Seborrheic Dermatitis

What is seborrheic dermatitis?

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Seborrheic dermatitis is a rash characterized by red, scaly patches. This form of dermatitis often occurs on the scalp and causes dandruff. However, seborrheic dermatitis can occur anywhere on the body, especially the back, face, and upper chest. This rash is a form of chronic eczema, and there is no known cure. When seborrheic dermatitis occurs in infants, it is known as “cradle cap.”

While seborrheic dermatitis is often harmless, living with the rash can be uncomfortable. Most people experience constant itching, which can be difficult for long periods of time. If you suspect you have seborrheic dermatitis, schedule an appointment with your dermatologist or primary care physician. While there are many over-the-counter treatments, confirming the diagnosis is essential. Additionally, for those with more severe forms of seborrheic dermatitis, a doctor can prescribe a stronger treatment option if necessary.

What causes seborrheic dermatitis?

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There is no known cause of seborrheic dermatitis. However, doctors think that two primary factors contribute to its occurrence:

  • Yeast: The skin is home to a variety of microorganisms, including bacteria and yeast. One specific type of yeast, known as Malassezia, is extremely common on the skin’s surface. When there is an excess of this type of yeast, the skin can have an inflammatory response. In many people, this leads to excess oil production, which can contribute to eczema and seborrheic dermatitis.
  • Oil: The skin keeps itself healthy by producing oil via sebaceous glands. These glands are overactive in some people. This causes the skin to produce more oil than usual. This, in turn, can lead to seborrheic dermatitis and other types of eczema.

Oil overproduction can be a result of hormonal changes. Doctors suspect this may be part of the reason why infants frequently develop seborrheic dermatitis. When the birthing parent experiences hormonal changes during the end of pregnancy, the infant’s oil glands can become stimulated. This causes oil overproduction during the first weeks and months of life.

Are there any risk factors for seborrheic dermatitis?

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While researchers don’t understand the exact cause of seborrheic dermatitis, certain groups are more likely to develop the condition. This includes:

  • People who are overweight
  • Those who experience frequent and high levels of stress
  • Individuals with poor skin care and general hygiene
  • People who have certain medical conditions, including acne, Parkinson’s disease, and HIV
  • Those experiencing hormonal changes, like during puberty and pregnancy
  • Individuals who use harsh products, including skin care products, detergents, and soaps
  • People who live in dry, cold climates
  • Those who live in high-pollution areas

Unlike other skin conditions, there does not appear to be a genetic link with seborrheic dermatitis. In almost all cases, this rash develops as a result of environmental or personal care factors. Seborrheic dermatitis occurs most often in infants and middle-aged people. However, individuals of any age can develop this condition.

Are there any seborrheic dermatitis triggers?

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While seborrheic dermatitis has no known cause, certain experiences can trigger the onset of symptoms. This includes periods of high stress, heavy and sustained alcohol use, and seasonal shifts.

What are the symptoms of seborrheic dermatitis?

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Seborrheic dermatitis symptoms can vary by person. However, certain characteristics are more common than others. The rash itself will often develop scaly patches that may flake off. This is known as dandruff. In more severe cases, the skin can develop erythematous plaques. These lesions are usually elevated and develop a thick crust. Additionally, most cases of seborrheic dermatitis are red, itchy, and greasy. In some cases, it may be accompanied by hair loss.

Seborrheic dermatitis can affect any part of the body. However, it is most common in the following areas:

  • Anywhere the skin produces excessive oil, like the face and eyebrows
  • On the nose
  • Around or inside the ear canal
  • A person’s hairline
  • On the upper chest, especially if a person has body hair

The American Academy of Dermatology Association provides excellent photos for patient reference. In some severe cases, seborrheic dermatitis may lead to immunodeficiency of the affected skin. When this happens, the patient is at an increased risk for bacterial, fungal, and viral infections.

Seborrheic dermatitis can often resemble other common skin conditions. This includes psoriasis, atopic dermatitis, tinea versicolor, rosacea, and dandruff. Seeing a doctor for a diagnosis can help rule out these similar conditions. This will help the patient find a more appropriate treatment method.

In infants, seborrheic dermatitis occurs primarily on the scalp. However, it may also appear in the diaper area.

