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Seborrheic dermatitis is a skin condition in which the skin becomes red and inflamed before developing scaly flakes of white, gray, or yellow skin. This condition is most common on areas of the body where sweat glands are abundant, such as the scalp and groin, and it can also appear in the folds of the skin, in areas such as the neck and armpits. This condition is not harmful, but it can be unsightly, and many people choose to seek treatment for it for this reason.
The cause of seborrheic dermatitis is not understood. It has been linked with some conditions like Parkinson's disease, and also with oily or dirty skin. The condition is extremely common, especially in the mild forms known as dandruff in adults and cradle cap in babies. One of the issues with seborrheic dermatitis is that it looks like many other skin conditions, making diagnosis important to ensure that the condition is addressed appropriately.
When a patient presents with a condition which looks like seborrheic dermatitis, the doctor may decide to take a scraping to examine it under the microscope. This can reveal clues to other skin conditions which might be causing the outbreak. If the samples do not provide additional information, the doctor may proceed with treatment for seborrheic dermatitis and recommend a follow up visit to confirm that the diagnosis was correct.
Some cases of seborrheic dermatitis have been linked with colonies of yeast or bacteria. In these patients, antibiotics and antifungals can be used to kill the organisms. Other patients may be given steroids to help them cope with the inflammation. Keeping the skin clean and dry with a mild soap and gentle toweling after cleaning is also important to keep seborrheic dermatitis under control.
Outbreaks seem to get worse in the winter, and the condition can also manifest in response to physical or emotional stress. People who are prone to developing seborrheic dermatitis generally need to exercise stringent hygiene recommendations to keep the skin condition from flaring up. These recommendations include keeping the skin clean and dry, and they may be supplemented with dietary recommendations to cut down on natural oils in the skin.
In addition to being unsightly, seborrheic dermatitis can also be very itchy. Patients can expose themselves to the risk of infection by repeatedly scratching and creating wounds which can be used as access points to the body by bacteria and other organisms. Slapping, rather than scratching, can address really irritating itches, and drugs can also be prescribed to cut down on the itching.
Seborrheic dermatitis tends to be chronic, and there's usually no strategy that stops it permanently. But treatments — including many you can try at home — may control your signs and symptoms during a flare-up. 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.
Creams and lotions that you apply to affected body areas and medicated shampoos are all mainstays of treatment. In very severe cases, physicians may prescribe oral medications with whole-body effects. Products are available with several kinds of active ingredients. Some preparations include active ingredients from more than one category.
These agents seem to work by reducing numbers of Malassezia yeast in affected areas of your body. Antifungal agents commonly used to treat seborrheic dermatitis include:
Ketoconazole is found in shampoos, foams, gels and creams. It's available in over-the-counter products in a 1 percent concentration and prescription products at a 2 percent strength. Some studies show that the 2 percent strength may be more effective. In a small percentage of people, ketoconazole can cause irritation, itching and burning.
Ciclopirox is found in prescription shampoos and skin products. It may cause irritation, itching and burning in a small number of people.
Terbinafine (Lamisil) is sometimes prescribed in tablet form to treat severe episodes, but studies of its effectiveness are limited. Most doctors are cautious about prescribing oral antifungal agents for seborrheic dermatitis because these drugs can have serious side effects, and seborrheic dermatitis tends to be a chronic condition. Side effects of terbinafine include severe allergic reactions and liver problems.
These agents help symptoms by reducing inflammation, itching and discomfort. They're generally recommended for short-term, occasional use because long-term use over large areas of your body can cause significant side effects. These include local effects, such as skin damage and excessive hair growth, and whole-body effects such as increased susceptibility to infection, high blood sugar and suppression of certain hormones.
Examples of corticosteroids include:
Hydrocortisone is available over the counter in a 1 percent strength cream that can be used on body areas other than your scalp. It's available in higher strength creams by prescription.
Desonide (Desowen, Desonate) is available by prescription as a gel or ointment for application to your scalp and other body areas.
Betamethasone (Beta-Val) is also available by prescription as a cream or lotion for use on your scalp and other parts of your body. It's a stronger category of steroid, and its use is usually limited to a few weeks at a time.
These prescription creams are derived whole-body medications that lower the activity of your immune system. Research and clinical experience suggest they're about as effective as antifungal and corticosteroid creams and lotions. Because more extensive exposure to the whole-body drugs may increase risk of skin cancer or lymphoma, the Food and Drug Administration (FDA) recommends that these creams be used only after other treatments haven't helped you, or if you can't tolerate other treatments. The FDA also advises against long-term use of these medications.
Additional active ingredients in some shampoos include:
Selenium sulfide is found in products available by prescription. Some people who use selenium sulfide experience scalp irritation or lightening of their hair color.
Salacylic acid is a mild compound that loosens up scale in the scalp.
It's important to use treatments for seborrheic dermatitis exactly as the package directs or as your physician prescribes. 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 time to work.
If you've shampooed faithfully for several weeks and you're still experiencing an itchy, flaky scalp, talk to your doctor. You may need a prescription-strength shampoo or lotion.