What Is Seborrheic Dermatitis?

Seborrheic dermatitis is a common inflammatory skin condition that affects areas with many oil (sebaceous) glands, such as the scalp, face, trunk, and groin. It causes a dry, flaky, itchy rash that may appear as yellowish flakes or redness in people with lighter skin tones or purplish and light-colored spots in people with darker skin tones.

The exact cause of seborrheic dermatitis is unknown, though research suggests genetic and environmental factors likely play a role. It is a chronic condition that can come and go, with periods of improvement and flare-ups. Treatments can help manage symptoms and may include topical creams or ointments, medicated shampoos, and lifestyle modifications. 

Anyone can develop seborrheic dermatitis, which affects an estimated 3% of the population worldwide.

Types

There are two types of seborrheic dermatitis: infantile and adult. The two types are similar and classified based on the age at which symptoms first develop. 

Infantile Seborrheic Dermatitis

When seborrheic dermatitis develops in infants, it is called "cradle cap." In babies, it first appears as greasy, scaly patches on the scalp and may eventually become a crusty, thick mass that covers the entire head. Cradle cap can sometimes develop on a baby's body, especially in the diaper area. Cradle cap is harmless and tends to resolve on its own within a few months.

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Adult Seborrheic Dermatitis 

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In adults, seborrheic dermatitis usually develops between ages 20 to 40, though it can develop at any age and is especially common in older adults. People assigned male at birth are more likely to develop seborrheic dermatitis than those assigned female at birth.

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Seborrheic Dermatitis Symptoms 

Seborrheic dermatitis can develop anywhere on the body but is most common on areas of the skin with a high concentration of sebaceous (oil) glands, such as the scalp, nose, eyebrows, eyelids, behind the ears, and chest. Symptoms include dry skin, redness or rash (especially in skin folds), itching, burning, and eyelid inflammation.

Dry, Flaky Skin

With seborrheic dermatitis, the skin is usually dry and can become flaky. Flakes may be white or yellowish. This is particularly noticeable where there is hair or a red rash, such as on the scalp (this is commonly called dandruff), eyebrows, sides of the nose, and behind the ears.

Redness or Rash 

Affected areas of the skin develop a scaly rash, which appears red on lighter skin tones. People with darker skin tones may notice the rash appears darker or lighter than their natural skin tone. The rash can cause scaly plaques anywhere on the body except for the palms of the hands and soles of the feet.

Itching or Burning 

Seborrheic dermatitis can cause itchiness or a burning sensation. This is typically mild but may feel more severe on the scalp. Scratching the affected areas can further irritate the skin, so it is best to avoid itching and treat the rash to help relieve itchiness and burning.

Blepharitis (Eyelid Inflammation) 

Blepharitis occurs when the oil glands in the eyelids become inflamed. This can cause the eyelids to become red, swollen, and itchy. The eyelashes may become crusty or have a dandruff-like appearance.

Maceration (Rash in Skin Folds) 

A rash in the skin folds, known as maceration, is when the skin softens and breaks down due to excessive moisture. This is most common in the armpits, groin, and under the breasts. The rash may appear red, raw, and irritated and be itchy, tender, and uncomfortable.

What Causes Seborrheic Dermatitis? 

The causes of seborrheic dermatitis are not fully understood. It is not contagious and cannot spread from person to person. Research suggests several factors likely contribute to its development, such as:

• Yeast overgrowth: Overgrowth of a type of yeast called Malassezia is linked to an increased risk of seborrheic dermatitis. This yeast usually lives on the skin without causing problems, but if it grows in numbers, it may trigger an inflammatory reaction, leading to a rash.
• Excess sebum oil: The overproduction of sebum—oil created by sebaceous glands on the skin—can create an environment that promotes the growth of the yeast Malassezia, leading to inflammation and symptoms of seborrheic dermatitis. 
• Hormonal levels: Hormonal disorders and fluctuations in hormone levels, especially during puberty, menstruation, and pregnancy, can increase sebum production and contribute to the onset or exacerbation of seborrheic dermatitis.
• Genetics: Research suggests that certain genetic mutations—particularly those in genes connected to immune response and skin cell development—may play a role. 

Risk Factors 

Certain risk factors can increase the likelihood of developing seborrheic dermatitis, including: 

• A history of other skin conditions, including acne and psoriasis 
• Certain medical conditions, including human immunodeficiency virus (HIV), Parkinson's disease, and epilepsy 
• Recovering from a stroke or heart attack 
• Cold weather 
• Stress and fatigue 
• Hormonal changes
• Certain medications, such as Ridaura (auranofin) to treat rheumatoid arthritis and lithium for treating bipolar disorder

Diagnosis

Usually a dermatologist—a healthcare provider who treats conditions affecting the skin, hair, and nails—diagnoses seborrheic dermatitis. They can usually diagnose it by visually inspecting the affected areas to look for characteristic signs, such as redness, scaling, and greasy or flaky skin. Your healthcare provider will also ask about your symptoms and medical history.

Other skin conditions share similar symptoms with seborrheic dermatitis, so diagnostic tests may be performed to confirm the diagnosis. These tests include skin scraping and a skin biopsy.