When to see a doctor about seborrheic dermatitis?

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Most people can manage seborrheic dermatitis symptoms at home. They do this with over-the-counter products and dandruff shampoos. However, some people have difficulty controlling their symptoms. If you experience any of the following, you should schedule an appointment with your dermatologist or primary care physician:

  • Painful and/or extremely red rash site
  • Dandruff shampoo and other over-the-counter products do no provide relief
  • The rash is leaking fluid, crusting, or producing pus
  • Patches are causing significant discomfort

New parents should contact their pediatrician if an infant’s cradle cap symptoms persist past six months or are severe.

While people can often manage seborrheic dermatitis on their own, having a doctor on your side can help. Ruling out other, more severe conditions, can provide piece of mind. Additionally, if your seborrheic dermatitis is severe, a doctor can prescribe stronger medications to mitigate symptoms. When in doubt, call your dermatologist.

How is seborrheic dermatitis diagnosed?

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Patients will need to see a dermatologist or primary care physician to receive a seborrheic dermatitis diagnosis. At the appointment, your doctor will perform a physical examination. They will take special care to inspect the affected areas of the skin. Before arriving at the appointment, prepare to explain your symptoms. This should include when they started, what they feel like, and – if the rash is recurring – how often they happen.

In many cases, a doctor will ask to perform a skin biopsy before providing a diagnosis. They use this to rule out other conditions, like a fungal or bacterial infection. During the procedure, the doctor will either scrape off or cut out affected skin cells. They will then examine the sample under a microscope. Receiving a diagnosis may take a few days.

What are treatments for seborrheic dermatitis?

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There is no cure for seborrheic dermatitis. However, there are various treatments to help alleviate symptoms. People with mild cases can try at-home treatments before seeing a doctor. Popular over-the-counter options include antifungal and anti-itch creams, wearing loose clothing to limit skin irritation, and switching to a hypoallergenic laundry detergent and soap. People use dandruff shampoos to treat seborrheic dermatitis on the scalp.

For people with severe seborrheic dermatitis, or for whom over-the-counter treatments do not work, prescription treatments are an option. Working with a doctor to develop a treatment can yield results. Common prescription options include:

  • Prescription-strength antifungal medication: These medications are available in the form of ointments, creams, and shampoo. However, they can cause side effects, including liver damage and allergic reactions.
  • Prescription-strength ointments and shampoos: Many doctors advise patients to apply desonide, hydrocortisone, and/or fluocinolone to affected areas. These treatments are not intended for long-term use, but they can be very effective.
  • Light therapy: Phototherapy can reduce pain and itchiness associated with seborrheic dermatitis, eczema, and psoriasis. This treatment uses ultraviolet (UV) light to reduce inflammation and slow skin cell production. This can help address oil overproduction in the sebaceous glands.
  • Metronidazole: This antibacterial medication comes in both gel and cream form. Patients apply the medication to the affected area daily until symptoms resolve or improve.

Keep in mind that these treatment options are recommended for adults. Treatment is not typically necessary for infants with cradle cap. Parents can help manage symptoms by washing the baby’s scalp with mild shampoo. Take care to avoid dandruff shampoos, as they often contain salicylic acid – an ingredient that is unsafe for infants. Additionally, parents can loosen scaly patches with a soft brush. If the condition does not resolve within six months, call your pediatrician to develop a treatment plan.

What is the outlook for people living with seborrheic dermatitis?

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While seborrheic dermatitis is not a dangerous condition, it can be difficult to live with. This form of dermatitis is chronic. This means that patients will experience recurring symptoms over the course of several years – sometimes decades. Working with a doctor can help patients recognize triggers and develop treatment options when flare-ups occur. Additionally, a doctor can provide a definitive diagnosis. This will rule out other, potentially dangerous skin conditions.

Patients can take a variety of steps to reduce the severity and recurrence of seborrheic dermatitis. This typically includes lifestyle changes, like:

  • Getting regular exercise
  • Increasing length and quality of sleep
  • Reducing emotional stressors through therapy, meditation, and/or journaling
  • Recognizing and eliminating potential triggers

In general, people with seborrheic dermatitis live long, healthy lives. If you are ready to take control of your recurring rash, schedule an appointment with a dermatologist or primary care physician.