Seborrheic Dermatitis

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Seborrheic Dermatitis (seb derm) is a common, itchy, scaling rash affecting the face, scalp, and other areas. It is most likely to occur where the skin is oily. Seborrheic dermatitis may appear at any age after puberty. It fluctuates in severity and may persist for years if left untreated.

Dandruff with flakes and scaly particles is an uninflamed form of seborrheic dermatitis. Cradle cap is a form of seborrheic dermatitis found in babies.

What Does Seborrheic Dermatitis Look Like?

On the scalp, seborrheic dermatitis causes diffuse or localized pink, light red, or skin colored areas with yellowish or white bran-like scale. It may extend to affect the entire scalp. Seborrheic dermatitis is also common within the eyebrows, on the edges of the eyelids (blepharitis), inside and behind the ears, and along the creases of the nose and unto the cheeks.

Less commonly it affects the skin-folds of the armpits, middle of the chest, upper back, or even groin. It typically is itchy, but not always, and can be quite variable from day to day.

What Is the Cause of Seborrheic Dermatitis?

Seborrheic dermatitis is believed to be an inflammatory reaction to a proliferation of a normal skin inhabitant, a yeast called Malassezia. Seb derm is common and is not contagious or related to diet.

Treatment

Seborrheic dermatitis in adults may be very persistent. However, it can generally be kept under control with regular use of anti-dandruff shampoos and intermittent applications of topical steroids.

SCALP TREATMENT HINTS:

  • Over the counter dandruff shampoos work well (some work better than others for some patients). Head and Shoulders Intensive Care or Nizoral are good ones, but there are now many others available. Note: more and more shampoo brands now offer dandruff shampoos due to a large percentage of the population with dandruff or seb derm. Prescription dandruff shampoo has 2% ketoconazole.
  • Most commonly recommended shampoo ingredients include: ketoconazole, selenium sulfide, zinc pyrithione, though there are others that work well also. Use every time when washing hair. Consider switching occasionally until a favorable shampoo is discovered.
  • Seb derm may wax and wane with the seasons (for example, it may increase during times of less humidity or increase in others when the temperature is hot and the scalp is oily)
  • May use a dandruff conditioner also for extra treatment or opt for regular conditioner.
  • Thicker shampoos with coal tar (treats redness), or salicylic acid (treats thick scaliness), may help in severe cases. Some patients then return to regular dandruff shampoos.
  • * Let suds soak on scalp for 4-5 minutes before rinsing. This crucial step is often missed. 5 – 6 minutes is excellent, but do what you can (if only 2 or 3 minutes, that is great and better than a quick rinse out).
  • Topical steroid solutions can be applied to the scalp a few nights during the week at night. They help decrease inflammation and itch.
    • Fluocinonide or clobetasol solution is a stronger cortisone that is essential to penetrate the thick scalp skin and evaporate easily due to the alcohol within the solutions.
    • Derma-Smoothe is a topical cortisone mixed with a peanut oil (medium strength cortisone in a unique oil mixture). This decreases inflammation and itch, while hydrating the scalp. Apply this whenever very dry, consider at night before a weekend and rinse out in the AM as the scalp/ hair will be “sticky.”

Use either Fluocinonide, Clobetasol solution or Derma-Smoothe oil. Use one of the three 1-4 x per week, typically at night depending on the severity. As the Derma-Smoothe is an oil, use when scalp is dry and needs a moisturizer also. Some patients prefer this some days and then use the Clobetasol or Fluocinonide or others. You are welcome to modify the treatment as you see which things work.

FACE, EARS, CHEST AND BACK

  • Cleanse the skin thoroughly daily or as needed. Excessive scrubbing generally doesn’t help.
  • Topical antifungals including Ketoconazole, Oxistat, or Ciclopirox cream or gel work well.
  • Typically patients apply daily when rash is present. Could apply twice daily. When improved, you can get away with applying 1-5 x weekly or even less often than that.
  • Topical cortisones: hydrocortisone, desonide, and betamethasone valerate lotion, cream, or foam are common prescriptions used. These can be applied 1-2 times a day for 1 to 2 weeks.
  • *Often patients mix the cortisone with a topical antifungal cream to get the best of both worlds. For example, commonly patients mix Ketoconazole 2% cream in a 1:1 (or 2:1) ratio in an empty container, like a pill bottle, with betamethasone valerate lotion.
  • Other effective topical antimicrobial creams include sulfur lotions or creams like Clarifoam, sulfacetamide sulfur, Klaron lotion, or metro cream/gel.
  • Other non-cortisone creams used include Promiseb®, also available in shampoo. Apply 1-2 x daily.

    Oral anti-fungal pills are also effective for scalp and or face involvement. They are typically reserved for severe cases or to get a big boost in treatment. Take one 200 mg Ketoconazole weekly, always with an acidic drink (OJ, soda, etc.) to improve absorption. Sweating in the area of the seb derm for 1-1 ½ hours after taking pill will increase its efficacy (consider wearing a snow hat or something similar). Consider doing this oral treatment then repeating in a week. At that point you should be good for months. repeat process in 3-4 months when severe again. Use topical treatments to extend the life of the oral medication (topical cortisone weekly along with regular shampoo usage)

Photo credit: American Academy of Dermatology

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David Myers, MD
Dr. David Myers is a board certified dermatologist and Fellow of the American Society for Mohs Surgery. His expertise and attention to detail will guarantee your satisfaction during your visit. If your needs are medical, cosmetic, or surgical, Utah Valley Dermatology can help.
David Myers, MD

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