment combines psoralen with light therapy (photochemotherapy). After you take psoralen by mouth or apply it to the affected skin, you're exposed to ultraviolet light. This therapy may not work for people with thick hair.

You may be able to control seborrheic dermatitis with lifestyle changes and home remedies. Many of these are available in over-the-counter (nonprescription) forms. You may need to try different products or a combination of products before your condition improves.

The best approach for you depends on your skin type, the severity of your condition, and whether your symptoms affect your scalp or other areas of your body. But even if your condition clears up, it is likely to come back at some point. Watch for the symptoms and resume treating the condition when it recurs.

Wash your hair with medicated anti-dandruff shampoo

Try over-the-counter anti-dandruff products, such as:

  • Shampoo with pyrithione zinc (Head & Shoulders) or selenium (Selsun Blue), used daily
  • Shampoo with the antifungal ketoconazole, used twice weekly, alternating with your daily shampoo
  • Tar shampoo (Neutrogena T/Gel, DHS Tar)
  • Salicylic acid shampoo (Neutrogena T/Sal), used daily

These shampoos may be especially helpful for dandruff (mild seborrheic dermatitis). If one type of shampoo works for a time and then seems to lose its effectiveness, try alternating between two types. Be sure to leave your shampoo on for the full recommended time — this allows its ingredients to work. These shampoos may be rubbed gently on the face, ears and chest and rinsed off completely.

Other home remedies

The following over-the-counter treatments and self-care tips can help you control and manage seborrheic dermatitis:

  • Soften and remove scales from your hair. Apply mineral oil or olive oil to your scalp. Leave it in for an hour or so. Then comb or brush your hair and wash it.
  • Wash your skin regularly. Rinse the soap completely off your body and scalp. Avoid harsh soaps and use a moisturizer.
  • Apply a mild corticosteroid cream. If that doesn't work, try the antifungal cream ketoconazole.
  • Avoid products that contain alcohol. These can cause the disease to flare up.
  • Wear smooth-textured cotton clothing. This helps keep air circulating around your skin and reduces irritation.
  • If you have a beard or mustache, consider shaving it off. Seborrheic dermatitis can be worse under mustaches and beards. If this is the case for you, shaving might ease your symptoms.
  • Avoid scratching. Scratching can increase irritation and your risk of infection. Apply hydrocortisone cream or calamine lotion to temporarily relieve itching.
  • Gently clean your eyelids. If your eyelids show signs of redness or scaling, wash them each night with baby shampoo and wipe away scales with a cotton swab. Warm or hot compresses also may help.
  • Gently wash your baby's scalp. If your infant has cradle cap, wash the scalp with nonmedicated baby shampoo once a day. Gently loosen the scales with a small, soft-bristled brush before rinsing out the shampoo.

Many alternative therapies, including those listed below, have helped some people manage their seborrheic dermatitis. But evidence for their effectiveness isn't conclusive. It's always a good idea to check with your doctor before adding any alternative medicines to your self-care routine.

  • Tea tree oil. Tea tree oil, either alone or added to your shampoo, may help treat seborrheic dermatitis. Some studies suggest that tea tree oil may trigger an allergic reaction or affect certain hormones in your body.
  • Fish oil supplements. Some evidence shows that taking fish oil supplements, which contain omega-3 fatty acids, may help seborrheic dermatitis.
  • Aloe vera. In a study of people who used aloe cream twice a day for four to six weeks, 62 percent saw reduced scaling and itching.
May 30, 2014