During skin scraping, a small amount of skin is scraped off with a blade or needle and sent to the lab to check for fungal infections. You may feel scratching while the healthcare provider collects the skin sample.

For a skin biopsy, your dermatologist will numb the affected area and remove a small amount of skin. The sample is sent to the lab where it is examined under a microscope to check for signs of skin conditions, such as psoriasis.

Treatments for Seborrheic Dermatitis  

There is no cure for seborrheic dermatitis, but treatments can help manage symptoms and prevent flare-ups. There are both over-the-counter (OTC) and prescription treatments for seborrheic dermatitis.

Over-The-Counter Treatments 

OTC treatments may effectively manage mild seborrheic dermatitis, relieving symptoms and helping control flare-ups. These include dandruff shampoos and topical creams.

Specialized dandruff shampoos are readily available without a prescription and contain active ingredients such as salicylic acid, zinc, resorcinol, ketoconazole, coal tar, or selenium sulfide. These shampoos can help reduce inflammation, scaling, and flaking. 

OTC hydrocortisone creams or ointments containing low-strength corticosteroids may help alleviate inflammation, redness, and itching associated with seborrheic dermatitis.

Prescription Medications

If you have seborrheic dermatitis on your face or severe flare-ups that do not respond to OTC treatments, your healthcare provider may prescribe medications such as:

• Antifungals: Antifungal topical lotions, gels, or creams (e.g., ketoconazole, ciclopirox, clotrimazole) and antifungal shampoos target the overgrowth of yeast (Malassezia) on the skin.
• Corticosteroids: Topical corticosteroids applied directly to the affected area can help reduce inflammation to relieve itching, redness, and swelling. 
• Calcineurin inhibitors: These medications (e.g., pimecrolimus, tacrolimus) are applied topically to the affected area to help regulate your immune response, reducing inflammation and itching. 
• Medicated shampoos: If over-the-counter dandruff shampoos are ineffective, your healthcare provider may prescribe stronger specialized shampoos containing active ingredients such as antifungal agents (e.g., ketoconazole) or coal tar to manage seborrheic dermatitis on the scalp.

Lifestyle Modifications

Healthy lifestyle habits may improve seborrheic dermatitis and reduce the frequency of flare-ups. This may include: 

• Gentle skin and scalp cleansing: Avoid personal care products that contain alcohol, which can dry the skin and cause a flare-up.
• Spending time outdoors: Seborrheic dermatitis often clears up in the summer, possibly due to increased sunlight exposure or higher humidity.
• Minimizing stress: Stress relieving techniques, such as breathwork, meditation, and journaling can help lower stress levels.
• Eating a healthy, balanced diet: Diets high in processed foods are linked to increased rates of seborrheic dermatitis. Aim to eat a diet rich in fruits, vegetables, and whole grains. 

Prevention

While seborrheic dermatitis cannot be completely prevented, certain habits and lifestyle modifications may help reduce the frequency and severity of flare-ups. These include:

• Maintaining good hygiene: Regularly cleanse your skin and scalp with gentle, non-irritating cleansers to remove excess oil, dirt, and dead skin cells.
• Avoid harsh products: Use mild, fragrance-free skincare products and avoid harsh chemicals that can irritate the skin and worsen symptoms.
• Managing stress: Stress can worsen seborrheic dermatitis, so it's important to find effective stress management techniques such as exercise, meditation, or seeking support from a therapist or friends.
• Keeping skin dry: Moisture can contribute to yeast growth, so shower after sweating and thoroughly dry your skin after bathing. 
• Avoiding triggers: Identify and avoid substances that trigger your flare-ups, such as certain foods, alcohol, hot weather, and specific skincare products. 
• Considering lifestyle modifications: Healthy lifestyle choices, such as maintaining a balanced diet, getting enough sleep, and avoiding excessive alcohol consumption, can support your overall skin health.

Related Conditions 

People with seborrheic dermatitis often have other skin conditions, such as: 

• Psoriasis: Seborrheic dermatitis and psoriasis share similar symptoms, such as redness, scaling, and skin inflammation. Studies show increased rates of seborrheic dermatitis among people with psoriasis.
• Rosacea: Seborrheic dermatitis and rosacea frequently occur together and share similar symptoms, such as facial redness. 
• Malassezia folliculitis: This condition is characterized by inflammation and infection of the hair follicles caused by an overgrowth of the yeast Malassezia, similar to seborrheic dermatitis. Malassezia folliculitis can occur alongside seborrheic dermatitis, particularly in areas with abundant sebaceous glands.

Living With Seborrheic Dermatitis 

Seborrheic dermatitis is a chronic condition that requires ongoing management, as symptoms can come and go. While the condition is physically harmless, it can have a significant emotional impact on your life. People with seborrheic dermatitis may feel self-conscious about the visible symptoms, and studies show that living with the condition is linked to increased feelings of self-consciousness and anxiety.

If you have seborrheic dermatitis, it is important to remember that you are not alone. It is a common condition and can usually be managed with treatments and lifestyle modifications. It may be helpful to talk about your thoughts and feelings with family and friends or join a support group with others who share similar experiences. If seborrheic dermatitis impacts your quality of life and emotional health, your healthcare provider can offer guidance and treatment options that may help.