Seborrheic Dermatitis: Causes, Symptoms, Diagnosis, and Treatment Options

What Is Seborrheic Dermatitis?

Seborrheic dermatitis, also known as seborrheic eczema, is a very common and non-contagious skin condition. It mostly affects oily parts of the body. It mostly occurs on the scalp but may also occur on the face, eyebrows, sides of the nose, back of the ears, eyelids, chest, belly button, breasts, and groin. It can affect both adults and teenagers. It is also known as dandruff if it occurs on the scalp. In infants, it is known as cradle cap. This condition is chronic, meaning it can be managed but may recur periodically.

How Common Is Seborrheic Dermatitis?

About 11 percent of the general population has seborrheic dermatitis. It commonly affects infants younger than three months old and adults aged 30 to 60 years. It is most often seen in men than in women.

Recent research indicates that it is more prevalent in people whose immune systems are compromised and in people with certain neurological disorders.

What Causes Seborrheic Dermatitis?

It is unclear exactly what causes seborrheic dermatitis. However, an overgrowth of the yeast Malassezia, often found on the skin, is likely associated with it. Redness and inflammation may result if this yeast overgrows.

Hormonal abnormalities, such as increased androgen levels (male hormones also found in women), a family history of skin conditions including psoriasis, rosacea, or eczema, and increased oil production in the skin, could all be contributing factors.

Some things that can exacerbate seborrheic eczema include:

• Lack of sleep and stress.
• Cold and dry weather.
• Naturally oily skin.
• Using alcohol-based lotion or cream.
• Using harsh soap, detergent, chemicals, or solvents.
• Some medications, including Psoralen, Interferon, and Lithium.

Recent research also indicates that an imbalance of the skin’s natural bacteria (skin microbiome) and disruption of the skin’s protective barrier can also lead to the development of seborrheic eczema.

What Are the Major Risk Factors for Seborrheic Dermatitis?

Having the following health issues can make a person more prone to seborrheic dermatitis:

1. Weakened Immune Systems:

• Organ transplant recipients.
• Adult Hodgkin's and Non-Hodgkin's Lymphoma.
• Human immunodeficiency virus (HIV) infection.
• Alcoholic pancreatitis.

2. Psychiatric Disorders:

• Depression.

3. Neurological Diseases:

• Parkinson's disease.
• Tardive Dyskinesia.
• Epilepsy.
• Facial nerve palsy.
• Spinal cord injury.

4. Congenital disorders:

• Down's syndrome.

5. Psychotropic medications:

• Lithium.
• Buspirone.
• Haloperidol decanoate.
• Chlorpromazine.

What Are the Symptoms of Seborrheic Dermatitis?

Seborrheic dermatitis signs and symptoms may include:

• Itchy white skin flakes (dandruff) on the scalp, eyebrows, beard, or mustache. The flakes often come loose when scratched, mixed in with the hair, or shed onto the neck and shoulders.
• Red scales on the skin.
• Crusty yellow scales on the baby's head (cradle cap). The cradle cap does not itch, but scratching it may further inflame the area and break the skin, leading to bleeding or mild infections.
• Blepharitis (a condition of scaly redness on the edges of the eyelids).
• Thick, pinkish patches of skin on both sides of the face.
• Flaky patches on the chest and at the hairline, shaped like a flower petal or a ring.
• Redness in the folds and creases of the genitals, armpits, and beneath the breasts.
• Inflammation of hair follicles on the cheeks and the upper half of the trunk.

How Is Seborrheic Dermatitis Diagnosed?

Seborrheic eczema is easy to diagnose due to its appearance and distribution on the affected skin. The health care provider can likely determine seborrheic eczema by examining the skin. No blood, urine, or allergy tests are needed. The doctor may perform a skin biopsy to rule out conditions similar to seborrheic eczema.

How Is Seborrheic Dermatitis Treated?

Seborrheic eczema sometimes clears up, but it is often a lifelong condition, and it can be easily controlled with good skincare. Medicated shampoos, lotions, and creams are the first-line treatment for seborrheic eczema. However, before considering prescription remedies, the doctor may recommend home remedies, such as dandruff shampoos.

If home remedies do not help, the doctor may prescribe any of the following treatments:

1. Creams, Shampoos, Gels, Ointments, or Solutions That Control Inflammation:

• Topical corticosteroids that can be applied once or twice daily to the scalp or other affected areas include Hydrocortisone, Fluocinolone, Clobetasol, and Desonide. If used for many weeks or months, these corticosteroids can cause thinning of the skin or streaks or lines on the skin. They effectively clear seborrheic eczema and are easy to use, but should be used sparingly.
• Creams or lotions containing calcineurin inhibitors, such as Tacrolimus and Pimecrolimus, may be effective and have fewer adverse effects than corticosteroids. However, they are usually applied to the affected area twice daily.

2. Antifungal Gels, Creams, or Shampoos in Combination With Another Medication:

Based on the severity of the symptoms, the doctor may prescribe a topical medication with 2 percent Ketoconazole or one percent Ciclopirox or both to be used alternately.

3. Antifungal Medication as a Pill:

If the condition does not improve with other treatments, the doctor may prescribe antifungal medication in pill form. These drugs may cause possible side effects and drug interactions.

4. Home Remedies:

It is possible to control seborrheic eczema with lifestyle changes and home remedies. Many of these are available over the counter (nonprescription). However, the best approach varies from person to person. In addition, it depends on the skin type, the severity of the condition, and whether the symptoms affect the scalp or other body areas. But even if the condition resolves, it will likely come back at some point. So watchful waiting and resuming treatment of the condition when it recurs is essential.

The following self-care advice and over-the-counter medications may help manage seborrheic dermatitis:

• Wash the scalp regularly. Try over-the-counter dandruff shampoos if the regular shampoo fails to help with seborrheic eczema. Use over-the-counter dandruff shampoos that contain one of the following active ingredients:

  • Pyrithione zinc.
  • Selenium sulfide.
  • Ketoconazole.
  • Coal tar.
  • Salicylic acid.
• Shampoo the baby's scalp daily with warm water and baby shampoo for the cradle cap. To soften thick patches, rub mineral oil onto the area and gently brush it with a baby hairbrush to help peel the scales off. Before trying one, consult a pediatrician about medicated shampoos, as they can irritate the skin.
• Soften and remove scales from the hair by applying mineral or olive oil to the scalp.
• Avoid hair styling products, such as hair sprays, gels, and other styling products, while treating the condition.
• Avoid alcohol-based skin and hair products that can cause the disease to flare up.
• Wear smooth-textured cotton clothing that helps keep air circulating on the skin, thereby reducing irritation.
• Regularly shampoo the facial hair (eg, beard or mustache). Seborrheic eczema can worsen under mustaches and beards.
• Gently clean the eyelids. If the eyelids show redness or scaling, wash them each night with a gentle shampoo and wipe away scales with a cotton swab. Warm or hot compresses can also benefit.

Recent research has found that occasional use of antifungal shampoos, even after the skin condition has cleared, can help prevent seborrheic eczema from recurring.

For seborrheic dermatitis of the face, doctors are increasingly finding that non-steroid anti-inflammatory creams are a better alternative to steroid creams. This is because steroid creams can cause side effects on the face.

In more severe cases where symptoms do not improve with treatment, a low dose of oral Isotretinoin (a tablet) is effective.

Recent research has also found that probiotics can be effective. They may do this by rebalancing the skin's natural levels of healthy bacteria, which can help alleviate symptoms.

How Is Seborrheic Eczema Prevented?

Some simple healthy things can help reduce the risk of seborrheic eczema, including:

• Get plenty of sleep.
• Control emotional stress.
• Get some safe sun.
• Follow healthcare professionals' instructions for using medicated shampoos and skin products.
• A cradle cap is a natural, harmless condition that can be simply treated at home.

When To See a Doctor?

One has to see a doctor if:

• The symptoms get worse, or there are flare-ups. The healthcare provider may change the medication dosage, add a different medication to the treatment regimen, or change medications.
• The condition causes discomfort, leading to sleep loss or distraction from daily routines.
• The condition is causing embarrassment and anxiety, affecting the quality of life.
• The skin is infected.
• The self-care steps could have been more successful.

What Is the Outlook or Prognosis for People With Seborrheic Eczema?

Cradle cap is a harmless condition that affects most babies. It usually does not cause itching, pain, or discomfort. However, seborrheic eczema is a lifelong condition, so managing it on some level for the rest of one's life is essential. In adolescents and adults, seborrheic eczema of the scalp, the face, and the body is a condition that comes and goes throughout life. However, it can be easily controlled with treatment. Therefore, it can be effectively managed with simple at-home treatments.

The condition gets better quickly with regular treatment. However, one should see a health care professional if the condition does not respond to regular treatment or if the affected area causes pain, forms crusts, or oozes fluid or pus.

Conclusion

Seborrheic eczema is a common, non-contagious skin condition that results in red, itchy, flaky skin on the scalp and other oily areas of the body. While it is a chronic condition that may flare up periodically, it is not a serious health concern. With proper treatment, scalp care, and lifestyle changes, it is possible to effectively control the condition. If seborrheic dermatitis persists or worsens, it is best to consult a skin care specialist for further evaluation.

Key Takeaways

• Seborrheic dermatitis is a common, non-communicable skin condition that causes scaly, red, itchy skin.
• It primarily affects the scalp and oily areas of the body.
• Medicated shampoos and antifungals can be used to control the condition.
• It is a chronic condition that can be managed.